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Surgery and wound healing (MOD) > Basic wound management > Flashcards

Basic wound management Flashcards

1
Q

What are the 3 phases of wound healing (some overlap)?

A

Lag or inflammatory phase
Repair phase
Remodelling

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2
Q

What 3 components make up the repair phase of wound healing?

A

Connective tissue repair
Wound contraction
Epithelialisation

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3
Q

What local factors affect wound healing?

A 
Wound perfusion 
Tissue viability - trauma, dehydration
Fluid accumulation - haematoma, seroma
Infection 
Mechanical factors - tension, motion, pressure
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4
Q

What systemic factors affect wound healing?

A

Impaired immune function - systemic disease, glucocorticoids

Neoplasia

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5
Q

What 3 factors are used to classify wounds?

A

Degree of contamination
Aetiology
Location

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6
Q

What are the degrees of classification for a wound?

A

Clean (no break in asepsis)
Clean-contaminated (minor break in asepsis)
Contaminated (major break in asepsis)
Dirty (abscess, foreign material, old traumatic wounds)

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7
Q

Give examples of wound aetiologies

A 
Abrasion 
Avulsion 
Degloving injury 
Incision 
Laceration 
Puncture wound 
Burn
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8
Q

What is an avulsion wound?

A

Wound involving partial/complete tearing away of skin

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9
Q

What is a degloving injury?

A

Type of avulsion - extensive section of tissue torn away, severing its blood supply

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10
Q

What is the difference between an incision and a laceration?

A

Incision - sharp force trauma

Laceration - blunt force trauma

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11
Q

What are the two types of wound management?

A

Closed management

Open management

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12
Q

What is surgical debridement?

A

Surgical removal of dead/damaged/infected tissue

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13
Q

What is the purpose of surgical debridement? What should it be followed with?

A

To improve the healing of the remaining healthy tissue

Lavage

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14
Q

What is the purpose of wound lavage/irrigation?

A

Remove debris
Decrease number of bacteria
Prevent further contamination

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15
Q

A surgical drain may be required for wound closure. What is a surgical drain?

A

Tube placed during surgery to allow drainage of pus/blood/fluid

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16
Q

What are the layers of dressing?

A

Contact
Padding
Conforming
Cohesive

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17
Q

Are adherent or non-adherent dressings used for the contact layer?

A

Non-adherent

Adherent = slow healing, no longer meet stand of care

18
Q

Give examples of non-adherent dressings that can be used for the contact layer

A 
Calcium alginate
Fenestrated polyester dressing
Hydrocellular foam dressings
Hydrocolloid dressings
Polethylene/polyurethane film 
Petrolatum-impregnated gauze
Hyperosmoar agents
Maggots
Silver dressings
19
Q

How can maggots be used to aid wound healing? What species is used?

A

Used for wound debridement

Lucilia sericata maggots

20
Q

How does calcium alginate work as a non-adherent dressing?

A

Absorbs exudate and water on wound surface

Forms gel that doesn’t adhere to wound

21
Q

Calcium alginate is extremely absorbent and can be used as a non-adherent dressing. How long can it be left in place?

A

7 days

If non-infected

22
Q

When are fenestrated polyester dressings mainly used?

A

For protecting wounds with an intact surface e.g. primarily closed surgical wounds
Polyester film stops adherence

23
Q

Hydrocellular foam dressings are often used for what types of wounds?

A

Open wounds

Especially ulcers

24
Q

What are hydrocolloid dressings mainly composed of? How do they work?

A

Cellulose

Forms gel as absorbs moisture - barrier to bacteria

25
Q

Polyethylene/polyurethane film dressings are used for what types of wounds?

A

Wounds with an intact surface

Left on for longer than an absorbent dressing

26
Q

What are the disadvantages of petrolatum-impregnated gauze as a contact layer?

A

May slow epitheliasagtion

Not used for wounds in late stages of repair

27
Q

When may petrolatum-impregnated gauze be used as a contact layer?

A

To protect wounds with an intact surface, but fragile epidermis

28
Q

Give an example of hyperosmolar agent used as a contact layer

A

Manuka honey

29
Q

How can hyperosmolar agents (honey) be useful for contact layers of a wound?

A

Dehydrates bacteria

Inhibits their growth

30
Q

What are the benefits having silver dressings as a contact layer?

A

Silver has direct antibacterial effect

31
Q

What is the purpose of the secondary (intermediate) layer of a wound dressing?

A

Draw XS fluids away from wound
Obliterate dead space by providing pressure
Protecting the wound by padding/supporting/imbolising

32
Q

What may be included in the secondary layer of a wound dressing?

A

Splint

33
Q

What is the purpose of the tertiary (outer) layer of a wound dressing?

A

Secure rest of bandage in place

Provide some pressure and support

34
Q

What happens if the tertiary (outer layer) of a wound dressing is too loose?

A

Wound may slip and lose contact with the primary/contact layer

35
Q

What happens if the tertiary (outer layer) of a wound dressing is too tight?

A

Compromises circulation

Causes venous congestion

36
Q

What materials are most commonly used for a tertiary outer layer of a wound dressing?

A

Gauze bandage covered with Vetrap

37
Q

What is the appropriate management technique for clean or clean contaminated wounds?

A

Primary closure

Immediate sutures without tension

38
Q

What is the appropriate management technique for contaminated wounds?

A

Delayed primary closure
Close 1-5 days after injury, before granulation
Lavage and debride daily whilst open

39
Q

What is the appropriate management technique for a contaminated to dirty wound?

A

Secondary closure
Close >5 days post injury after granulation. Excise wound edge/granulation tissue margin and epithelialise skin edges, then close

40
Q

What is the appropriate management technique for a wound unsuitable for closure (large skin deficits)?

A

Second intention healing

No closure - heal by granulation, epithelialisation and contraction

Surgery and wound healing (MOD) (4 decks)

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