5] Surgical Wounds Flashcards
(82 cards)
1
Q
Sutures are for
A
Small incisions
2
Q
Steristrips for?
A
Reinforcing subcutaneous skin closures
3
Q
Staples for
A
Large incisions
4
Q
Tissue adhesives for
A
Used in linear incisions or lacerations
5
Q
Suture removal in the face
A
3-5 days
6
Q
Suture removal in trunk, arms, legs, scalp
A
7 days
7
Q
Suture removal in hands, feet, over joints, back
A
10-14 days
8
Q
What do u document with sutures ?
A
Document # of sutures/staples removed andpatient tolerance to procedure
9
Q
Sutures should be removed before
A
epidermis
has migrated into
the deeper parts ofthe dermis
10
Q
Removal of necrotic tissue from a wound to improve or facilitate the healing process
A
Debridement
11
Q
Necrotic tissue is typically the result of
A
Poor blood supply
Prolonged inflammation
Bacterial damage
12
Q
Dead/necrotic tissue serves as a
A
inflammatory stimulus and a medium for bacterial growth
13
Q
Debridement should start when
A
Within 3 day of Dx
14
Q
If a patient has a systemic infection, debridement should start
A
Within 12 hours
15
Q
Systemic infection signs (5)
A
Increased temperature Leukocytosis Confusion Agitation Symptoms have no other identified cause
16
Q
Benefits of debridement (4)
A
Removal of bacteria
Stimulation of growth factors
Removes senescent cells
Removes hyperprolifeative, nonmigratory tissue
17
Q
May be yellow, green, gray or black
May be loose and stringy or thick and leathery
A
Necrotic tissue appearance
18
Q
2 main types of debridement
A
Selective and nonselective
19
Q
3 types of SELECTIVE debridement
A
Sharp/surgical
Enzymatic
Autolytic
20
Q
3 types of NONselective debridement
A
Mechanical
Wound irrigation
Hydrotherapy
21
Q
Use of scalpel, forceps, scissors, (by trainedPT, RN or PA) to remove dead tissue
A
Sharp/surgical debride
22
Q
Quickest method
A
Sharp debride
23
Q
Sharp/surgical debride always used when ?
A
signs of advancing cellulitis or sepsis
24
Q
Where can sharp/surgical debride be performed
A
Bedside or OR
25
Precautions of sharp debride (3)
Caution with sharp debridement if pt has
prolonged bleeding time (check PT, PTT,
INR)
Avoid aggressive debridement if wound does not have adequate blood supply to heal
Only physicians are licensed to cut healthy
tissue – do not attempt to deroof a tunnel or
sinus tract
26
Topical enzyme agents degrade necrotic tissue
Enzymatic debride
27
Enzymatic debride is a great option for
non-surgical candidates, pts in LTC, homecare
28
is often performed
| prior to application to increase surface area for contact
Cross-hatching/scoring eschar
29
Do not use enzymatic debride in conjunction with
Silver dressings
30
Examples: santyl, medihoney
Enzymatic Debridement
31
Uses the body’s own enzymes to break down necrotic tissue
Autolytic Debridement
32
Apply a moisture-retentive dressing; fluid
| accumulates which aids in the lysis/softening of necrotic tissue
Autolytic Debridement
33
What softens the tissues in autolytic debride?
Phagocytic cells and preotelytic enzymes; digested by macrophages
34
Slowest method of debride
Autolytic
35
Autolytic debride CANNOT be used with?
Infected wounds
36
Selectively debride
necrotic tissue
Secrete enzymes that breakdown proteins and digest
bacteria
Maggots
37
Maggots are applied when?
Every 2-3 days
38
Maggots are contra-indicated for
limb-threatening wounds,
psychological distress,
bleeding abnormalities,
deep-tracking wounds
39
Uses an external force to remove necrotictissue
Mechanical debride
40
What does non-selective mean?
Does not discriminate between viable and nonviable tissue
41
Mechanical debride may cause ? So you might have to do what for the pt?
May cause pain;
| Consider premedicating patient
42
Examples: wet to dry, water jet
Mechanical debride
43
Moving water dislodges loose debris; used for large wounds that need aggressive
cleaning/softening of necrotic tissue
Whirlpool
44
Whirlpool is contraindicated in
Granulating wounds b/c it might macerate the wound bed
45
Disadvantages of?
```
Periwound maceration
Trauma to wound bed
Waterborne infections
Cross-contamination
Dependent position may increase edema
Potential for burns
```
Whirlpool
46
Specialized equipment that provides pulsating irrigation, followed by suction; operates with the same principle as a carpet shampooer
Pulses lavage with suction
47
Disadvantages for Pulsed Lavage with Suction
```
risk of inhalation of
aerosolized particles (requires gown plus
eye/face protection); risk of driving organisms deeper into wound; may cause pain
```
48
Who can oNLY do sharp debride?
PTs
49
When do you NOT debride?
-Stable heel wounds with firmly adherent eschar
-Do not debride necrotic arterial wounds
-Do not debride in patients who are at risk for
bleeding (check PT, PTT, INR)
-Systemic infection
- Unidentified structures in wound bed
Dry gangrene
Debridement may be delayed in patients whoare critically ill, unstable or severely neutropenic, as long as it is not infected
50
Why not debride stable eschar onheels?
Less blood flow
Small amount of subcutaneous tissue over calcaneus
Highly susceptible to infection
Takes longer time to heal
51
Selective versus nonselective
Location, type and amount of necrosis present
Type and amount of necrotic tissue removed
Instruments used and settings used if
applicable
Documentation for debride
52
Most amputations are performed for
Ischemic disease of LE
53
Pathophys of amputations
```
PVD
Trauma
Tumor
Infection
Congenital limb deficiency
```
54
removes toe and corresponding metatarsal bone
Ray amputation
55
removes forefoot
Transmetatarsal amputation
56
cuts
| through ankle joint
Symes amputation
57
Complications with amputations (4)
Infection
Dehiscence
Excessive wear of prosthesis causing breakdown
Phantom limb pain
58
Post recovery ambulation rate for hip disarticulation
0-10%
59
Post Recovery Ambulation Rate for AKA
38-50%
60
Post Recovery Ambulation Rate for knee disarticulation
31%
61
Post Recovery Ambulation Rate for BKA
80%
62
```
Causes:
Violating lifting
precautions or excess
Wound infection
Tight sutures which cut off blood flow to
wound edges leading tonecrosis
Decreased skin
integrity
```
Dehiscence
63
What is dehiscence
Surgical complication where the wound ruptures along the incision
64
Sutures break, stretch or cutthrough tissue, knots slip,
suture too thin, insufficient
number of sutures
Dehiscence due to technical factors
65
Age >65, emergency operation,cancer, hemodynamic
instability, intra-abdominal
sepsis, wound infection,
hypoalbuminemia, obesity, use of steroids, heavy coughing,
ascites
Dehiscence due to patient Factors
66
Lacerations how do you fix it?
Irrigate/debride to remove debris
67
Abnormal opening between 2 epithelial surfaces
Fistula
68
External fistulas empty into?
The environment like skin
69
Internal fistulas empty into?
Other organs
70
Esophageal fistula
Clear or white output
71
Gastric fistula
Green output
72
Small bowel fistula
Light brown or tan output
73
Internal organ protrudes from the wound
Evisceration
74
If evisceration occurs, what do you do?
```
1- stay calm
2- keep it moist
3- keep pt NPO for immediate surgery
4- lower head of bed less than 20 deg
5- monitor vitals and assess for Signs/Sx of shock
```
75
Beta-hemolytic Streptococcus
| pyrogenes Develops following a breach in the mucous membranebarrier
Necrotizing fasciitis
76
Early signs of necrotizing fasciitis includes
Early signs include reddened,
| swollen, extremely painful area of cellulitis; fever
77
With progression of necrotizing fasciitis, dark red
| induration of epidermis and bullae filled with ? And then?
Blue/purple fluid and then As progression continues, skin becomes blue, maroon, or black
78
How does necfasc happen?
Bacteria make protein that destroys tissue directly
Toxins released
Immune system destroys healthy tissue in fight against bacteria
79
Diagnosed via tissue culture, ESR, WBC,ultrasound, CT scan
Nec fasc
80
Treatment for nec fasc
Treatment includes early, aggressive surgical
debridement and broad-spectrum IV antibiotics.
Wound is packed and kept moist; often requires daily debridement
81
This skin graft Includes the epidermis and part of the
dermis; more fragile; more
contraction; smoother/shinier; abnormally pigmented
Split thickness skin graft
82
This skin graft includes the epidermis and the entire
| dermis; better cosmesis; less contraction
Full thickness skin graft
