Wound, Tissue Repair & Scar

Question 1

What is keloid?

Answer 1

Keloid is a scar which shows extreme outgrowth so that scar tissues grow beyond the limits of original wound and shows no tendency to resolve.

Question 2

What is Hypertrophic scar?

Answer 2

Scars that rise above the skin level but stay within the confines of the original wound and often regress over time

Question 3

What are the particular sites that keloids grow on?

Answer 3

• Central chests(probably most common)
• Back
• Shoulder
• Earlobes

Question 4

How much time does hypertrophic scars(HTS) take to develop after trauma?

Answer 4

within 4weeks

Question 5

How much time does keloids take to develop after trauma?

Answer 5

tends to occur 3 months to years

Question 6

Treatment of keloid?

Answer 6

• Intralesional injection of steroid (Triamcinolone acetate) is now recommended as the 1st line of treatment for keloids
• Surgical excision(alone leads to high recurrance rate- so it may be combined with other modalities such as topical application of silicone sheets or use of radiation or pressure or intralesional corticosteroid injection)
• Silicone sheet application
• Pressure application
• Topical retinoids

Question 7

Treatment of hypertrophic scars?

Answer 7

• surgical excision and primary closure of wound is indicated if scare is still hypertrophic after 6months
• Pressure application: particularly for burn scars
• Silicone sheet application
• Intralesional injection of triamcinolone

Question 8

Classification of surgical wounds?

Answer 8

• Clean wound(Class 1)
• Clean/contaminates wounds(Class 2)
• Contaminated wounds(Class 3)
• Dirty wounds(Class 4)

Question 9

What are class 1 wounds?

Answer 9

It includes:

• Those in which no infection is present
• Only microflora potentially contaminate the wound
• No hollow viscus is entered
• No inflammation
  eg: Hernia repair, breast biopsy

Question 10

What are class 2 wounds?

Answer 10

It includes:

• those in which a hollow viscus such as the respiratory, ailmentary or genitourinary tracts with indigenous bacterial flora is opened, but under controlled circumstances without significant spillage of contents
• No inflammation
  eg: Cholecystectomy, elective GI surgery

Question 11

What are class 3 wounds?

Answer 11

It includes:

• Open accidental wounds encountered early after injury, those with extensive introduction with bacteria into a normally sterile area of body due to major breaks in sterile technique(eg:open cardiac massage)
• Uncontrolled spillage of viscus contents such as from the intestine
• Inflammation is apparent
  eg: Penetrating abdominal trauma, large tissue injury, enterotomy during bowel obstruction

Question 12

What are class 4 wounds?

Answer 12

It includes:

• Traumatic wounds in which a significant delay in treatment has occured and in which necrotic tissue is present
• wound in which pus is present
• wounds created to access a perforated viscus accompanied by a high degree of contamination
• severe inflammation is seen
  eg: Perforated diverticulites, necrotizing soft tissue infection

Question 13

Phases of wound healing?

Answer 13

1. Inflammatory (or reactive) phase
2. Proliferative (or regenerative or reparative) phase
3. Maturational (or remodelling) phase

Question 14

Steps for Reducing Surgical site infections(SSIs)?

Answer 14

• Prophylactic antibiotics
• Pre op shaving is not done
• Monofilament sutures
• Proper apposition of wound and prevention of any dead space and hematomas
• Proper washing of hands with detergent solution containing added chlorhexidine or an iodine based antiseptic
• Bowel preparation for intraabdominal surgeries
• Skin preparation with antiseptic solution

Question 15

Most common cause of bacteria found in SSIs?

Answer 15

Staphylococcus aureus and

coagulase-negative staphylococcus

Question 16

Most common cause of bacteria found in SSIs of GIT operations?

Answer 16

Enterobacter species

E.coli

Question 17

Best way to control external hemorrhage?

Answer 17

External compression