Flashcards in Chapter 7: Wounds and Wound Healing Deck (10):
A 37-year-old woman is being treated for a nonhealing elbow wound following excision of a benign nevus. She has been on home TPN for the past 18 months following resection of most of her small bowel due to mesenteric venous thrombosis. Laboratory evaluation reveals zinc deficiency. The most likely mechanism for her no-healing wound is:
Decreased fibroblast proliferation, decreased collagen synthesis, and impaired overall wound strength.
i. Vitamin K: 2,7,9,10 carboxylation of glutamate; syn of clotting factors can lead to hematoma
formation and alatered wound healing.
ii. Vitamin A: increases inflam response, increases collagen syn, and increases influx of macs into
iii. Mg is required for protein syn.
iv. Zinc is cofactor for RNA and DNA polymerase.
v. Lack of any one of these vitamins or trace elements will adversely affect wound healing.
A 75-year-old man who resides in a nursing home because of progressive dementia and hemiplegia becomes febrile and is found to have a sacral desubitus ulcer. The base of the wound is gray and covered with and exudate. The wound edges are erythematous. What is the most effective next step to reduce the bacterial load in this wound?
Debride necrotic tissue from the wound
A 39-year-old woman presents because of a nodule at an incision site. She underwent a cesarean section approximately 5 months ago. On examination she has healed Pfannenstiel incision with a 1.5 cm firm nodule in the center of the incisions. The nodule is excised microscopically reveals a granuloma with giant cell formation with polarize refractive material. The most likely diagnosis is:
A 37-year-old man comes to clinic two weeks following an elective inguinal hernia repair. He has minimal pain controlled with ibuprofen. The incision, which was closed with an absorbable suture, appears to be healing normally. There is minimal swelling and no erythema or ecchymosis. A biopsy of the wound at this time would likely reveal:
Predominantly collagen with scarce inflammatory cells
A 64-year-old man comes to the office for a routine 3-month follow-up after elective open colon resection for a primary ademocarcinoma of the cecum, T2N0M0. He has noted a slight amount of drainage from his incision site for some time, otherwise he has had an unremarkable postoperative course. On physical examination there is a small, ulcerated nodule on his midline incision, which is draining serious fluid. What should be performed?
Excision of the lesion and tract with pathologic analysis
A 67-year-old man has been under your care for chronic leg ulcer. His wound has been progressing nicely, but over the last few weeks you notive a significant thickenin and overturning of the wound edge. The appropriate intervention at this point should be to:
Biopsy of the wound edges*
A 27-year-old man comes to clinic with a recurrent umbilical hernia three months after initial repair. His BMI is 26. His diet is high in dairy, breads, and meats and he rarely eats fruits or vegetables. A complete blood count is normal. Before attempting repair of the recurrent hernia, supplementation of which of the following should be started and maintained after surgery?
A 75-year-old man is scheduled to undergo left inguinal hernia repair with local anesthesia, and sedation. He has a history of hypertension treated with hydrochlorothiazide and lisionpril. He weighs 60 kg. There is a reducible left inguinal hernia. What is the safest maximum volume of 1% lidocaine that can be used for local anesthesia in this man?
40 mL???????? (10,20,30,40,50mL choices)
i. Rule of safest volume:
1. Xylocaine (lidocaine): 4.5 mg/kg (350mg) (7mg/kg w/ epi—500mg)
2. Bupivacaine 2.5mg/kg (175mg) (3.5 mg/kg w/ epi)—225 mg)
ii. 1% = 10mg/mL
1. 2% is 2g/100mL or 2000mg/100mL 20mg/mL
A 61-year-old male is in the recovery room following elective colon resection for colon cancer. This surgery lasted two hours and there was minimal blood loss and intraoperative contamination. Cefoxitin was administered 30 minutes prior to incision. What is the most appropriate postoperative antibiotic regimen for this patient?
There is no need for antibiotics