Final

Question 1

Expected complications of surgery

Answer 1

Inflammation
Edema
Stretching
Dehiscence
Increased risk of infxn
Scarring

Question 2

Keloid scar

Answer 2

Develops outside of normal incision site

More common when incisions are made across Langer’s lines

Question 3

Hypertrophic scar

Answer 3

Stays within incision site but grows bigger within the site

Question 4

Abscess scalpel type

Answer 4

11

Question 5

Shave biopsy scalpel type

Answer 5

10 or a derma blade

Question 6

What is the tension at a wound 10-14 days after a closure?

Answer 6

5-6% of strength

Question 7

What is the tension at a wound 1 month after closure?

Answer 7

30-40% of strength

Question 8

When do you use 1/100,000 epi?

Answer 8

Typical procedures

Question 9

When do you use 1/10,000 epi?

Answer 9

Anaphylaxis IV

Question 10

When do you use 1/1000 epi?

Answer 10

IM

Question 11

How much epi do you inject?

Answer 11

0.3 cc

Question 12

Why do we perform corner stitches?

Answer 12

Decreases the chance of compromising circulation

Question 13

What is in biopsy containers to preserve the sample?

Answer 13

10% formalin

Question 14

Use horizontal and vertical mattress sutures when..

Answer 14

elliptical removal with a lot of tension

Question 15

Why do we use langers lines?

Answer 15

• reduces scarring
• reduces tension
• improves healing time

Question 16

Delayed closure time frame

Answer 16

4 days or 96 hours if there are no signs of infxn

Question 17

Laner’s lines

Answer 17

correspond to natural orientation of collagen fibers in the dermis and parallel to the orientation of the underlying muscle fibers

Question 18

Three phases of healing

Answer 18

1. inflammatory: immediate-2-5 days. bleeding stops. inflammation.
2. proliferative: 5 days-3 weeks. granulation. contraction. epithelialization.
3. maturation: 3 weeks-2 years. collagen forms which increases tensile strength to wounds.

Question 19

Four groups of wounds

Answer 19

1. clean
2. clean-contaminated
3. contaminated
4. dirty and infected

Question 20

Primary (first) intention

Answer 20

• Start with a clean wound
• Close promptly
• produce minimal edema
• have no local infxn
• have no serious discharge
• heal in a minimum of time
• heal w/ good skin edge approximation and eversion
• heal with minimal scar formation

Question 21

2 scenarios of secondary intention

Answer 21

1. wound hails to heal via primary intention due to excessive tissue trauma and/or loss, imprecise approximation of tissues
2. wound is left open on purpose (a “paper cut”, abrasion or draining and abscess). Wound allowed to heal w/o closure, heals from inner layers towards the surface (“granulation from below”)

Question 22

Pros of secondary intention

Answer 22

simple

relatively low risk of infxn

Question 23

Cons of secondary intention

Answer 23

• may take a long time to heal

- tends to cause larger scars

Question 24

What size sutures for hand wounds?

Answer 24

4-0 or 5-0

Question 25

Third intention (delayed primary closure)

Answer 25

1. debride wound of non-vital tissues 2. leave wound open 3. pack wound w/ a sterile dressing 4. cover with a supporting bandage: REPEAT DAILY 5. healing "open" wound gradually gains sufficient resistance to infxn and granulation tissue covers the raw edges 6. when health granulation tissue develops, usu in 4-6 days, draw the granulated surfaces together 7. carefully approximate skin edges and underlying tissues w/ sutures as accurately as possible

Question 26

Tx of choice for most abcesses

Answer 26

Incision and drainage

Question 27

Excision

Answer 27

any removal of tissue by cutting the entire lesion out/off

Question 28

Wound care overview

Answer 28

1. assess for wound contamination and tissue damage 2. check flexion/extension of all joints against resistance for underlying nerve and tendon damage 3. R/O fractures 4. In relatively "clean" wounds: first inject anesthesia with a 25-27 g needle from inside of wound outward just under the skin 5. In "contaminated" wounds clean skin first 6. then inject anesthesia in fan like pattern through skin surface around laceration 7. REMEMBER: no anesthetics w/ epinephrine in areas of limited blood supply 8. clean and debride as nedded 9. culture if risk of inxn 10. carefully close wound & bandage appropriately: apply minor surgery tincture, antibiotic or vaseline

Question 29

Suture removal time: face

Answer 29

3-5 days

Question 30

Suture removal time: scalp

Answer 30

5-7 days

Question 31

Suture removal time: extremity (low tension)

Answer 31

6-10 days

Question 32

Suture removal time: extremity (high tension)

Answer 32

10-14 days

Question 33

Suture removal time: abdomen

Answer 33

6-12 days

Question 34

Suture removal time: chest and back

Answer 34

6-12 days

Question 35

Complications of wound healing

Answer 35

1. ecchymoses 2. hematomas 3. seromas 4. infxn 5. wound dehiscence 6. bad scarring 7. loss of function