Wounds and Wound closure Flashcards
Types of wounds (5)
Incisions Lacerations Abrasions Contusions Penetrating injuries
Stages of wound healing
I - inflammation - 0-3 days
II - destruction - 2-5 days
III - proliferation - 3-25 days
IV - Maturation - up to 1 year
Patient factors effecting wound healing (5)
Age and weight Nutritional status Blood disorders Drug therapy Other systemic diseases
Wound factors effecting healing (6)
Location Devitalisation of tissue/ Blood supply Foreign material Infection Tension on sutures
Assessment of a skin wound - History
General health and co-operativity of patient
Full Hx including mechanism of injury, age of wound, contamination, presence of FB
Assessment of a skin wound - Examination (5)
Circulation and movement of wound edges Sensation of skin and distal structures Damage to underlying structures Assess skin edges - contamination and need for subcut sutures Does the wound cross Langhan's lines
Max dose of LA (Lidocaine)
3mg/kg –> 100mg = 10ml of 1% so a 70Kg man can have 20ml of 1% or 10ml of 2% –> 5-10ml is usually enough though
If combined with adrenaline can have 7mg/kg
Lidocaine can also be potentiated with bicarbonate
Lidocaine toxicity
Occurs if injected systemically - metallic taste, peri-oral tingling, fits, comas, CVS depression and arrhythmias (ventricular ectopics)
Always aspirate to check you arent in a vein when giving local
Methods of providing local anaesthesia
Local inflitration - most common and easiest
Field/nerve block - Target the nerve supplying the area and inflitrate LA directly around it
Ring block - a form of field block used for fingers and toes
Cleaning Wounds
Normal saline irrigation can be used when there is no specific contamination
‘Dirty’ wounds should be cleaned with iodine solution
For thorough cleaning of a dirty wound anesthetize first
Problems associated with suturing
Poorly anaesthetised wound
Wound itself is too old, too deep, contaminated or profusely bleeding
If deep structures are effected or wound is gaping superficial sutures may not be enough
Problems with suturing technique
Bent needle
Knots coming undone or suture cuts out/breaks
Too many sutures used or too high tension used
When Suturing the head
Use tepid water when cleaning to reduce bleeding
Very vascular so take deep and large bites - do not clip vessels without help. But when suturing the face (which can be done later than normal, >6hrs after injury) take smaller bites
Use 3/0 sutures - Review in 7 days
When Suturing the trunk
3/0 or 4/0 and review after ten days
Back skin particularly is very tough
When Suturing the limbs
For arms use 3/0 or 4/0 but 5/0 in children - review are 7 days unless crossing a joint
For legs 3/0 and leave for longer as undermore tension
