Wound Management

Question 1

• produced by sharp objects that cut through the skin
• amount of energy required to cut skin with sharp object is low therefore little energy directed to surrounding tissue with minimal cell damage
• results in lowe risk of infection and problems with wound healing because remaining tissue is not devitalized
• usually heal with good results

Answer 1

Shear forces

Question 2

• more energy delivered to wider area
• lots of cell damge and death- devitalization of surrounding tissue= higher infection risk
• ragged edges (stellate wounds or macerated edges
• more prone to infection

Answer 2

compressive forces

Question 3

• impact from oblique angle
• can produce flap, jagged edges
• more tissue destruction than shear injury due tearing of tissue
• infection risk

Answer 3

Tensile Injury

Question 4

steps for wound healing

Answer 4

inflammation

• serves to remove bacteria, foreign debris and devitalized tissue
• if prolonged results in poor wound healing

Epithelialization

• in sutured wounds, surface of wound develops epithelial covering impermeable to water in 24-48hs
• eschar and surface debris impair this process by inhibiting epithelial cell migration

fibroplasia

• by fourth day fibroblasts being synthesizing collagen, initiating scar formation
• characterized clinically by pebbled red tissue in wound base

Contraction

• movement of skin edges toward center of defect, primarily in direction of underlying muscle
• everting skin edges at time of repair accounts for subsequent wound contraction

scar maturation

• strenght of wound increases rapidly from day 5-17, more slowly for additional 14 days and further collagen remodeling/maturation for 2 years

Question 5

golden period of wound closure

Answer 5

refers to the time after injury that wound can be safely closed without increased risk of infection (usually 6-24hrs)

• delay in wound cleaning is most important variable

Question 6

• faster healing
• more comfortable for patient
• less scaring

Answer 6

primary closure

Question 7

• slower, more painful
• large scar
• good for contaminated wounds and those at risk of infection

Answer 7

secondary closure

Question 8

pros: excellent approximation
cons: timely, can strangulate tissue
uses: low/medium tension wounds
bigger bites for deeper wounds can decrease tension

Answer 8

Simple interrupted

Question 9

pros: rapid closure, can give you room to swell
cons: less meticulous, if your knot breaks..
uses: skin closure (with deep sutures)

Answer 9

continuous running

Question 10

pros: Quicker than simple interrupted, brings more tissue together per knot
cons: strangulation
uses: bleeding scalp wounds, initial approximation of high-tension wounds

Answer 10

horizontal mattress

Question 11

• pros: wound eversion. Advantage of deep and superficial sutures
• cons: strangulation
• uses: high tension areas

Answer 11

vertical mattress

Question 12

pros: quick, cost effective
cons: least precision, scarring
uses: linear laceration

Answer 12

Staples

Question 13

pros: fast, cost effective, no need for physician removal
cons: slough off

Answer 13

SteriStrips

Question 14

pros: painless, forms a microbial barrier, quick, heals quickly with good cosmesis
cons: can be messy, get into eyes
uses: low tension wounds

Answer 14

dermabond

Question 15

• less tensile strength
• close deep structures: fascia, dermis
• wide range of absorption times
• generally do not use on skin

Answer 15

absorbable

Question 16

• more tensile strength
• often used in skin
• can become an infection risk

Answer 16

non-absorbable

Question 17

suture size based on location

Answer 17

scalp: 4, 5
face: 6
trunk: 5
extremities: 4, 5
digits: 5

Question 18

when to give toxoid vs TIG

Answer 18

unknown/ less than 3 series of doses: toxoid and TIG
3 or more- last 5 years: no prophylaxis
3 or more- last 10 years: toxoid
3 ormore last > 10 years: toxoid and tig

Question 19

antibiotics for all open fractures

Answer 19

• gram pos/neg: cefuroxime, vancomycin