SOFT TISSUE SX: wound management

Question 1

what are the 3 phases of wound healing

Answer 1

1- inflammation
[inflammatory and debridement phase]
2-proliferation
3-maturation

Question 2

Sutures are removed during which phase of the wound healing process?

Answer 2

phase 2-proliferation

Question 3

Which phase has the most gain in wound strength?

Answer 3

maturation

Question 4

What are 3 characteristics of the inflammatory phase?

Answer 4

hemorrhage & clot formation ,,,,increase blood flow ,,,,,start to control bacterial infection

Question 5

Which 2 types of cells will become present during the inflammatory phase?
What are their functions?

Answer 5

neutrophils [phagcytose bacteria & die]

macrophages [phagocytose debris, produce proteases, release cytokines]

Question 6

What are 2 characteristics of the proliferative phase?

Answer 6

granulation tissue formation &
epithelialisation

Question 7

Describe the difference between healthy and unhealthy granulation tissue

Answer 7

H: resistant to infection, red, moist, flat, nutrient and oxygen supply, lattice for scar formation

UH: pale, not progressing, necrotic debris or infection

Question 8

What are a 5 factors that promote epithelialisation?

Answer 8

healthy granulation bed
absence of infection
‘’ ‘’ necrotic debris
oxygen at wound surface (vessels)
moist wound

Question 9

What are 2 characteristics of the maturation phase?

Answer 9

scar contraction and collagen remodelling

Question 10

What are the two types of factors affecting wound healing

give 5 examples of each

Answer 10

host factors:
-old age
-hypoalbuminemia
-endocrine disorders
-metabolic disease
-medication

local factors:
-foreign material
-infection
-trauma
-desiccation
-hypoxia

Question 11

What are the 4 types of wound closure options available

briefly describe the differences in closures and when they wound be used

Answer 11

primary [immediate surgical closure of healthy wounds]

delayed primary [moderate tissue trauma by dirty objects, closure after bacteria and debris is eliminated but before granulation starts]

secondary [closure once granulation tissue has formed]

second intention [inflammation –>proliferation –>maturation]

Question 12

What are the 3 steps to open wound management?

Answer 12

1. initial assessment n preparation
2. debridement
3. granulation

Question 13

What are techniques to assist with initial assesment and preperation?

Answer 13

-prevent further contamination (asepsis, sterile dressing, clip widely)
-lavage to remove contaminants

Question 14

Describe debridemment and devitalised tissue

Answer 14

-sharp dissection/ scraping with blade/ rubbing with dry swab for compromised tissue
-devitalised tissue: white, green, black, does not bleed when nicked

Question 15

How often is dressing changed during debridement?

Answer 15

every 12-24 hours/before dressing is satirated

Question 16

When should dressing be changed to non-adherent?

Answer 16

when all necrotic tissue is removed, exudate remains, and granulation starts

Question 17

What is autolytic debridement?

Answer 17

Question 18

What type of wound dressing is used during the granulation phase?

Answer 18

non-adherent dressing
ex-hydrocellular foam dressing

Question 19

What is the major aim of the granulation phase?

Answer 19

achieve moist wound environment

Question 20

What are some benifits of using hydrogel in wound care?

Answer 20

fits irregular wounds well and prevents adherence of a second layer

Question 21

What are some characteristics of healthy granulation tissue?

Answer 21

-red
-uniform
-minimal exudate
-progressing daily
-no significant bacterial infection
-good blood supply
-no devitalised tissue
-no foreign material

Question 22

What are the 3 layers of bandages and their functions?

Answer 22

1. primary (contact) layer
2. intermediary layer [holds contact layer in place, absorb exudate, padding, support, analgesia]
3. tertiary layer [conforming/cohesive, apply pressure, protect from environmental contamination]

Question 23

Are antibiotics indicated in traumatic/open wounds?

Answer 23

yes

Question 24

What are two examples of topical antimicrobials in wound care?

Answer 24

-silver dressings
-honey dressings

Question 25

Answer 25

`

Question 26

Answer 26

Question 27

name 7 halstead principals

Answer 27

1 strict aseptic technique 2gentle tissue handling 3meticulous haemostatis 4 preservation of blood supply 5obliteration of dead space 6 accurate apposition of tissue 7minimise tension

Question 28

What are stay sutures?

Answer 28

temporary sutures used to manipulate tissue during an operation

Question 29

How should the panniculus be treated in order to preserve blood supply?

Answer 29

if panniculus is present: create it as a flap and move to the side, dissect below [panniculus has blood supply, you want it to be intact] if panniculus is absent: continue dissection as normal

Question 30

What are some techniques to reduce tension in a wounds?

Answer 30

-distribute tension evenly through all wound layers -follow tension lines -tension relieving suture patterns -reconstructive techniques (flaps/grafts)

Question 31

What is the primary tension holding layer of the wound?

Answer 31

subcutaneous

Question 32

Should wounds be closed parallel or perpendicular to tension lines?

Answer 32

parallel

Question 33

What is undermining? What is an advantage and disadvantage of undermining?

Answer 33

undermining seperates dermal layer from below connective layers advantage: tension relief disadvantage: increases dead space

Question 34

What are walking sutures?

Answer 34

absorbable, simple interrupted sutures that distribute tension throughout wound

Question 35

What is the name of this type of tension relieving sutures

Answer 35

mattress sutures

Question 36

What is the name of this type of tension relieving sutures

Answer 36

relaxing incisions

Question 37

What is the name of this wound closing defect?

Answer 37

dog ears

Question 38

What is the name of this wound closure irregular defect?

Answer 38

centripetal closure/geometric wound closure

Question 39

What are two types of pedicle flaps?

Answer 39

Question 40

Decribe the two types of pedicle flaps and their difference?

Answer 40

axial pattern flaps: uses a direct cutaneous vessel

Question 41

What are some advantages and disadvantages of a free skin graft?

Answer 41

advantages: applicable to distal extremity disadvantages: no vascular supply, expensive, healthy granulation bed required, must develop blood supply form wound bed, intolerant of movement