Wound Healing / Closure

Question 1

What are stages of wound healing

Answer 1

Haemostasis
Inflammation
Regeneration
Remodelling

Question 2

Haemostasis phase

Answer 2

Vasoconstriction
Platelet plug
Generation of fibrin clot

Question 3

Inflammation phase

Answer 3

Neutrophils migrate
Release of growth factor - VEGF
Fibroblasts migrate

Question 4

Regeneration phase

Answer 4

Platelet derived growth factor stimulates fibroblasts
Collagen produced
Angiogenesis
Granulation tissue forms

Question 5

Remodelling phase

Answer 5

Longest phase
Fibroblast differentiate
Wound contracts
Collagen reomdells
Microvessels regress
Leaves pale scar

Question 6

What impairs heeling

Answer 6

Vascular disease
Shock
Sepsis 
Drugs 
Co-morbid - DM 
All impair microvascular flow

Question 7

What drugs

Answer 7

NSAID
Steroid
Immunosuppression
Anti-cancer
Ciprofloxacin

Question 8

What are principles of wound management

Answer 8

1 - Inspection and exploration
2 - Wound irrigation e.g. 0.9% saline
3- Wound excision - any devitalised
4- Wound closure

Question 9

If high degree of contamination / devitalised tissue what should you do

Answer 9

NEVER close during 1st management
Often return to operating theatre after 48 hours
Repeat steps 1-3
NEVER CLOSE A DIRTY WOUND

Question 10

What do you use to clean wound

Answer 10

Sterile saline up to 48 hours

Shower after 48 hours

Question 11

What are methods of wound closure

Answer 11

Primary = most common 
Delayed primary 
Skin graft
Local flap
Distant flap 
Secondary intention

Question 12

What is primary closure

Answer 12

Steristrip - not a lot of strength if mobile area
Suture - requires LA and removal
Stables

Question 13

When is it used

Answer 13

Clean wounds

No significant tissue loss

Question 14

What is delayed primary

Answer 14

Close within 24 hours before granulation occurs

Use if area is swollen

Question 15

What type of graft

Answer 15

Split thickness

Full thickness

Question 16

What is split thickness graft

Answer 16

Consist of epidermis
Various amounts of dermis
Use of mesh means large areas covered

Question 17

How does the donor site heal

Answer 17

Granulation

Question 18

Issues

Answer 18

Contract more than full thickness

Poor colour match

Question 19

What is a full thickness graft

Answer 19

Entire dermis and epidermis

Question 20

How does donor site heal

Answer 20

Requires closure

Question 21

Issues

Answer 21

Only limited size can be used

Question 22

What is a flap

Answer 22

Block of tissue with own blood supply

Used to reconstruct defects with insufficient blood or tissue characteristic needed

Question 23

Types of flap

Answer 23

Skin
Muscle 
Myocutaneous
Fascial
Fascialcutaneous

Question 24

What is a distant flap

Answer 24

Transferred from remote location

Question 25

What is secondary intention

Answer 25

If not brought together by primary wound will heal but takes longer and leaves a scar

Question 26

When is it used

Answer 26

Dirty wound | Tissue loss where closure will result in infection and breakdown

Question 27

What is required

Answer 27

Time | Dressing changes

Question 28

What happens if wound dehiscence occurs

Answer 28

Senior help urgent Sepsis 6 If superficial = pack If deep = surgery

Question 29

How does skin graft work

Answer 29

Graft must attach to recipient site and gain a blood supply

Question 30

When can they not be used

Answer 30

Bone, tendon or cartilage stripped of outer covered Exposed metalwork Open joint Cross-infectio

Question 31

What readily accepts a graft

Answer 31

Muscle | Fascia

Question 32

What is unsuitable

Answer 32

Fat

Question 33

What are abnormal scars

Answer 33

Hypertrophic | Keloid

Question 34

What is a hypertrophic scar

Answer 34

Raised above normal level due to excess collagen Within boundaries Often red and nodular

Question 35

What does it occur with

Answer 35

Full thickness

Question 36

What happens over time

Answer 36

Resolves | Contractuerss

Question 37

How do you help

Answer 37

Massaging | Sustained pressure

Question 38

What are keloid scars

Answer 38

Extend outwit boundaries of original scar Occur within 3-4 week Pink or red plaque with no nodules Can become very large

Question 39

How do you Rx

Answer 39

Steroid injection Sustained pressure Excision + RT = last ditch

Question 40

What is process of suturing

Answer 40

Anaesthetise Cleans wound Suture Dressing

Question 41

What do you use for anaesthetic

Answer 41

Lidocaine 3mg without adrenaline or 7mg / kg with adrenaline

Question 42

What do you do after administer

Answer 42

Check pin-prick Assess depth and damage Remove foreign body and debride prior to closure

Question 43

What do you discharge with

Answer 43

Advise on wound management / dressing S+S of wound problems Follow up advise

Question 44

What are special wounds

Answer 44

Lips Face Pre-tibial laceration Knuckle 'fight bite'

Question 45

Lips and face

Answer 45

Cosmesis | Requires careful suturing

Question 46

When is pre-tibial laceration common

Answer 46

Elderly as thin and fragile skin

Question 47

What is is issue

Answer 47

Suture won't hold

Question 48

How do you Rx

Answer 48

Remove haematoma Replace flap but do not cause tension so may not close Steristrip and dres Advise to rest and elevate leg

Question 49

What are issues with knuckle injury

Answer 49

Prone to infection FB common Always X-ray as risk of fracture to metacarpal

Question 50

How do you Rx

Answer 50

Hep B cover Ax cover 2 closure if signs of infection

Question 51

What are types of gangrene

Answer 51

Wet Dry Gas

Question 52

Dry

Answer 52

Due to lack of blood supply

Question 53

Wet

Answer 53

If bacteria invades

Question 54

Gas

Answer 54

Gas forming organism