Wounds and Wound healing Flashcards
what is primary wound healing
wound is created by clean incision and wound edges are approximated - closure with sutures, stapels, adhesives, steri-strips
What is secondary wound healing
no ‘artificial’ wound closure; healing ONLY via physiologic closure
aka secondary intention
what is tertiary wound healing
usually secondary to concern for infection in “dirty wound”
left open to allow for drainage, debridement, circulation of abx prior to closure
primary closure several days later once danger of infxn is deemed low enough
AKA Delayed primary closure
What are the stages of cound healing
-hemostsis
-inflammation
-proliferation
-remodeling
Why is graunlation tissue important
essential for complete wound healing
3 main functions: immune, proliferation, replacement
what is the purpose of myelofibroblasts
wound bed contraction
have actin-myosin, adhesion molecules bind collagen - retraction
what are the types of suture materials
non-absorbable: braided and monofilament
Absorbable: braided and monofilament
What is the Swage
where needle meets the suture (same diameter)
if you have a gauge that is a bigger number, what does that mean about the suture
it is a smaller suture
what are the types of needles?
- tapered
- blunt
- cutting
- reverse cutting
when is surgical glue contraindicated
wounds under tension
complex stllate lesions, crush wounds, poor wound approximation
wounds on hands/feet/over joints
oral mucosa or other mucosal surfaces or areas of high moisture
wounds in hairy areas
wounds requiring high level of precision
bite wounds/infxn risk
allergy to adhesive
what are the two main categories of wound dressings
non-absorbing and absorbing
how can complications of wound healing be prevented in a patient with ehlers-danlos
mutlilayer closure
sutures left in place 2x longer
other interventions to reduce tensile forces
how do anti-inflammatories/steroids/immunomodulators affect wound healing
delay healing due to altered inflammatory reaction
why do anticaogulants affect wound healing
inhibit coagulation cascade which reduces fibrin
What is a keloid
excessive wound helaing - from any tissue insult
fibroblasts continue to multiply after wound healed.
15x more common in AA, spanish or asian pts
what are the most common locations of keloids
delts
anterior chest
back
earlobe
how can keloids be treated
intralesional steroid - first line
cyotherapy (prone to pigment changes)
surgical excision
What is a hypertrophic scar
excessive wound healing - from any tissue insult
excessive collagen deposition
when do hypertrophic scars present
within 4 weeks of injury
confined to original wound borders
what are the risks of developing pressure ulcers
increasing age
thin skin or low body weight
malnutrition
immobility
medical co-morbidities that delay wound healing
what areas are the highest risk areas for pressure ulcers
Heels
sacrum/coccyx
greater trochanters
what is stage 4 pressure ulcer
full thickness skin loss
exposed bone, muscle or tendon
what is a deep tissue pressure injury
purplish skin discoloration
potential for deeper tissue damage
