Dermatology and Wounds

Question 1

What is primary closure

Answer 1

Wound is closed in the acute phase, on the initial presentation to the provider

Question 2

When is primary closure used

Answer 2

Low risk of infection, retained foreign body, neurovascular compromise or damage to critical underlying structures

Question 3

What is delayed primary closure

Answer 3

Wound is irrigated, cleaned, debrided and bandaged. Repair is scheduled for a later date (4-6 days)

Question 4

When is delayed primary closure used

Answer 4

High risk of infection, provides faster and more cosmetically pleasing outcomes than healing by secondary intention

Question 5

What is secondary intention

Answer 5

Wound is allowed to heal spontaneously

Question 6

When is secondary intention used

Answer 6

Often reserved for dehisced surgical wounds or wounds presenting very late after the injury occurs. Healing slower and often leads to significant scarring

Question 7

Key historical components

Answer 7

Mechanism of injury, location, time of injury, medical history/cormorbid conditions, tetanus immunised status, associated symptoms

Question 8

Key physical exam components

Answer 8

Location and damage to underluing structures, presence of devitalised tissue, contamination and/or presence of foreign body, complete neurovascular exam

Question 9

Indicators for adhesive tapes or steristrips

Answer 9

Low tension, linear, superficial, areas where skin is thin and may not hold structures

Question 10

Contraindicators for adhesive tapes or steristrips

Answer 10

High tension wounds, wounds that require layered closure, wounds in high moisture areas

Question 11

Indications for tissue adhesive glues

Answer 11

Low tension, linear, superficial, <4cm in length

Question 12

Contraindications for tissue adhesive glues

Answer 12

High tension wounds, wounds that require layered closure

Question 13

Indications for staples

Answer 13

Scalp lacerations, linear laceration on trunk or extremities where cosmesis is not a priority

Question 14

Contraindications for staples

Answer 14

Gaping wounds requiring layered closure, wounds in areas where cosmesis is a high priority

Question 15

Indications for simple interrupted sutures

Answer 15

Clean wounds with little perceived risk of infection, wounds in areas where cosmesis is paramount, wounds over tendons or nerves which need some type of closure for protection

Question 16

Contraindications for simple interrupted sutures

Answer 16

Heavily contaminated wounds, wound with high risk of infection, non cosmetic animal bites, wounds with high risk of tissue destruction

Question 17

What is definition of an incision

Answer 17

Break in the skin caused by sharp object

Question 18

What is the definition of a laceration

Answer 18

Break in the skin caused by blunt force

Question 19

What is the definition of an abrasion

Answer 19

Superficial damage to the epidermis only

Question 20

What is the definition of a puncture

Answer 20

Depth of wound exceeds length or width

Question 21

What is usually used for anaesthetic for wound closure

Answer 21

1% lidocaine

Question 22

When is tetanus given

Answer 22

> 6 hours old at presentation, depth>length, containing devitilised tissue, possibly contaminated with soil or manure, showing clinical evidence of sepsis

Question 23

When is tetanus given

Answer 23

> 6 hours old at presentation, depth>length, containing devitilised tissue, possibly contaminated with soil or manure, showing clinical evidence of sepsis