Wound Healing / Closure Flashcards Preview

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Flashcards in Wound Healing / Closure Deck (54)
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1

What are stages of wound healing

Haemostasis
Inflammation
Regeneration
Remodelling

2

Haemostasis phase

Vasoconstriction
Platelet plug
Generation of fibrin clot

3

Inflammation phase

Neutrophils migrate
Release of growth factor - VEGF
Fibroblasts migrate

4

Regeneration phase

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

5

Remodelling phase

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

6

What impairs heeling

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

7

What drugs

NSAID
Steroid
Immunosuppression
Anti-cancer
Ciprofloxacin

8

What are principles of wound management

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

9

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

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

10

What do you use to clean wound

Sterile saline up to 48 hours
Shower after 48 hours

11

What are methods of wound closure

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

12

What is primary closure

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

13

When is it used

Clean wounds
No significant tissue loss

14

What is delayed primary

Close within 24 hours before granulation occurs
Use if area is swollen

15

What type of graft

Split thickness
Full thickness

16

What is split thickness graft

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

17

How does the donor site heal

Granulation

18

Issues

Contract more than full thickness
Poor colour match

19

What is a full thickness graft

Entire dermis and epidermis

20

How does donor site heal

Requires closure

21

Issues

Only limited size can be used

22

What is a flap

Block of tissue with own blood supply
Used to reconstruct defects with insufficient blood or tissue characteristic needed

23

Types of flap

Skin
Muscle
Myocutaneous
Fascial
Fascialcutaneous

24

What is a distant flap

Transferred from remote location

25

What is secondary intention

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

26

When is it used

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

27

What is required

Time
Dressing changes

28

What happens if wound dehiscence occurs

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

29

How does skin graft work

Graft must attach to recipient site and gain a blood supply

30

When can they not be used

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