Wound Repair Flashcards

Question

Common use of polyglactin

Answer 1

Dissolves slowly Use for lower layer in layered closure Exception is where you don't want to lose strength (i.e., cracking open chest- use wire)

Answer 2

15-60 days

Answer 3

Dissolves more slowly

Answer 4

Suture size expressed in numbers of zeros in the diameter | Larger the number, the smaller the suture

Answer 5

3-0 for trunk 4-0 for extremities 5-0 for digits 6-0 for face

Answer 6

Has round cross-section | Good for really deep wounds

Answer 7

Triangular cross-section Pushes knot upward Further out of the hole leaves less of a scar Great for face

Answer 8

Triangular cross section Sits down in the whole Leaves more of a scar, but more strength and protects the knot more

Answer 9

Use a small radius for layers | Use a larger radius for a wide cut

Answer 10

3-4" pair with both tips sharp | Use for cutting tissue, dissecting, and undermining

Answer 11

For top of skin

Answer 12

Moving lateral or parallel to the skin

Answer 13

For holding suture needle | Needle should be held at the proximal 1/3 of the shaft, perpendicular to the driver

Answer 14

Used for clamping bleeders | Good for foreign body, retracting tissue to get to something deep

Answer 15

For grasping tissue and suture needle Have teeth to improve grip Used to lift tissue from underneath Should be held like a pencil

Answer 16

Introduce the suture needle into the skin at a 90 degree angle Suture depth should be just above bottom of wound and should be at least as wide as it is deep Enter dermis at the same level as where you exited the other side of the wound

Answer 17

Place driver between suture ends and, with non-dominant hand, wrap suture (needle end) over the instrument twice (first throw only) Grasp short end of suture with driver and pull through Repeat these steps in the opposite direction from the throw before, using only one loop around the driver Each loop you make should be wrapped toward the wound

Answer 18

3-0, 4-0 monofilament: at least 4 throws 5-0, 6-0 monofilament: at least 6 throws Braided suture requires fever throws to hold Pull knot off to side

Answer 19

Halves (start in the middle and go to one side first) | End to end

Answer 20

Similar to simple interrupted, except that only the first and last passes are tied

Answer 21

Advantage: Faster Disadvantages: Harder to get tight, comes unraveled if any loop breaks

Answer 22

Variation of running stitch | Easier to keep tight

Answer 23

Provides layered closure with one stitch Creates everted wound edges Deep bite is made first, followed by a more superficial bite in the same plane, but in the opposite direction They hold more tension, good for a wound over a joint

Answer 24

Good for high tension wounds or wounds that need to hold most of the tension on one side First bite is nl Move down the wound and bite back in opposite direction

Answer 25

``` Can do interrupted or running Avoid "train-track" scar appearance Used for surgical or very clean wounds Sutures are placed upside-down to bury knots Final tail is hidden ```

Answer 26

Splinting sometimes required Shaving traumatizes skin and contaminates wound NEVER shave an eyebrow Take special care to align all natural (and unnatural) landmarks If incision has to be made, try to make it along natural skin tension lines Excessively dirty wounds need recheck

Answer 27

Incision made at 45 degree angle to wound Excess tissue undermined and flap pulled across wound Excess tissue cut over original incision and sewn

Answer 28

``` Easy to use and very quick Can often be placed without anesthesia Don't require sterile technique Automatically evert wound Leave scars -In ER, primarily used in scalp ```

Answer 29

Anesthetize first- still building a psyche LET for 15-20 mins, then return to staple Let them hear the sound of the staple before you start stapling

Answer 30

Very quick, no anesthesia or sterile technique required Be very judicious about where and how you use it -May pull off sooner in an area with a lot of tension -Mostly just forehead and around the eyes, volar part of the arm Wound must be clean/dry NO ACTIVE BLEEDING Put glue over the top of the skin

Answer 31

Rarely used for primary wound closure More effective for reinforcing Sometimes used to re-approximate skin tears Often used in conjunction with glue Can be useful to reinforce thin skin when suturing

Answer 32

Sometimes used in wilderness medicine and nursing homes

Answer 33

``` Keep dry and covered for 24 hrs Dirty wounds need recheck in 48 hrs No submersion for several more days Elevate if applicable Clean 2-3 x daily with soap and water -Peroxide should only be used for face to keep scars from scabbing -Minimal abx ointment bc wound needs to be dry Watch for signs of infection APAP or NSAIDs for pain ```

Answer 34

Wounds >12 hrs old at presentation- leave open Tooth-related wounds Crush wounds Heavily contaminated wounds Wounds of relatively avascular areas Wounds involving joint spaces, tendons, or bones Severe paronychia and felons (abscess in pulp of fingertip) Wounds in pts with hx of valvular heart dz Wounds in IC pts

Answer 35

A non-tetanus prone wound in a pt who has not had a Td in the past 10 yrs A tetanus prone wound in a pt who has not had a Td in the past 5 yrs Any wound in an adult pt who has not had adequate immunization

Answer 36

``` >6 hrs old >1 cm deep Stellate or avulsion configuration Associated with devitalized tissue Contaminated with soil, feces, or saliva From a missile From a puncture or crush Associated with burn or frostbite ```

Answer 37

``` Extensor surfaces Age >65 Diabetics Chronic steroid use Smokers ```

Answer 38

Prep area with alcohol or other skin cleanser Cut the suture with iris scissors as close to the skin as possible Tight sutures may need to be cut with a #11 blade Cut farthest from the knot possible Mattress suture needs two cuts

Answer 39

Organic material present in abscess makes it difficult to numb well Field block safest way to anesthetize skin -Alternative: make superficial narrow field over top of abscess -Include area where pus seems most superficial Often helps to inject V-shaped area of anesthetic under abscess if underlying structures permit

Answer 40

Apply cleansing agent in circular motion Cover wound with fenestrated drape or several drapes around field Wash cleansing agent away from field with sterile water or saline

Answer 41

Using #11 blade, stab downward into area of maximal fluctuance Allow most of pus to run out Widen incision to approximately 2 cm Probe wound using blunt dissection techniques to break up loculations Obtain cultures if indicated Irrigate with sterile saline Use forceps to fill cavity with 1/4 inch packing gauze (iodoform or plain)

Answer 42

If MRSA suspected, pt should be prescribed 10 days of abx -Bactrim DS 2 twice daily OR Clindamycin 300 mg 4x daily OR Doxycycline 100 mg twice daily Pain meds appropriate Pt should return in 48 hrs to have packing removed and wound checked -If wound tries to close, needs to be repacked Send pt home to irrigate Bactrim is best choice