Flashcards in Wound healing complications Deck (77)
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1
Outline some general complications of wound healing
Haemorrhage and haematoma
Swelling and oedema
Seroma
Dehisence
Infection - tissue necrosis
Scarring and contracture
Draining tracts
Exposed bone
Non-healing wounds
2
What are the different types of wound? 5
Elective incisional
Elective excisional
Traumatic complications
Acute
Chronic
3
What are Halsted's Principles of Surgery?
H - haemostasis
A - aseptic technique
L - light touch (atraumatic surgery)
S - supply of blood preserved
T - tension free closure
E - even tissue apposition
D - dead space obliteration
4
What are Esmarch's principles of wound management? 5
Non-introduction of anything harmful
Tissue rest
Wound drainage
Avoidance of venous stasis
Cleanliness
5
When can haemorrhage and haematoma occur?
Post-operatively:
Primary
Delayed primary
Secondary
6
What effect does a haematoma have on wound healing? 7
physical separation of wound edges
pressure on wound edges (necrosis and dehisence)
prevention of adherence of grafts and flaps
physical barrier to leukocyte migration
growth medium for bacteria
pain
organisation of haematoma may cause a deformity
7
How do you manage haemorrhage?
Pressure - light bandage, 12 hours
Restrict movement
Investigate coagulopathy
Supportive (fluids +/- blood products)
8
How do you manage haematoma?
none
aspirate - but infection risk
warm compress
9
What are DDx for swelling and oedema? 2
infection and cellulitis
10
What therapy is appropriate for swelling and oedema?
massage, support dressing, remove constricting structures
11
What is an axial pattern flap?
a myocutaneous flap containing an artery in its long axis
12
Define seroma
a collection of serum and tissue fluid in dead space
13
What are the effects of a seroma?
tissue separation
skin flaps
skin grafts
tension on incision lines
interference with blood supply
interferes with WBC migration
14
What are DDx for seroma? 3
haematoma, oedema, abscess, wound dehisence and herniation
15
What is best treatment for seroma?
Most resolve but prevention better than cure - no sepcific therapy.
CONSERVATIVE: aspirate, control dead space, control movemement, drainage (avoid suction), remove sutures
SURGICAL INTERVENTION: dehisence, secondary infection
16
What contributing factors may lead to seroma? 7
inflammation
lymphatic injury
poor haemostasis
traumatic surgery
implants
movement
dead space
17
What are reasons for dehisence?
primary healing defect
surgical technique, judgement, wound bed, trauma
18
When is dehisence usually seen? Exception?
3-5 days after surgery (unless self-trauma)
19
What are signs of dehisence?
serosanguinous discharge
swelling
necrosis, buising, discharge
20
What is appropriate therapy for dehisence? 2
second intention healing or surgical repair
21
What broad factors affect whether a wound will become infected?
bacteria
local wound environment
local and systemic defence
22
What are the 2 main reasons for tissue necrosis?
Inadequate blood supply
Inadequate debridement
23
When are scarring and contracture beneficial? 1
shear injuries
24
What might happen if you have excessive scar formation? 4
stenosis
functional incompetence
restriction of movement
contracture --> loss of function
25
What is a sinus?
blind ending tract that extends from one epithelial surface (epidermal or mucosal). Deep site of inection, FB, sequestrum
26
What is a fistula?
a communicating tract that extends form one epithelial tract to another (e.g. oronasal, rectovaginal, bronchooesophageal)
27
What are forage holes?
When you have an injury involving bone, you might assess the BM's supply of BVs in order to perform microvascular tissue transfer
28
What is forage?
= osteostixis = subchondral drilling
numerous holes are drilled with a fine Kirshner wire or microdrill burr through to subchondral bone so that bleeding is encountered. Particularly useful if bone with the defect is sclerotic or eburnated.
29
Name 2 skin repair techniques that brings additional blood supply back.
axial pattern flapp
microvascular tissue transfer
30
