Flashcards in Surgical Wounds, Trauma Wounds and Debridement Deck (68)
What are the Langer's Lines?
Lines surgical incisions should follow the natural skin direction
Classify a clean wound
Wounds made under aseptic surgical conditions, that do not enter the genitourinary, respiratory or alimentary tracts or oropharyngeal cavity.
Classify a clean contaminated wound
Wounds are contaminated by the resident flora or the cavities but there is no host reaction
Classify a contaminated wound
Contaminated by bacteria with no host reaction
Classify an infected wound
Clinical signs of infection present, with increase leukocyte and macrophage levels
What is primary intention?
Wound healing in which the edges are bought together by sutures, staples or glue.
What is delayed primary intention?
The would is left open for treatment with untied sutures insitu until deemed clean, in which it is then closed
What is secondary intention?
The would is left open to heal spontaneously with out mechanical intervention
Name the primary suture techniques
Simple square interrupted
Why are tension sutures used?
To provide additional support by inserting sutures into deeper layers
What are the principles for wound healing by primary intention?
1) Protect from physical and pathological assult
2) Absorb exudate
3) Maintain wound and body temperature
5) Avoid stress (analgesia)
6) Observe the suture line for complications
What are the indications for a drainage tube?
1) Abscessed cavity - prevent premature closure
2)Insecure intra-abdominal wound - compromised healing
3) Anticipated exudate - tissues that contain secretory glands
4) Risk of peritonitis - bowel, gastric and biliary
5) Extensive dissection
6) Traumatic Injury
Name three types of drains
1) Capillary Wicking
2) Negative pressure suction devices
What are the indications for percutaneous tubes
Gastrostomy - feeding or decompression
Jejunostomy - Feeding
Nephrostomy - Draining urine
Suprapubic Catheter - Draining urine
Biliary - Draining bile
Identify three primary aspects of peri-tubular skin care
1) Keep skin dry and clean
2) Peri-tubular leakage indicated french gauge is too small
3) Hypergranulation around tube indicates tube friction
What are the principles of drain management?
Client support and education
Maintain skin integrity
Observe type & amount of exudate
Observe for complications (discomfort, infection, dislodgement, blockage, loss of suction for VAC)
What are the primary surgical complications?
Occulsion of blood supply - necrosis
Seperation of a sutured would resulting in a cavity that requires either a second attempt at primary intention or will heal by secondary intention
What causes dehisence?
What is a fistula?
An abnormal track connecting one viscus to another viscus or to the skin
What causes a fistula?
1)Leaking surgical anastomosis
2)Spontaneous rupture due to obstruction, disease, trauma, radiotherapy damage
3) Mesenteric ischaemia
4) Sepsis - diverticulitis and appendicitis
What are examples of an internal fistula?
What are examples of an external fistula?
What are the principles of fistual management?
1) Patient comfort and support
2) Fluid and electrolyte replacement
3) Nutritional assessment & supplementation
4) Prevention and management of infection
5) Maintenance of skin integrity
6) Containment of effluent & odur
7) Cost effective care
What medication management is involved with a fistula?
Re-feeding via a distal fistula
A spontaneous rupture of the abdominal suture line and intestines protrude through the opening
4 types of abberant healing
3) Hypertrophic Scar
4) Keloid Scar
Define hyper grannulation
Raised granulation tissue above the level of the surrounding skin which commonly occurs as a result of friction, increased bacterial burden or infection