Wounds

Question 1

What makes up epidermis

Answer 1

Stratified squamous keratinised epithelium

Melanocytes - produce melatonin responsible for skin colour + protect against UV

Question 2

What makes up dermis

Answer 2

Connective tissue responsible for strength / elasticity
95% of thickness
Contains rich vascular plexus

Question 3

What is beneath dermis

Answer 3

Subcutaneous tissue
Fascia
Muscle
Penetrating vessels contributing to dermal plexus

Question 4

What is important in Hx of a wound

Answer 4

What caused it?
How long for? 
When did it occur?
Where did it occur? - clean or contaminated
Any chance of FB? 
Tetanus status
PMH of anything that would affect healing - DM / steroid / anti-coagulant 
Any allergies 
Previous experience with LA

Question 5

How do you examine wound and what for

Answer 5

Site, depth and length 
Check for damage to deeper structures (may need exploration under GA) 
- Check sensation
- Signs of nerve / vascular damage
Any FB
Any other injuries

Question 6

What are types of wound - acute

Answer 6

Bruise
Abrasion
Laceration 
Incised wound
De-gloving
Avulsion 
Crush 
Puncture
Haematoma

Question 7

What are chronic wounds

Answer 7

Ulcers
Sinuses
Fistula

Question 8

Bruise

Answer 8

Area of injury leading to escape of block

Initially black and changes colour due to breakdown of Hb

Question 9

Abrasion

Answer 9

Graze caused by rubbing or scraping

Can be heavily contaminated

Question 10

Laceration

Answer 10

Tear of tissue 2 to trauma

Leads to irregular edge with compromised blood supply

Question 11

Incision

Answer 11

Sharp object

Clean well defined age with viable vascularity

Question 12

De-gloving

Answer 12

Laceration where skin is sheared from underlying fascia

Can lead to skin ischaemia

Question 13

Avulsion

Answer 13

Tearing or forcible separation of structure from origin

Question 14

Crush

Answer 14

Tissue damage from compression

Question 15

Puncture

Answer 15

Penetration usually due to sharp object

Risk of infection as extends into SC

Question 16

Haematoma

Answer 16

Accumulation of blood in a tissue, organ or space

Can compress underlying structures

Question 17

Ulcer

Answer 17

Discontinuity of epithelial surface

Can be associated with infection or inflammation

Question 18

Sinuses

Answer 18

Blind track lined by granulation tissue from epithelial surface to surrounding tissue

Question 19

Fistula

Answer 19

Abnormal connection between two epithelial surfaces e.g. gut or skin

Question 20

What are wounds

Answer 20

Clean

Contaminated

Question 21

What are clean wounds

Answer 21

Surgical created or incised
Well defined edges
No contamination

Question 22

How can clean wounds be closed

Answer 22

Primary intention

Question 23

What are contaminated wounds

Answer 23

Laceration / crush / avulsion / de-gloving
Contain foreign material or large amounts of revitalised tissue
Any bite
Any wound >6 hours

Question 24

How do you close

Answer 24

NOT safe by primary

Question 25

What is a tetanus prone wound

Answer 25

Any significant devitalised tissue 
Any puncture 
Wounds requiring surgery but delayed >6 hours 
Contact with soil / manure
Contact with FB
Any open fracture
Evidence of sepsis 
Frost bite injury

Question 26

How do you Rx

Answer 26

500g tetanus Ig + muscle relaxant

Vaccination if not had full 5 vaccine

Question 27

What do you do if not tetanus proned wound

Answer 27

Look at immunisation history
If had all 5 = no Rx
If not fully vaccinated = give vaccine and inform GP

Question 28

If a wound is highly contaminated what is required

Answer 28

Clean prior to Rx
May need to clean with LA or in theatre
Irrigation

Question 29

If risk of foreign body

Answer 29

Explore wound
X-ray before closing
May need USS if wood / plastic as won’t show up