Physiology of Injury and Wound Healing

Question 1

Dehiscence

Answer 1

partial or total separation of a layer of tissue after closure

5-10th postop day

excessive tension

wrong suture/bad technique

coughing, vomiting, straining

Question 2

Intraop tissue handling

Answer 2

length + duration

dissection technique

duration of surgery

amount

hemostasis

precise approximation

elimination of dead space

secure closure

Question 3

Class 1 wound

Answer 3

clean

infection rate 1-5%

primary closure

ideal conditions/no break in asepsis

no drain

no entry to GU/aerodigestive tracts

no inflammation

Question 4

When is a wound considered contaminated?

Answer 4

4-6 hours old

Question 5

Cardinal signs of inflammation

Answer 5

pain

heat

redness

swelling

loss of function

Question 6

How should tissue be handled

Answer 6

as little time

as gently as possible

Question 7

Process of inflammation

Answer 7

response mechanism to destroy invading organisms, dilute toxins, wall off injury

occurs when injured tissue releases histamine

Question 8

Histamine

Answer 8

small blood vessels dilate

increase blood flow

heat, redness, swelling

Question 9

Fistula

Answer 9

tract between two epithelium lines surfaces

open at 2 ends

Question 10

Adhesion

Answer 10

abnormal attachment of surfaces or structures

pain/bowel obstruction

previous surgery, infection, foreign body

Question 11

First intention

Answer 11

primary union

class 1

heals side to side in sterile wound

no dead space

proper approximation

proper suturing

Question 12

First intention phase 2

Answer 12

proliferation phase

3rd postop day-20 days

fibroblasts multiply/bridge edges

fibroblasts secrete collagen that forms fibers

Question 13

First intention phase 3

Answer 13

maturation/differentiation phase

14th postop day-12 months

wound contracts from myofibroblasts

collagen density increases

formation of new blood cells decreases

cicatrix