Surgery - Wounds & Wound Healing Flashcards

1
Q

What are the four stages of wound healing?

A

Haemostasis (immediate)
Inflammation (0-3 days)
Proliferation (3 days - 3wks)
Remodelling (3wks - 1yr)

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2
Q

Describe haemostasis

A

Platelets aggregate in response to exposed collagen
-release inflammatory markers
-activate clotting & complement cascade
Haemostasis achieved by vasospasm & thrombus formation

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3
Q

Describe inflammation

A

Vasodilatation & increased capillary permeability (oedema)
Neutrophils enter tissue –> debride & kill bacteria
Macrophages phagocytose debris & ensure fibroblast migration

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4
Q

Describe proliferation

A

Fibroblasts synthesise collagen
Myofibroblasts cause wound contraction
Angiogenesis is stumlated by hypoxia & cytokines
-creates granulation tissue

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5
Q

Describe remodelling

A

Re-orientation/maturation of collagen fibres

-increases wound strength

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6
Q

What is granulation tissue?

A

Combination of capillary loops/myofibroblasts

  • small, red foci that bleed easily (capillary loops)
  • commonly seen when scab picked
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7
Q

What is the purpose of granulation tissue in wound healing?

A

Capillary loops allow inflammatory cells to enter damaged tissue
-promote defence & healing

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8
Q

What are the signs of infected granulation tissue?

A

Painful discharging
Erythematous
Swollen
Systemic features

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9
Q

What is Epithelialisation?

A

Covering of denuded surface w/ epithelial tissue

-occurs from outer edges of wound after granulation

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10
Q

When does healing by primary intention take place?

A

When there is close apposition of clean wound edges

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11
Q

What are the stages of healing by primary intention?

A

Thrombosis in cut blood vessels prevents haematoma formation
Coagulated blood forms scab to keep wound clean
Fibrin forms weak framework b/w edges
-capillaries proliferate & secrete collagen
Elastic network of dermis cannot be replaced

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12
Q

When does healing by secondary intention take place?

A

When skin edges cannot be clearly opposed

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13
Q

What are the stages of healing by secondary intention?

A

Phagocytosis removes debris
Granulation tissue fills defect
Epithelial regeneration covers surface

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14
Q

Which form of healing results in greater loss of tissue?

A

Healing by secondary intention

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15
Q

What factors affect wound healing?

A
Age 
Diabetes
Nutrition
Smoking
HGH levels
Infection
Inflammatory condition (RA)
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16
Q

What are ‘tidy’ wounds?

A

Lacerations, abrasions, wounds w/ min skin loss

-can be closed primarily if <12hrs old

17
Q

What are ‘untidy’ wounds?

A

Wounds w/ marginal necrosis, crush injuries or tearing injuries w/ skin loss
-require wound excision w/ removal of debris/dead tissue

18
Q

When is delayed closure indicated?

A

Wounds >6hrs old OR

Heavily contaminated

19
Q

What is the procedure of delayed closure?

A

Dressed & inspected daily further from necrosis & inflammation
-closed at 48hrs/72hrs

20
Q

What are the potential complications of abdominal wound closure?

A

Dehiscence

Herniation

21
Q

What are the important components of abdominal wound closure?

A
Mass closure (midline incision)
   -continuous fascial closure w/ single suture
   -1cm bites 1cm apart
Layered closure (other abdo incision)
Remove sutures at 10 days
22
Q

What are the signs of inflammation in a wound/around a suture?

A
Calor (heat)
Rubor (erythema)
Tumour (swelling)
Dolor (pain)
Function laesa (loss of function)
23
Q

What are the management options for an infected surgical wound?

A
No treatment
Oral/IV antibiotics
Re-intervention on ward/in theatre
   -open
   -drain
   -debride
   -rinse &amp; pack wounds
Cultures