Wound Healing Lecture Powerpoint Flashcards
Common types of wounds (5)
- Abrasion (superficial violation of epidermis and part of dermis, doesn’t need to be repaired)
- skin tears (skin peeled off, doesn’t need to be repaired)
- lacerations (an UNINTENTIONAL cut - differentiating it from an incision, from a sharp carve)
- avulsions (type of laceration that involve significant portion of tissue and skin being ripped off, can be hard to get good supply to flap)
- puncture (something piercing deep into the body)
Risk factors to consider in determining treatment of a wound (4)
- location (some areas more vascular)
- type of wound (MOA, depth)
- patient characteristic (diabetic, NSAIDS or anticoags, obese, immunosuppressed)
- Timing (longer wait, greater risk of infection)
The golden period of wound healing/closure (4)
- No evidence exists to guide clinical decision making on the timing for closing traumatic wounds
- some recommend to close neck face or scalp wounds within 24 hours
- some recommend upper extremity and torso within 12 hours
- some recommend lower extremities within 8 hours
A wound that has been open and not tended to within 4 hours is automatically classified as a ___ type wound
dirty type
3 options if a patient is at higher risk (for infection) or if they fall out of the general golden rule for when to close a wound?
- close with a pentrose drain or stapling not completely shut
- secondary intention (leave wound open and apply packing changed daily)
- tertiary closure (dressing for a period then once confident no infection bring patient back in for suturing)
Does a patient need antibiotics if they have a clean uncomplicated wound and are relatively healthy?
No, typically can heal on own or with petroleum
When should antibiotics be considered in a wound? (7)
- open fracture
- cartilage involvement
- grossly contaminated wounds
- bite wounds
- foreign bodies (some)
- delayed presentation
- diabetics
Tetanus prophylaxis in wounds
-given when patient has not received tetanus vaccine in more than 5 years or if they cannot remember, if pregnant or 11 and older and has not received Tdap get Tdap if unknown can give tetanus toxoid
Lidocaine with epi is contraindicated in what areas (4) and why?
- Fingers, toes, tip of nose, and penis
- epi increases duration of lidocaine action and decreases local hemorrhage but can be so strong it results in necrosis of these distal tissues in some cases
Skin prep vs wound prep
Substances used on skin can be very harmful to subQ tissue such as betadine, hydrogen peroxide. Wounds should be prepped with normal saline or water and the skin around should be treated with betadine to disinfect
Common nonabsorbable sutures types (4)
- nylon (good workability)
- prolene/polyester (fair workability)
- surgical stainless steel
- silk (most workable)
Common absorbable suture types (4)
- vicryl (braided)
- PDS (monofilament)
- monocryl (monofillament)
- fast absorbing gut
When should braided vs nonbraided sutures be used?
Braided should not be used in cases of increased risk of infection as they are sources of bacteria to hide
Suture sizing USP sizing
The higher number such as 10-0 has the smallest diameter at .020-.029mm, all the way down to 1-0 or 0 which is the larger .35-.339mm diameter, then 1, 2, 3,4 (.4, .5, .6mm respectively)
Simple interrupted suture
Nonabsorbable suture method that is go to method of repair, goes across the wound transversely moving up
