Wounds Flashcards
What makes up epidermis
Stratified squamous keratinised epithelium
Melanocytes - produce melatonin responsible for skin colour + protect against UV
What makes up dermis
Connective tissue responsible for strength / elasticity
95% of thickness
Contains rich vascular plexus
What is beneath dermis
Subcutaneous tissue
Fascia
Muscle
Penetrating vessels contributing to dermal plexus
What is important in Hx of a wound
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
How do you examine wound and what for
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
What are types of wound - acute
Bruise Abrasion Laceration Incised wound De-gloving Avulsion Crush Puncture Haematoma
What are chronic wounds
Ulcers
Sinuses
Fistula
Bruise
Area of injury leading to escape of block
Initially black and changes colour due to breakdown of Hb
Abrasion
Graze caused by rubbing or scraping
Can be heavily contaminated
Laceration
Tear of tissue 2 to trauma
Leads to irregular edge with compromised blood supply
Incision
Sharp object
Clean well defined age with viable vascularity
De-gloving
Laceration where skin is sheared from underlying fascia
Can lead to skin ischaemia
Avulsion
Tearing or forcible separation of structure from origin
Crush
Tissue damage from compression
Puncture
Penetration usually due to sharp object
Risk of infection as extends into SC
Haematoma
Accumulation of blood in a tissue, organ or space
Can compress underlying structures
Ulcer
Discontinuity of epithelial surface
Can be associated with infection or inflammation
Sinuses
Blind track lined by granulation tissue from epithelial surface to surrounding tissue
Fistula
Abnormal connection between two epithelial surfaces e.g. gut or skin
What are wounds
Clean
Contaminated
What are clean wounds
Surgical created or incised
Well defined edges
No contamination
How can clean wounds be closed
Primary intention
What are contaminated wounds
Laceration / crush / avulsion / de-gloving
Contain foreign material or large amounts of revitalised tissue
Any bite
Any wound >6 hours
How do you close
NOT safe by primary
What is a tetanus prone wound
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
How do you Rx
500g tetanus Ig + muscle relaxant
Vaccination if not had full 5 vaccine
What do you do if not tetanus proned wound
Look at immunisation history
If had all 5 = no Rx
If not fully vaccinated = give vaccine and inform GP
If a wound is highly contaminated what is required
Clean prior to Rx
May need to clean with LA or in theatre
Irrigation
If risk of foreign body
Explore wound
X-ray before closing
May need USS if wood / plastic as won’t show up
