Exam 3 Wound Closure Flashcards Preview

Q4 EM Surg > Exam 3 Wound Closure > Flashcards

Flashcards in Exam 3 Wound Closure Deck (21):
1

Wounds closure general rules? (5)

Close anatomical layers
Approximate, don't strangulate
Use anatomical landmarks as guidelines
Eliminate dead space
Avoid tension across edges

2

Primary Wound Closure/Healing by 1st Intention done when?

How?

Best for?

Closed w/i 24 hrs of injury, before development of granulation tissue

Edges are directly approximated

Best for clean, fresh, well-vascularized wounds

3

Secondary Wound Closure/Healing by 2nd Intention is?

Best for?

Wound left open/allowed to close by epithelialization and contraction

Infected/contaminated wounds

4

Tertiary Wound Closure/Healing by 3rd Intention is?

Best for?

Delayed primary closure
U several days post injury

Previously contaminated wounds

5

Traumatic Wound management?

Cleanse surrounding skin
Remove hair
Epi for anesth/bleed control
Irrigation
Debridement

6

Use of betadine/ABX soap in wound care?

Keep away from exposed tissue/out of the wound

7

Do not use epi where?

Areas of P distal ischemia:
ears, digits, nose, penis

8

Leave wounds open when? (5)

Human bites
> 8 hrs post (except for face)
Inflammed/infected
Crushed or ischemic tissue
High, sustained steroid use

9

Scalp wound suture selection?

Skin = 4-0/5-0 microfil or staples
Deep = 4-0 absorb

10

Face wound suture selection?

Skin = 5-0 to 7-0 monofil
Deep = 5-0 absorb

11

Trunk/Extremity suture selection?

Skin = 4-0/5-0 monofil
Deep = 3-0/4-0 absorb

12

Hand suture selection?

Skin = 5-0 monofil
Deep = 5-0 absorb

13

Foot suture selection?

Skin = 3-0/4-0 monofil
Deep = 4-0 absorb

14

Benefits of interrupted sutures?

Drawbacks?

Good for all wound types
Partial removal possible if infection

Slow to place

15

Benefits of continuous sutures?

Drawbacks?

Good for clean wounds
Fast placement/removal

Infection compromises wound

16

Wound dressing for clean wounds stay in place how long?

48 hrs to allow epithelialization

17

Contaminated wounds dressed how?

Packed open
∆d Q 8-12 hrs

18

Wound healing: Early phase includes? (2)

Days 0-4

1) Hemostasis:
Vasoconst/clotting
Cell recrutiment

2) Inflammation:
Vasodilation
WBC/PMN migration to cleanse
Macrophages @ day 3 stim fibroblasts/collagen

19

Wound healing: Intermediate phase includes? (3)

Days 4-30

1) Epithelialization:
Reestablish barrier

2) Angiogenesis:
New capillaries

3) Fibroblasts:
Migrate/proliferate
Build matrix

20

Wound healing: Late phase includes? (3)

1) Matrix deposition:
Glycans/Hyaluronic acid framework for collagen

2) Collagen synth:
Builds CT along stress lines of scar

3) Wound contraction:
Closes edges during collagen synth
Lasts ~15 days

21

Wound healing: Final phase includes? (2)

Days 30 - 2 yrs

1) Scar remodeling/maturation:
Collagen continues to organize and becomes dense
Scar becomes avascular/acellular

2) Wound strength:
85% of strength @ 6 wks
90% @ 6 mo
Never reaches 100%