Wounds Flashcards
Mechanical debridement of wounds consist of
Wet-to-dry, wet-to-wet dressing, manual debridement with gauze or irrigation
Best choice of suture for closure of contaminated wounds
Totally not sure about this one. A monofilament absorbable suture - Monocryl? But PDS if under a lot of tension
Most important factor in management of contaminated/Infected wounds
Removal of devitalised tissue
Granulation tissue consist of
Collagen (type III), capillaries, fibroblasts
Describe the phases of wound repair
Inflammatory: Haemostasis and inflammation Tissue Formation: Angiogenesis, Fibroplasia, Tissue Formation, Epithelialisation, Contaction Remodelling/Maturation: Replacement of hyaluronan in provisional cellular matrix with proteoglycans in extracellular matrix Alignment of collagen fibres Gain in strength of wound
2 main cell types in wound healing inflammatory phase
Platelets and neutrophils
Differences between low and high pressure lavage in wound irrigation
Low pressure lavage is ideal; 10-15psi. Can used 35ml syringe with 19 gauge needle, holes punched in the top of a saline bottle. Encourages debris and bacteria to wash away from the wound High usually uses a single water jet. pressure lavage is bad: eg. WaterPik. Causes more tissue trauma and may force debris/bacteria further into tissues. However, this can be utilised in circumstances, such as abdominal lavage
What are the 3 purposes of drains
Facilitate elimination of dead space Evacuate existing fluid and gas accumulation Prevent anticipated formation of fluid collections
What are the advantages and disadvantages of penrose drains?
Advantages: Economical Can be used in lots of situations Disadvantages May kink Not useful in body cavities Passive only, no suction possible
What are the advantages and disadvantages of Jackson-Pratt drain
Advantages: Closed or open system Excellent for body cavities Less reactive Disadvantages: Attaching container can be difficult depending on location
What locations should be used to drain a) fluid and b) air from the thorax?
a) Ventral (2 inches above elbow) 7th intercostal space (front of rib) b) Dorsal 12th intercostal space (front of rib)
What complications can occur with drains
Foreign body response Ascending infections Portion of drain left in wound Loss of function/blockage Linkage of drain Suture dehiscence Damage to vessels and nerves
Which dressings can be used for heavily infected wounds?
Hypertonic saline dressing Honey Antimicrobial dressing Should use surgical debridement first
What are the advantages of calcium alginate dressings?
Calcium in dressing interacts with sodium in wound, providing wound exudate, stimulating fibroblasts and epithelial cells and speeds wound homeostasis Calcium modulates epithelial cell proliferation and migration Conform, vertical wicking, good for moderately to heavily exudative wounds Can moisten if insufficient exudate Change 3-7 days so fewer chances for contamination and reduced cost
Define bacterial contamination, colonisation and infection
Contamination: Bacteria without multiplication or trauma to host Colonisation: Attached to tissue and multiplying but not causing trauma to host Infection: Bacteria invade healthy tissue and multiply, overwhelming host’s response
What are the four classes of wound?
Clean: Surgical and do not involve resp, GI or urogenital Clean contaminated: Surgical with lumen of resp, GI or urogenital Contaminated: Traumatic, gross contamination, necrotic debris Infected: Large numbers of bacteria, inflammation, edema, suppuration
What is a keloid?
Similar to hypertrophic scar but extends beyond original wound margin and rarely regresses. May be due to increased number of epidermal Langerhans’ cells. Treatment: Steroid injection, surgical excision, radiation therapy, compression and tension reduction used
Name 3 tension relieving suture patterns
Horizontal Mattress Far-near-near-far Walking suture
Describe a V-Y Plasty
V-shaped incision with the point of the V directed away from the defect to be closed Close the original defect Close V incision by converting it to a Y Longer legs of the V make a greater degree of tension relief Use for eyelid scar revision and closing elliptical defects
What is a method of closing a circular skin defect
a.Suture along relaxing skin lines of tension then remove dog ears b. Convert to X or Y c. Excise 2 triangles on opposite sides, creating a fusiform defect; height of triangle should be equal to dimeter of the circle; removes skin of 1.5x original defect d. Double S-shaped incision with bi-winged excision e. Bow tie f. Combined V incision
Describe a bipedicle flap
Single longitudinal incision parallel to defect, or one incision on each side Skin flaps approximately same width as original defect Two sources of blood supply remain Burrow’s triangles can be used to help with excess laxity/dog ears Original defect is closed New incision(s) are left open
What is the difference between a rotation flap and a transposition flap
Rotation flap: Create semicircular incision and move tissue laterally to cover defect Transposition flap: Rectangular, single pedicle flap created adjacent to defect and rotated on it’s pedicle. Can be rotated up to 180 degrees but rotation shortens flap
What are the 3 purposes of drains
Facilitate elimination of dead space Evacuate existing fluid and gas accumulation Prevent anticipated formation of fluid collections
What are the advantages and disadvantages of penrose drains?
Advantages: Economical Can be used in lots of situations Disadvantages May kink Not useful in body cavities Passive only, no suction possible
What are the advantages and disadvantages of Jackson-Pratt drains
Advantages: Closed or open system Excellent for body cavities Less reactive Disadvantages: Attaching container can be difficult depending on location
What locations should be used to drain a) fluid and b) air from the thorax
a) Ventral (2 inches above elbow) 7th intercostal space (front of rib) b) Dorsal 12th intercostal space (front of rib)
