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Surgery M4 part 1 > Wounds > Flashcards

Wounds Flashcards

1
Q

What are the phases of wound healing?

A

INFLAMMATORY
PROLIFERATIVE
REMODELING

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2
Q

What occurs in a wound from day 0 to day 5?

A

HAEMOSTASIS & INFLAMMATION
1- clotting cascade initiated
2- platelet aggregation
3- release of cytokines & growth factors
4- chemotaxis of macrophages to help in phagocytosis & wound debridement
5- activation of fibroblasts & endothelial cells

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3
Q

what are the signs of the inflammatory phase in wound healing?

A 
redness 
heat 
swelling
pain
loss of function at wound site

(phase is short if there’s no infection or contamination)

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4
Q

What are the characteristics of the proliferative phase?

A
  • FIBROBLASTS from surrounding tissue secrete collagen I & III
  • ENDOTHELIAL CELLS from intact venules form new capillary buds which will form granulation tissue with fibroblasts
  • EPITHELIAL CELLS from wound edges migrate to close the epithelial defect
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5
Q

What occurs in the maturation phase?

A

deposition of collagen in the wound

  • collagen III first then collagen I
  • collagen fibers become thicker & arrange along the lines of stress to increase the tensile strength of the wound
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6
Q

How long does remodeling continue for?

A

1 year

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7
Q

When does wound contraction start?

A

starts immediately & continues for 2 - 3 weeks

MYOFIBROBLASTS help diminish the size of wound

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8
Q

What are the general factors that affect wound healing?

A

AGE
decreased protein turnover in elderly slows healing

DEBILITATING DISEASE
like uremia, jaundice, cirrhosis, malignancy, & diabetes

IRRADIATION

  • inhibit wound contraction & granulation tissue formation
  • prior irradiation causes ischemia due to end arteries obliterans

NUTRITION

  • proteins: essential for collagen synthesis
  • Vit C: maturation of protocollagen
  • Vit. A: epithelialization
  • calcium, zinc, manganese & copper

DRUG INTAKE
steroids inhibit inflammatory response & fibroblast formation

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9
Q

What are the local factors affecting wound healing?

A

VASCULARITY

  • good blood supply in face & scalp help rapid healing
  • bad blood supply below the knees delay healing

IMMOBILIZATION
wounds over joints or weight bearing have smaller healing powers

TENSION
cause ischemia & delayed healing

INFECTION
bacteria competes with fibroblasts for oxygen & nutrition
- they secrete collagenolytic enzymes

FOREIGN BODIES & NECROTIC TISSUE impair healing

ADHESION TO A BONY SURFACE
prevents wound contraction

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10
Q

What are the types of wound healing?

A

PRIMARY INTENSION

  • clean wounds immediately closed by sutures or clips
  • minimal scar

SECONDARY INTENSION

  • edges not approximated or gaping due to hematoma or infection
  • filled with granulation tissue
  • ugly scar

TERTIARY INTENSION

  • contaminated wounds left open for 5 days
  • if there are no signs of infection delayed primary sutures could be done
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11
Q

surgical incision & wounds caused by sharp objects are classified as? How should they be treated?

A

Tidy wounds

  • primary sutures
  • healed by primary intention
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12
Q

crushing, tearing, avulsion, devitalised injury, vascular injury, multiple irregular wounds & burns are classified as? What complications could they cause?

A

Untidy wounds
Could cause: - wound dehiscence
- infection
- delayed healing

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13
Q

What are the 2 types of wounds?

A

CLOSED

  • contusions
  • hematoma

OPEN

  • abrasions
  • incised
  • lacerated
  • penetrating
  • bites
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14
Q

a blow with a blunt object causing extravasation from the injured blood capillaries, the area is painful & swollen & is bluish then brownish then green. What is this called & what is its treatment?

A

CONTUSION

elevation & anti-inflammatory ointment

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15
Q

excessive bleeding that is cystic in the beginning then after hours begins to clot and later liquifies is called? What are the complications caused?

A

HEMATOMA

  • absorption
  • organization by fibrosis
  • abscess
  • liquifaction & cyst formation
  • calcification (myositis ossificans)
  • abscess
  • false aneurysm
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16
Q

What are abrasions & why do they hurt? How should they be managed?

A
  • scraping of superficial layer of skin due to friction with hard rough surface
  • sensitive nerve endings are exposed
  • clean with anti-septic
  • nonadherent dressing
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17
Q

how is an incised wound caused?

A
  • sharp cutting instruments
  • long than it is deep
  • edges are clean cut
  • tendons & nerves are liable to be cut
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18
Q

severe violence with a blunt object will cause?

A

LACERATED wound

  • irregular in shape & severely traumatized
  • devascularized & contaminated

could cause DEGLOVING INJURY

  • in skin & subcutaneous tissue from deep fascia
  • skin devascularization becomes apparent in a few days
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19
Q

How are penetrating wounds caused?

A

penetration by a pointed object that could injure deep structures

  • small external opening
  • has poor drainage so it encourages infection
20
Q

What type of wounds do bites cause?

A

Lacerated wounds with bone, joint, tendon, vessel, & nerve involvement

Puncture wounds with high risk of infection (difficult to irrigate & decontaminate

21
Q

A superficial wound involves?

A

the epidermis alone

22
Q

a partial thickness wound involves?

A
  • epidermis

- dermis

23
Q

a full thickness wound involves?

A
  • epidermis
  • dermis
  • fat
  • fascia
  • exposes bone
24
Q

How should any open wound be managed?

A

1- direct local compression to stop BLEEDING
2- splint & arrange for x-ray if there is a suspected fracture
3- saline irrigation & removal of foreign bodies THEN antiseptic
4- inspection of all structures within wound
5- repair large veins or arteries & ligated small veins or arteries
6- repair nerves or tendons
7- repair muscles by mattress sutures if incised cleanly
excise ischemic or necrotic muscle
8- if there is a possibility of infection, external bone fixation
9- leave deep fascia open if wound is contaminated or there is extensive tissue destruction

25
Q

What are the complications of WOUND HEALING?

A

HEMORRHAGE

  • slipped suture
  • erosion of blood vessels
  • infection
  • dislodged clot

INFECTION
- due to purulent material draining from wound
- its greater when wounds contain necrotic tissue, foreign
bodies, or blood supply & local tissue defense is reduced
- bacteria inhibits wound healing

EVISCERATION
- visceral organs protrude through wound opening due to total separation of wound

DEHISCENCE

  • partial or total separation of wound layers
  • BURST ABDOMEN

STRETCHING

CONTRACTURE
- usually in burns

26
Q

What are the signs & symptoms of an infected wound?

A
  • contaminated or traumatic 2 - 3 days
  • post-op surgical wound 4 - 5 days
  • fever, tenderness & pain at wound site & inflamed edges
  • odorous & purulent drainage (yellow, green, or brown)
  • elevated WBC
27
Q

What are the complications of wounds?

A

GENERAL

  • shock
  • crush syndrome
  • compartment syndrome

LOCAL

  • infection: pyogenic or specific
  • gangrene: vascular or infective
  • complications of healing
28
Q

a closed injury causing hematoma leading to increased pressure will cause?

A

COMPARTMENT SYNDROME

- usually associated with a bone fracture aggravating ischemia

29
Q

What are the signs of compartment syndrome?

A
  • Pallor
  • pulslessness
  • pain
  • paresthesia
  • diffuse swelling
  • cold limb

IF IT PROGRESSES

  • gangrene
  • chronic ischemic contracture leading to a deformed limb
30
Q

What are the problems associated with compartment syndrome?

A
  • renal failure
  • gangrene of limb
  • chronic ischemic contracture
  • disabled limb
31
Q

How should compartment syndrome be treated?

A

pressure will be more than 30mmHg
1- FASCIOTOMY should be done until muscle bulges out
2- antibiotics
3- catheterisation
4- mannitol or diuretics to flush the kidney
5- fresh blood transfusion
6- hyperbaric oxygen

32
Q

What are the dreaded problems of crush injury?

A
  • renal failure
  • hypovolemic shock
  • sepsis
33
Q

What does crush syndrome lead to?

A

extravasation of blood & release of myohaemoglobin into the circulation leading to acute tubular necrosis & acute renal failure

34
Q

What are the causes of crush syndrome?

A
  • earthquakes
  • mining & industrial accidents
  • air crash
  • tourniquet
35
Q

What is the pathogenesis of crush injury?

A

1- tension increases in the muscle compartment
2- circulation impeded & ischemic damage increases
3- urine becomes discolored & scanty in 3 days
4- patient becomes restless, apathic, & delirious with onset of uremia

INJURY IS WORST THAN INITIAL LOOK (life threatening)

36
Q

What are the effects of crush syndrome?

A
  • renal failure
  • toxaemia
  • septicemia
  • disability with extensive tissue loss
  • gas gangrene
37
Q

How is crush syndrome treated?

A
  • relieve tension by multiple parallel deep incisions
38
Q

Keloid is more common in?

A
  • black people

- women

39
Q

What are the predisposing factors for keloid?

A
  • genetic (familial)

- defect in maturation & stabilization of collagen fibrils

40
Q

What is the commonest site for Keloid formation?

A

over sternum

41
Q

Whats the pathology of keloid?

A
  • continues to grow even after 6 months
  • extends into adjacent normal skin
  • brownish?pinkish black in color (vascular)
  • painful, tender, & hyperaesthic

proliferating immature fibroblasts & blood vessels & type III collagen

42
Q

What diseases may be associated with Keloid?

A

Ehlers Danlos syndrome

Scleroderma

43
Q

How should Keloid be treated?

A
  • excision & skin grafting
  • irradiation
  • excision & irradiation
  • steroid injection
  • silicone gel sheeting
  • laser therapy
  • vitamin E/palm oil massage
  • intralesional excision
44
Q

What are the different characters of a hypertrophic scar? (compared with keloid)

A
  • not genetic or familial
  • occurs anywhere in the body
  • growth limits up to 6 months
  • limited to scar tissue only
  • pale brown in color
  • not tender or painful
  • self-limiting
  • responds to steroid injection
45
Q

What are the common sites for a hypertrophic scar?

A
  • wound crossing tension lines
  • deep dermal burns
  • wounds healed by secondary intension
46
Q

What are the complications of a hypertrophic scar?

A
  • breaks repeatedly & causes infection & pain

- may turn into Marjolin’s ulcer (SSC) after repeated breakdown

Surgery M4 part 1 (47 decks)

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