76: Post-Op Dresssings - Yoho Flashcards Preview

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Flashcards in 76: Post-Op Dresssings - Yoho Deck (4)
1

bandage scissors (not the black ones)

  • always use the proper tool for the job
  • Other materials:
    • non-adherent mesh
      • lay over wound, put sterile gauze on top of this
      • helps get the dressing off
    • sterile gauze
    • gauze roll
    • paper tape
      • may choose this if person has allergies to adhesives
    • ace/elastic badage
    • bandage scissors

2

purpose of dressings

  • keep the area clean (infection control)
    • takes 3 days for epithelization
      • plastic surgery will take out sutures at 3 days
    • need to achieve 30% tensile strength (keep sutures in until then)
      • keep in 10-14 days (really 17 days - dont keep them in that long )
      • afterwards we apply steristrips (holds the epidermis together)
  • maintain the correction (alignment)
    • no additional correction
  • compression (swelling reduction)
    • reduce swelling
  • absorb bleeding, etc.

3

notes from the video

(rewatch online)

  • purpose: to maintain the correction, but can undo the correction if done incorrect
  • make curved incisions rather than linear to reduce contraction and make it closer to relaxed skin tension lines
    • make hatch lines, match them up in suturing to ensure proper alignment
  • Bunion Post-op
    • adaptic down first
    • 4X4 gauze, make a cut into 1/3 and 2/3 to wrap around toe. add additonal gauze dorsally
    • roll bandage around forefoot medial to lateral, keeping scissors in hand, half wrap around toe
    • plantarflex, invert and adduct at MPJ to hold toe straight
    • tape to hold down, stockinette over it all, can add ACE bandage
    • remove with scissors from plantar side
    • dressing change 3-4 days, then at a week sutures out and new dressing with steri strips
  • Taylor's bunion Post-op
    • 3x3 guaze, cut through 3/4 way for toe wrap. add another gauze dorsally
    • 3 inch cling starting lateral to medial, half wrap around toe, tuck up toe near 4th with wrap
    • tape finish, stockinette, add ACE bandage
    • if putting tape on skin, use paper tape
    • remove with scissors plantarlly
  • Hammertoe Post-Op dressing
    • unroll and fold a 4 x 4 in half, wrap around toe with free edges medial and lateral
    • add gauze dorsally
    • 3 in cling starting dorsally medial -> plantar -> lateral
    • half wrap around each affected toe
    • reverse direction of taping to balance forces on toes, going around each again
    • remove dressing along medial side of foot
  • P&A post-Op
    • total nail = need adaptic, partial does not
    • 2in or 1 inch
    • wrap medial to lateral (for lateral nail removal), reverse for removal on other side of nail. trying to allow good drainage. doesn't matter direction if total  nail removal
    • small coban to hold, toe sock, coban wrap again in good direction

4

complications from dressings

  • vascular compromise
    • too tight dressing
    • can lead to dehiscence
  • cause alignment problems
  • wound dehiscence
    • influenced by the dependent position of the foot increasing tension on sutures
  • increased inflammatory response
    • if its too tight

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