Wound closure and healing Flashcards
(99 cards)
1
Q
Wounds are designated as what 2 things?
A
- intentional or
2. unintentional
2
Q
What can unintentional wounds be?
A
- incidental
- traumatic
- chronic
3
Q
What is the classification of an intentional wound type?
A
surgical
4
Q
What is an example of an intentional wound type?
A
an incision made into intact tissue
5
Q
What are classifications of a traumatic wound type?
A
- open or closed
- simple or complicated
- clean or contaminated
6
Q
What do traumatic intentional wounds include?
A
both life-threatening and less serious injuries
7
Q
What is an example of an incidental intentional wound?
A
pressure-related injury caused by compromised circulation as a direct result of inadequate or inappropriate surgical positioning
8
Q
What is an example of a chronic intentional wound?
A
chronic pressure injury as a result of tissue loss from arterial insufficiency or venous stasis
9
Q
What does suture mean?
A
to stitch together
10
Q
what does ligate mean?
A
to tie off a blood vessel to prevent or stop bleeding
11
Q
What is ligation also used for?
A
to tie off the base of a tissue mass
12
Q
What are the material classifications for suture?
A
- natural or synthetic
- absorbable or non-absorbable
- single strand (monofilament) or several strands (multifilament)
13
Q
What do non-absorbable sutures resist?
A
enzymatic activity
14
Q
How does the body protect a non-absorbable suture?
A
the body’s inflammatory response to a foreign body walls off the suture, protecting it from being broken down
15
Q
What is a class 1 non-absorbable suture?
A
- silk or synthetic
2. monofilament
16
Q
What does a class 1 non-absorbable suture look like?
A
twisted or braided
17
Q
What is a class 2 non-absorbable suture?
A
- natural or synthetic fibers
2. monofilament or multifilament
18
Q
What does a class 2 non-absorbable suture look like?
A
twisted or braided
19
Q
What can a class 2 non-absorbable suture be?
A
coated
20
Q
What does coating do for class 2 non-absorbable sutures?
A
- reduces friction when passing through tissues
2. coating affects thickness but not tensile strength of suture
21
Q
What is a class 3 non-absorbable suture?
A
monofilament or multifilament metal wire
22
Q
What are the uses for non-absorbable suture?
A
provides long-term tissue support
23
Q
What are examples of places non-absorbable suture would be used?
A
- fascia
- tendons
- abdominal wall
24
Q
How are absorbable sutures assimilated into the body?
A
by tissues through the health process through…
- digestion via enzyme activity OR
- hydrolysis from a chemical reaction with tissue fluids
25
What are absorption times for absorbable sutures?
depends, vary with the suture
26
What do absorbable sutures look like?
monofilament or braided
27
What are the 2 possible compositions of absorbable sutures?
1. surgical gut
| 2. synthetic
28
what is surgical gut absorbable suture?
made from collagen derived from healthy mammals
29
What are the 2 uses of absorbable sutures?
1. deep tissues
| 2. tissues that heal rapidly
30
What are 4 examples of absorbable suture uses?
1. bowel anastomosis
2. urinary tract
3. biliary tracts
4. small vessel ligation
31
What are 2 types of configuration?
1. monofilament
| 2. multifilament
32
What is a monofilament configuration?
single-stranded
33
What is a multifilament suture configuration?
composed of several strands of suture material that are manufactured into a single strand by being braided or twisted
34
define capillarity
the capability of fluid that is absorbed by the suture to be transferred along the length of the suture
35
Explain suture size?
the suture size decreases as the zeros expressing the size increase (3-0 is smaller than 2-0)
36
what is the measurement of the suture's ability to recover its primary form and length after stretching or other deformation?
elasticity
37
what is the measure of the suture strand's capability to be stretched, tied, or otherwise misshapen from its original form without breaking?
plasticity
38
What is the inherent capability of the suture to keep or return to its original packaging shape after being stretched or tied?
memory
39
What do handling characteristics describe?
a suture's bending ability and how easily a suture can move through tissue and be tied down
40
What are the 4 handling characteristics?
1. pliability
2. tissue drag
3. knot tying
4. knot slippage
41
define pliability
how easily the suture bends
42
what does tissue drag address?
how easily the suture slips through the tissue
43
define knot tying
how easily can a particular suture be tied
44
define knot slippage
the ability of the knots to be slid down the suture
45
What are the 4 types of tissue reactions?
1. inflammation
2. absorption
3. infection potential
4. allergic reaction
46
```
What is the
a. characteristics
b. tensile strength
c. handling knot security
d. absorption rate
of cat gut?
```
a. absorbable monofilament
b. poor
c. good handling. poor knot security.
d. rapid variable rate within 2-14 days
47
```
What is the
a. characteristics
b. tensile strength
c. handling knot security
d. absorption rate
of monocryl/caprosyn?
```
a. absorbable monofilament
b. high
c. excellent
d. rapid within 14 days
48
```
What is the
a. characteristics
b. tensile strength
c. handling knot security
d. absorption rate
of vicryl/polysorb/dexon?
```
a. absorbable braided
b. moderate
c. excellent handling. moderate knot security
d. medium. about 3-4 weeks
49
```
What is the
a. characteristics
b. tensile strength
c. handling knot security
d. absorption rate
of PDS/biosyn/maxon?
```
a. absorbable monofilament
b. high
c. poor overall
d. slow. at least 6 weeks
50
```
What is the
a. characteristics
b. tensile strength
c. handling knot security
d. absorption rate
of nylon/prolene?
```
a. non-aborbable monofilament
b. high
c. poor
d. NA
51
Identify each component of this phrase: "I'll take a 5-0 prolene on a p-3."
1. 5-0: suture size
2. Prolene: suture type
3. P-3: Needle
52
What are the 3 parts of a surgical needle?
1. swage
2. body
3. point
53
describe swage
suture embedded into the end of a needle
54
describe body
round, rectangular, or flat
55
describe point
cutting, tapered, or blunt
56
What are the 2 types of threaded needles?
1. eyed
| 2. spring or French-eyed
57
What is the disadvantage of a threaded needle?
they have two suture strands rather than 1
58
what are interrupted stitch types?
single sutures, tied independently
59
what is an uninterrupted suture type?
continuous or running
60
what is a retention suture type?
heavy suture reinforcing the primary suture line
61
what is a subcuticular suture type?
suture under the epidermis
62
what is a purse-string suture type?
suture around a circular wound
63
What are the 4 other skin closure options?
1. skin staples
2. skin adhesives
3. adhesive tape strips
4. zipper closures
64
what is a terminal-end stapler used for?
used to close the end of the colon after the side-to-end anastomosis of the sigmoid and rectum has been completed
65
what is an end-to-end stapler used for?
used in a multi-step procedure with the end-result of achieving an internal anastomosis of hollow organ space
66
what is an internal anastomosis stapler used for?
used for side-to-bowel anastomosis
67
What are the advantages of staples?
o Easy to use
o Provides uniform incisional tension
o Faster wound closure
68
what is the 1 disadvantage of staples?
Require extraction, unless staples are absorbable
69
What are the advantages of adhesives?
1. reduced risk of infection
2. less scarring
3. eliminates skin closure device removal
70
What are the 3 disadvantages of adhesives?
1. limited to use of superficial wounds
2. higher allergic reaction rate
3. not optimal for slow healing health conditions
71
What are the advantage of wound closure/adhesive strips?
1. less expensive than other skin closure methods
72
What is the disadvantage of wound closure/adhesive strips
can lessen with moisture, causing wound compromise
73
What are the advantages of zippers?
o Skin stretching forces are distributed over a wide surface area , away from the wound edges
oMay replace the need for a tissue expander
o Faster application than suturing
o May provide a more cosmetic outcome
74
What are the disadvantages of zippers?
1. cost
| 2. may not be an optimal option in the obese population
75
What is a first intention/primary union wound healing type?
clean, approximated incision is closed with suture or other appropriate product
76
What is a second intention wound healing type?
wound heals by granulation, leading to wound contracture
77
What is a third intention/delayed primary closure?
1. delayed wound closure d/t considerable tissue loss and/or gross infection
2. wound is not devascularized
3. deep sutures are not used to avoid granuloma formation
78
What are the 4 surgical wound classes?
1. class 1 - clean
2. class 2: clean-contaminated
3. class 3: contaminated
4. class 4: dirty infected
79
What is an example of a class 1 wound?
total knee arthroplasty
80
What is an example of a class 2 surgical wound?
total hysterectomy; rasp-alimentary-or GI tract is entered
81
What is an example of a class 3 surgical wound?
gun shot wound
82
What is an example of a class 4 surgical wound?
incision and drainage of infected wound
83
What is the
a. location
b. timing
of a superficial incisional wound?
a. location: epidermis, dermis and SQ layers
| b. timing: within 30 days after the surgery
84
What is the
a. location
b. timing
of a deep incisional wound?
a. location: fascial and muscle layers
| b. between 30 and 90 days after the surgery
85
What is the
a. location
b. timing
of a organ space wound?
a. location: organ/space layer
| b. timing: between 30 and 90 days after the surgery
86
what is the removal of dead tissue from a wound?
debridement
87
What is negative-pressure wound therapy?
a wound therapy employed for difficult wounds that have not responded to other care methods
88
What does negative-pressure wound therapy involve?
applies constant, controlled, negative pressure to a wound into which a drainage sponge has been placed
89
What are the 3 components of negative-pressure wound therapy?
1. mechanical tension on tissues
2. macro deformation
3. micro deformation
90
What does mechanical tension on tissues cause?
fluid removal that reduces edema and decreases bacterial load
91
What does macro deformation do?
wound contracture
92
what does micro deformation do?
microscopic interaction between the wound tissue and the dressing
93
what are drains used for?
to provide an exit for blood, serum, bile, air, intestinal secretions, and pus
94
What do drains create?
a portal of entry for pathogenic microorganisms
95
What is required when emptying closed systems and changing a wound drain dressing?
aseptic technique
96
What is an example of a simple drain?
Penrose drain
97
What are examples of closed suction?
1. hemovac
| 2. Jackson-pratt
98
Coefficient of friction is an element of which suture material characteristic?
handling (tissue drag, knot typing, and knot slippage)
99
what is a temporary wound treatment that can produce growth factors and stimulate wound healing?
skin substitute
