Wound Management & Healing

Question 1

Inflammatory Phase

Answer 1

Begins immediately and lasts 3-5 days; platelets aggregate to form a fibrin clot, controls bleeding, and stabilizes wound edges; neutrophils and macrophages arrive to direct wound healing and remove bacteria and cellular debris

Question 2

Proliferative Phase

Answer 2

Begins 3-5 days after injury and lasts 2-4 weeks; characterized by invasion of fibroblasts, formation of granulation tissue, deposition of collagen, epithelialization, and wound contraction by myofibroblasts

Question 3

Granulation Tissue

Answer 3

Creates a surface for re-epithelialization, consists of fibroblasts, myofibroblasts, endothelial cells, inflammatory cells, and new blood vessels; appears pink with a cobblestone appearance

Question 4

Angiogenesis

Answer 4

Formation of new blood vessels

Question 5

Epithelialization

Answer 5

Process where epithelial cells cover the wound with new skin; starts 4-5 days after injury, begins at wound edges and moves inward

Question 6

Maturation Phase

Answer 6

Final phase of healing, begins ~3 weeks after initial injury and can continue for weeks and months; involves remodeling and realignment of collagen fibers along tension lines

Question 7

Factors Influencing Wound Healing

Answer 7

Include patient health, wound classification, and concurrent wound treatment; patient factors such as age, endocrinopathies, chronic infections, orthopedic & neurologic conditions, nutritional status, and obesity can affect healing

Question 8

Clean Wound

Answer 8

Atraumatic and surgically created under aseptic conditions

Question 9

Clean Contaminated Wound

Answer 9

Created by controlled, surgical entry into contaminated areas with minimal contamination that is easily removed

Question 10

Contaminated Wound

Answer 10

Recent traumatic wound with bacterial contamination or major contamination by bacteria from GI or urogenital tract

Question 11

Dirty Wound

Answer 11

Older wound with obvious infection, such as an abscess, bite wound, puncture wound, or necrotic tissue

Question 12

Steps in Proper Wound Management

Answer 12

1. Prevent further contamination
2. Remove foreign debris and contamination
3. Debride nonviable tissue
4. Manage wound drainage
5. Protect the wound through the inflammatory and proliferative phases
6. Select appropriate wound closure

Question 13

Cleaning Wounds

Answer 13

Involves wearing gloves, covering and filling the wound with sterile lubricant, using chlorhexidine or Betadine for cleaning, and flushing the wound with LRS or 0.9% NaCl

Question 14

Wound Debridement

Answer 14

Process of removing contaminated, devitalized, or necrotic tissue from a wound; can be done surgically or mechanically

Question 15

Staged Surgical Debridement

Answer 15

Involves repeated surgical debridement procedures to remove compromised tissue and questionable tissue left for possible removal later; commonly used for large wounds with substantial trauma

Question 16

En Bloc Excision

Answer 16

Debridement achieved by surgically excising completely around the wound and closing with primary closure; commonly used on small wounds

Question 17

Mechanical Debridement

Answer 17

Nonselectively debrides heavily contaminated wounds using an adherent bandage layer, such as a wet-to-dry bandage; used only in the inflammatory phase

Question 18

Biological Example

Answer 18

Maggots used to ingest necrotic tissue, beneficial for chronic wounds with poor tissue health

Question 19

Dead Space

Answer 19

Space created by tissue separation after surgery or trauma, fills with blood or serosanguinous fluid, excessive fluid accumulation impedes healing

Question 20

Minimizing Dead Space

Answer 20

Important in wound management to prevent fluid accumulation and infection, drains may be used for extensive dead space

Question 21

Wound Drains

Answer 21

Devices used to manage fluid drainage in wounds, categorized as passive, active, or negative pressure wound therapy

Question 22

Passive Drains

Answer 22

Allow fluid to flow along the drain surface via capillary action, placed in a dependent location for gravity drainage

Question 23

Active Drains

Answer 23

Create a vacuum within the wound for fluid removal, used for extensive wounds, removed when fluid production decreases

Question 24

Negative Pressure Wound Therapy

Answer 24

Controlled vacuum application for wounds unsuitable for normal drains, benefits include increased vascularization and reduced wound size

Question 25

Primary Closure

Answer 25

Direct surgical closure of fresh, clean wounds with sutures/staples, promotes rapid healing without granulation tissue

Question 26

Delayed Primary Closure

Answer 26

Closure method for older contaminated wounds, initially treated open for drainage before surgical closure

Question 27

Secondary Closure

Answer 27

Closure method for infected or failed primary closures, wound allowed to form granulation tissue before closure

Question 28

Second Intention Wound Healing

Answer 28

Healing method for older or infected wounds without surgical intervention, slower than primary closure with potential disadvantages

Question 29

Abrasion

Answer 29

Partial thickness dermal wounds that heal easily due to minimal dermal damage

Question 30

Laceration

Answer 30

Deeper wounds caused by tearing or cutting of skin and deeper tissues, minimal trauma to surrounding tissue

Question 31

Degloving Injury

Answer 31

Tearing off a large section of skin from underlying tissues, common in vehicular trauma, requires aggressive wound care

Question 32

Penetrating Wounds

Answer 32

Wounds caused by bites, bullets, etc., challenging to assess extent of injury, may lead to dead space accumulation

Question 33

Burn Classification

Answer 33

First-degree burns involve the outermost skin layer, second-degree burns affect epidermis and dermis, third-degree burns penetrate deep dermal layers

Question 34

Decubital Ulcers

Answer 34

Pressure sores from prolonged skin compression, common in recumbent patients, preventive care includes soft bedding

Question 35

Exuberant Granulation Tissue

Answer 35

Excessive granulation tissue hindering wound healing, managed by various methods including surgical excision