Wound Closure/Dirty Wounds

Question 1

closed by direct approximation of the wound edges is […] healing

Answer 1

primary

Question 2

wound is left open and allowed to heal spontaneously from the edges is […] healing

Answer 2

secondary

close via contraction and epithelialization

Question 3

wound is closed by active means after a delay of weeks or months is […] healing

Answer 3

tertiary

Question 4

how long do sutures stay in trunks/extremities?

Answer 4

7-10 days

Question 5

how long do sutures stay in face/neck?

Answer 5

4 days

Question 6

[…] and […] are used on skin because they are less reactive

Answer 6

prolene
nylon

Question 7

[…] needles for fascia/bowel
[…] needles for skin

Answer 7

tapered
cutting

Question 8

what size suture for deep tissue?

Answer 8

2-0 to 4-0

Question 9

what size suture for torso/extremities?

Answer 9

3-0 to 4-0

Question 10

what size suture for face/neck?

Answer 10

5-0 to 6-0

Question 11

cardinal signs of inflammation

Answer 11

rubor
dolor
calor
tumor

loss of function

Question 12

what kind of suture would you use for subcuticular skin closure?

Answer 12

monocryl

Question 13

3 types of absorbable sutures

Answer 13

chromic
vicryl
monocryl

Question 14

3 types of non-absorbent sutures

Answer 14

nylon
polyester
prolene

Question 15

for closure of muscle, […] provides the greatest strength

for closure of skin, […] provides the greatest strength

Answer 15

fascia
dermis

(deep sutures should be absorbable and placed in layer of greatest strength)

Question 16

do you close peritoneum?

Answer 16

no –increases likelihood of adhesions

Question 17

fascial closure should be done with […] or […]

Answer 17

PDS
prolene

Question 18

putting interrupted sutures in the fat decreases [….]

Answer 18

dead space

(no tension here)

Question 19

HIS FRIENDS mnemonic for factors that impair healing fistula

Answer 19

High output (>500 cc/24 hrs)
Injury
Size (less than 2 cm)
Foreign body
Radiation
Infection
Epithelialization
Neoplasm
Distal obstruction
Steroids

Question 20

risk factors for infection

Answer 20

foreign body
decreased blood flow
necrosis
long operation time
strangulation
hypothermia
hematomas
seromas
dead space
poorly approximated tissue

Question 21

patient factors for poor wound healing

Answer 21

older
smoking
obesity
malnutrition
diabetes
uremia
malignancy
immunosuppresion
chemotherapy
trauma
burn
hypovolemic shock
PAD
infection

Question 22

what labs/imaging do you want if you suspect infection?

Answer 22

CBC
CMP
lactate
blood cultures, wound cultures
UA

CT or US to look for abscess

Question 23

what should you use to suture a facial laceration?

Answer 23

6-0 prolene on cutting needle
do interrupted sutures
out in 3-5 days to prevent hash marks

(use absorbable in peds)

Question 24

how long should you leave staples in scalp?

Answer 24

10-14 days

Question 25

what is chromic used for?

Answer 25

large gashes in mouth or vaginal tears

Question 26

what should you counsel the patient on if they have a hematoma under the incision?

Answer 26

may auto-express as it liquifies, don't be alarmed

Question 27

what should you use to repair tendon?

Answer 27

4-0 prolene on tapered needle

Question 28

how long should sutures stay in back?

Answer 28

2+ weeks (very thick dermis)

Question 29

how long should sutures stay in abdominal incision?

Answer 29

10-14 days

Question 30

how would you describe an atraumatic wound with no GI, GU or respiratory involvement?

Answer 30

clean (3% infection rate)

Question 31

how would you describe a wound with minor sterile breaks or entrance to GI, GU or resp tract without significant contamination?

Answer 31

clean contaminated 8% infection rate

Question 32

how would you describe wound with entrance to GI, GU or resp tract with spillage of contents?

Answer 32

contaminated 15% infection rate

Question 33

how would you describe wound with soild and particulate matter?

Answer 33

contaminated 15% infection rate

Question 34

how would you describe wound with active infection like an abscess?

Answer 34

dirty 35% infection rate

Question 35

a wound is considered infected when the level of contamination is greater than

Answer 35

10 ^ 5 organisms per gram of tissue

Question 36

[...] is the most important technique to decrease bacterial load

Answer 36

debridement

Question 37

dressing changes should be limited to [...] to prevent adversely affecting the progression of wound healing

Answer 37

twice daily

Question 38

what type of antibacterials can be used topically to penetrate granulation tissue?

Answer 38

silver sulfadiazine mafenide acetate (do NOT use near eyes)

Question 39

unknown or incomplete tetanus immunization

Answer 39

tetanus toxoid and immunoglobulin

Question 40

complete tetanus series, but last immunization more than 5 years ago

Answer 40

tetanus toxoid

Question 41

complete tetanus series last immunization less than 5 years ago

Answer 41

nothing

Question 42

granulation tissue consists of [...] and [...]

Answer 42

capillaries and fibroblasts

Question 43

do systemic abx penetrate granulation tissue?

Answer 43

no

Question 44

how should you stop bleeding when you find a wound?

Answer 44

manual pressure (not tourniquet)

Question 45

after you debride a wound, how should you dress it?

Answer 45

pack open and change BID

Question 46

what should you expect if have an abdominal wound that is continuously leaking clear fluid?

Answer 46

dehiscence (fasical layer not closed)

Question 47

how should you treat wound dehiscence?

Answer 47

compression or debridement/closure depends on stability of the patient

Question 48

what is treatment of evisceration?

Answer 48

moist covering --> OR

Question 49

if you don't repair a fascial dehiscence, what will the patient get?

Answer 49

incisional hernia