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Z Dermatology Clin Med > Wound & Repair (last 6 pg's) > Flashcards

Wound & Repair (last 6 pg's) Flashcards

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1
Q

Most commonly used injectable anesthesia for wound care/repair?

A

Lidocaine

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2
Q

What can be combined with Lidocaine and what are the benefits?

A
  • Epinephrine
  • increases duration of anesthesia
  • reduces bleeding
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3
Q

What is the onset time and duration for lidocaine?

A
  • Onset: 4-10 minutes

- Duration: 60-120 minutes

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4
Q

Where should you NEVER use anesthetics with epinephrine and why?!

A
  • In anatomic areas with terminal circulation!
    • fingers, toes, ears, penis, nose
  • Increases risk of tissue necrosis
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5
Q

What is the onset time and duration for Mepivacaine?

A

-Onset: 6-10 minutes
-Duration: 30-60 minutes (simple blocks
90-180 minutes (nerve blocks)

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6
Q

One benefit of Mepivacaine over Lidocaine?

A

Less vasoconstriction with Mepivacaine, no need to use epinephrine with it

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7
Q

What can you use to reverse damage with accidental injection of anesthesia/epinephrine in areas with terminal circulation?

A

Nitroglyceran paste

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8
Q

What is onset time and duration for Bupivacaine?

A
  • Onset: 8-12 minutes

- Duration: 240-480 minutes

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9
Q

3 main types of topical anesthetics?

A
  • Lidocaine cream
  • Ethyl chloride spray
  • EMLA (lidocaine/prilocaine)
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10
Q

Lidocaine cream - application and duration/effect?

A
  • App: under occlusive gauze

- Duration/Effect: Apply 45 minutes before procedure

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11
Q

Ethyl Chloride spray - application and duration/effect?

A
  • App: Spray 2.5 cm from skin

- Duration/effect: lasts 1 min; turns skin white and hard

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12
Q

EMLA - application and duration/effect?

A
  • App: under occlusive gauze to intact skin

- Duration/effect: apply 45-60 mins before procedure

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13
Q

Direct Wound Infiltration - use and technique?

A
  • used for most minimally contaminated lacerations as an injection technique
  • goes from inside wound to outside to reduce infection risk
  • plane of injection: beneath dermis at jxn of superficial fascia
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14
Q

3 main types of injection techniques for infiltration?

A
  • Direction Wound Infiltration
  • Parallel Margin Infiltration
  • Digital Nerve Blocks
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15
Q

Parallel Margin Infiltration - use and technique?

A
  • Advantage of fewer needle sticks; preferred for grossly contaminated wounds
  • approach is through intact skin
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16
Q

Digital Nerve Blocks - use and technique?

A
  • MOST COMMON nerve block in minor wound care
  • recommended for lacerations distal to the level of mid-proximal phalanx of finger/toe
  • preferred for nail removal/paronychia drainage/repair of digital lacerations
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17
Q

Most common nerve block in minor wound care?

A

Digital Nerve Blocks

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18
Q

What is the rough guideline for how long from time of injury is considered safe to close a wound up?

A

6-8 hours

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19
Q

The solution to pollution is…

A

Dilution! :D

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20
Q

Primary wound closure?

A
  • used for clean/uncontaminated lacerations w/ minimal tissue loss
  • repair within 6-8 hours from time of injury
  • MUST aggressively clean, irrigate, debride wound before closure
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21
Q

Secondary wound closure?

A
  • used for skin infections, ulcerations, abscesses, punctures, small animal bites, partial thickness abrasions, 2nd degree burns
  • consists of thorough cleaning, irrigation, and debridement; leave wound open to heal on its own
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22
Q

Tertiary wound closure?

A
  • include bite wounds and lacerations beyond the 6-8 hour window
  • high bacteria count, antibiotics can be helpful
  • can be converted to ‘fresh’ wounds by I&D and closure; once wound appears clean and uninfected, may be closed
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23
Q

When do you close up a wound from a human bite?

A

NEVER

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24
Q

3 goals of quality closures?

A
  • Eliminate complications
  • Restore function
  • Reduce scarring
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25
Q

What are Langer’s lines?

A

helpful guidelines when closing a wound; correspond to natural collagen fibers in the dermis

26
Q

What are 3 techniques to help reduce tension and improve wound healing?

A
  • Follow Langer’s lines
  • Undermine when necessary
  • Use layered closure technique when possible/as needed
27
Q

What is useful about undermining?

A
  • creates “free” tissue under wound edges

- used for clean wounds only

28
Q

Generally, you use a ____ size suture for more cosmetically important areas

A

smaller

29
Q

2 different types of needles?

A
  • Cutting (most often)

- Tapering

30
Q

Where should you NEVER grab the tip of the needle to pull it through a bite?

A

The tip - it will dull it!

31
Q

What do occlusive, dry dressings help with in wound healing?

A
  • Decrease inflammation

- Increase reepithelialization

32
Q

layering of wound dressings?

A
  • non-adherent/permeable first layer
  • absorbant second layer
  • pressure top layer (as needed)
  • Gauze with tegaderm or band-aid
33
Q

When to use steri-strips for wound closure?

A
  • superficial, straight lacs under little tension
  • flaps where sutures may compromise vascular supply
  • lacs with greater than normal potential for infection
  • lacs in elderly/steroid-dependent patient
  • support for lacs after suture removal
34
Q

Advantages of steri-strips?

A
  • easy application
  • even distribution of tension
  • no suture marks
  • application by non-providers
35
Q

Disadvantages of steri-strips?

A

don’t work well on oily surfaces, hair, joints, lax skin, gaping wounds, wounds under tension, young or uncooperative patients

36
Q

Where do tapes not work well?

A

-irregular surfaces, bloody/wet/secreting wounds, hair, scalp, joints, or intertriginous areas

37
Q

When to use stapling for wound closure?

A
  • linear, sharp lacs of scalp, forehead, neck, trunk, buttocks, and extremities
  • temporary, rapid closure of extensive superficial lacs in patients requiring immediate surgery
38
Q

Advantages of staples

A
  • quick
  • tolerated well once placed
  • lower infection rates than suture
39
Q

When should you NOT use staples?

A

In areas that are going to be studied by CT or MRI

40
Q

When to use tissue adhesives (such as Dermabond) for wound closure?

A
  • fresh lac within ‘golden period’
  • lacs under low tension & easy to approximate
  • edges of wound clean & even
  • dry wounds with little to no bleeding
41
Q

Where should you NEVER use tissue adhesives?

A

Near the eyes!

42
Q

Advantages of tissue adhesives?

A
  • flexible
  • bacterial barrier
  • high breaking strength
  • espesh good for the face
  • no need for anesthesia
  • can shower normally
  • peels off spontaneously in 5-10 days (no follow-up needed)
43
Q

3 Key principles of suture care and wound aftercare?

A
  • Protection
  • Elevation
  • Cleanliness
44
Q

3 main things involved in wound aftercare?

A
  • Scheduling for suture removal
  • aftercare instructions
  • info on what to expect as wound heals
45
Q

Generally, timeline before suture removal in trunk/extremities?

A

10-14 days

46
Q

Generally, timeline before suture removal in face?

A

3-5 days

47
Q

Generally, timeline before sutural removal in scalp?

A

6-8 days

48
Q

Technique used for suture removal?

A

Cut under the knot, close to the skin surface

49
Q

When do most wound infections appear?

A

Within 4-5 days

50
Q

Signs of wound infection?

A
  • Excessive discomfort
  • Mucopurulent discharge
  • Erythema
  • Lymphangitic streaks
  • Fever
51
Q

Simple interrupted stitch?

A
  • single sutures, tied separately
  • deep or percutaneous
  • MOST common suture used
52
Q

Continuous closure/running simple stitch?

A
  • taking several full length bites of wound without tying individual knots
  • knots tied only at beginning and end of closure
  • deep or percutaneous
53
Q

Vertical mattress suture?

A
  • ‘far far near near’ stitch
  • take a large bite 1-1.5 cm away from wound edge, coming out equal distance on other side
  • needle reversed and returned for a smaller bite at the epidermal/dermal edge
  • acts as deep and superficial closure all in one
54
Q

Horizontal mattress suture?

A
  • used to achieve wound edge eversion
  • normal bite taken through both sides of wound, then second bite is taken adjacent to first exit and brought back to the original starting edge, ~0.5 cm from initial entry point
  • knot is then tied
55
Q

Subcuticular running closure?

A
  • often used to close straight incisions
  • use non-absorbable suture material
  • one strand used, without interruption, for entire laceration
  • choose a plane of skin (dermis, superficial cutaneous fascia) and take ‘mirror image’ bites horizontally the full length of the wound
56
Q

V-Y closure? (corner stitch)

A
  • often used with flaps with damaged, non-viable edges
  • edges can be excised to make a smaller, more viable flap
  • closes the wound as a “Y” rather than original “V” config.
57
Q

Bite?

A
  • amount of tissue taken when placing the suture needle in skin or fascia
  • includes both depth and width from wound edge
58
Q

Throw?

A

each suture knot consists of a series of throws; each throw is a pass through the skin

59
Q

Knot?

A

used to tie sutures during wound closure

60
Q

Most common knot?

A

Surgeon’s knot

61
Q

If you don’t like the way a particular suture looks, what should you do?

A

-Cut it out and START OVER

Z Dermatology Clin Med (18 decks)

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