Wound Management & Burns Flashcards
State the general principles of wound management
- Haemostasis
- Clean it
- Analgesia
- Skin closure
- Dressing & follow up advice
The TIMES mneumonic can help you systematically assess a wound; state the TIMES mneumonic
- Tissue involved (viable or non viable)
- Infection or inflammation
- Moisture leveles
- Edge of wound
- Surrounding skin
State some methods of cleaning a wound
- Disinfect skin around wound with disinfectant
- Decontaminate wound by removing foreign bodies
- Debride any devitalised tissue
- Irrigate with saline
- Abx
Stat some ways in which you can close the skin
- Adhesive strips (e.g. Steri-strips)
- Tisisue adhesive glue
- Sutures
- Staples
*remove sutures or strips 10-14 days after closure or 3-5 days if on head
Tetanus prophylaxis is required for any individual not up to date with or unsure of their immunisation status; true or false?
True
What is the max dose of lidocaine you can use in wound management with and without adrenaline?
- 3mg/kg
- Addition of adrenaline allows up to 7mg/kg
Wounds can heal by primary or secondary intention. For healing by primary intention remind yourself:
- When it occurs
- Faster or slower than secondary
- Process
- Scarring & function
Primary
- Occurs if edges close together
- Faster
- Process:
- Haemostasis
- Inflammation: inflammatory cells remove any debris & pathogens
- Proliferation: fibroblasts form granulation tissue and angiogenesis is stimulated by growth factors
- Remodelling: collagen fibres deposited to provide strength
- Complete return to function, minimal scaring
Wounds can heal by primary or secondary intention. For healing by secondary intention remind yourself:
- When it occurs
- Faster or slower than primary
- Process
- Scarring & function
- Sides of wound not opposed so healing occurs from bottom upwards
- Slower
- Process (SAME AS FOR PRIMARY just some differences):
- Haemostasis
- Inflammation: inflammatory cells remove any debris & pathogens. Larger response than in primary as more debris
- Proliferation: fibroblasts form granulation tissue and angiogenesis is stimulated by growth factors
- Remodelling: myofibroblasts contract the wound and deposit collagen for scar healing
- Wider more visible scar
Keloid scars can occur in both primary and secondary intention healing; true or false?
True
State some factors that can affect wound healing, include;
- Local factors
- Systemic factors
Describe negative-pressure wound therapy (commonly known as VAC); include how you put it on, how you apply it, contra-indications
- Sealed dressing put over wound then device applies negative pressure to wound
- Works by:
- Encouraging blood supply to wound site to help healing
- Reducing oedema
- Removing need for multiple dressing changes and hence decreased infection risk
- Contraindications:
- Exposure over a vessel or bowel
- Ongoing infection
- Tissue necrosis requiring further debridement
Wound contamination can be split into four classes; state these classes
*Just have brief idea of what is in each
What is the reconstruction ladder?
*Don’t need to know inside out, just know exists
Step-wise progression of wound management options. It is a guide and it may be approrpriat to jump rungs on the ladder
Compare split-skin thickness and full skin thickness skin grafts
What must both develop to heal?
- Split skin= does not contain whole dermis. Leaving behind some of dermis allows re-epithelialisation of donor site. Can be used for large areas
- Full skin= contains whole dermis. Donor site must be closed directly. Only be used for small areas.
Both must develop a new blood supply to heal
What is the difference between flaps and grafts?
- Flaps bring their own blood supply, grafts do not.
