Wound Healing Complications

Question 1

What are esmarch’s principles of wound management?

Answer 1

Non-introduction of harmful things
Tissue rest - i.e. don't rush to close a wound
Wound drainage
Avoidance of venous stasis
Cleanliness

Question 2

What is the most common cause of post-operative haemorrhage?

Answer 2

Failure of adequate haemostasis during surgery.

Coagulopathies may also cause this

Question 3

How may a haematoma interfere with wound healing?

Answer 3

Physical separation of wound edges
Pressure on wound edges - necrosis and dehiscence
Prevention of free skin graft adherance
Physical barrier to capillary/leukocyte migration
Growth medium for bacteria

Question 4

When would direct, surgical, management of bleeding be indicated?

Answer 4

Arterial bleeding that is severe/does not respond conservatively
Wound dehiscence due to pressure
Development of compartment syndrome
Secondary infection of haematoma

Question 5

How can a haematoma be treated if it occurs?

Answer 5

Application of a warm compres 3x daily for 7 days.

Question 6

What should be investigated in cases of:

a) Regional oedema
b) Generalised odeama

Answer 6

a) Veins, lymphatics and LNs surrounding the area for signs of occlusion etc.
b) Check hypoproteinaemia/cardiac disease?

Question 7

How can oedema be managed?

Answer 7

Mild: May not require therapy
Moderate: Massage, hot/cold packing, physiotherapy

Care with bandaging as may compromise blood flow further
Remove sutures if occluding vessels

Question 8

What is a seroma?

Answer 8

A collection of serum and tissue fluid that accumulates in a dead space between tissue planes of a wound.

Question 9

How can seromas be treated?

Answer 9

Small - probably don't require treatment
Large:
 - Drainage
 - Corticosteroid injection
 - Dead space management

Question 10

What are the causes of wound dihiscence?

Answer 10

1. Excessive forces on the incision

2. Poor wound holding strength

Question 11

When should inflammation/pyrexia resolve after surgery?

Answer 11

Within 48 hours.

Question 12

What is the way to manage an infected wound?

Answer 12

If superficial then open wound management including, debridement, drainage and lavage is indicated.

Deeper wounds may require exploration and introduction of a drain.

Question 13

When do delayed wound infections often occur?

Answer 13

When implants are used or if material is not properly cleaned from a site/is introduced to a surgical site e.g. hairs

Question 14

What is a n eschar?

Answer 14

The dry leathery necrotised tissue structure.

Question 15

What is wound contracture?

Answer 15

Loss of function of a body part, usually due to excessive scarring. Larger wounds left to heal by second intention are most at risk.

n.b. wounds comprising more than half the circumference of a limb are unlikely to heal by second intention

Question 16

When might adhesions occur?

Answer 16

When the normal balance between fibrosis and fibrinolysis is disrupted.

Question 17

What is a:

a) Sinus
b) Fistula?

Answer 17

a) Blind ending tract that extends from and epithelial surface
b) Communicating tract extending from one epithelial surface to another

Question 18

What is the treatment for a draining tract?

Answer 18

Identification and excision or,

Drainage and lavage then open wound management or closure with a drain

Question 19

How can exposed bone be encouraged to heal?

Answer 19

Drill holes if periosteum not present

Trim to wound level if protruding over the wound edges as this is unlikely to heal

Question 20

What common things will prevent wound healing?

Answer 20

Infection, necrotic tissue, foreign material, poor blood supply & unrecognised malignancy

Question 21

What are the methods that promote granulation tissue formation generally aiming to do?

Answer 21

Improve blood supply

Question 22

What are the most common factors preventing wound contracture?

Answer 22

Peripheral countertension

Restrictive fibrosis

Question 23

What is an indolent pocket wound?

Answer 23

Where granulation tissue forms with pliable skin around the wound edges and the surrounding skin becomes elevated above the wound bed.