Wound Management Flashcards
(36 cards)
What size and locations make higher rates of infections?
length greater than 5 cm, and non–head-and-neck
What should you remove right away whenever there is an injury to the hand?
remove rings
Pros and cons of sutures
strongest and most accurate but most time consuming and likely needle stick risk
when do you use absorbable sutures
do not need to be removed
what are the suture sizes for
scalp
face
trunk
extremeties
digits
scalp (3-0 or 4-0)
face (6-0)
trunk (4-0)
extremities (4-0)
digits (5-0)
what do the number of knot times correspond to for simple interrupted
suture size
4-0 = 4
5-0 = 5
what would you use for a long linear wound
running stitch
Avoided in irregular wounds
what are buried dermal used for
what is the most cosmetic suture
Cutaneous subcuticular
what is vertical mattress used for
deep wound (chunk of tissue)
what is horizontal mattress
better for angled flaps of skin and pulling the skin closer for eversion
disadvantage = skill dependent
what are staples used for and cons
non-facial, linear lacerations
staple removal is painful
super easy though
steri-strips/ tapes pros/cons
least strong (needs to be low tension) but least invasive
good for smaller skin tears
come off in a couple days
dermabond is typically used in
kids
it burns a bit, needs to be dry before or else it will not stick
a little weaker than staples
What is the mangamenet of face/scalp lacerations
- cleanse
- do not cut (because there is a lot of blood supply)
- consider a regional nerve block
- use a 6-0 nonabsorbable monofilament
best cosmetic results of face/scalp laceration?
- Forehead wounds that fall parallel to the lines of skin tension (and perpendicular to muscle fibers) yield the best cosmetic results.
- Close scalp lacerations with surgical staples or simple interrupted percutaneous sutures using nonabsorbable monofilament or rapidly absorbable material.
- Leave suture tails long, and use sutures of a color different than the hair for easy suture removal.
eyebrow laceration management
Use care to align the hair margins.
Use sutures that are a different color from the hair and leave long tails to facilitate removal.
What are the indications for eyelid suturing
Eyelid injuries within 6 to 8 mm of the medial canthus are at risk for canalicular laceration, especially if associated with medial wall blowout fractures.
Refer the following injuries to an ophthalmologist or oculoplastic specialist: (1) injuries involving the inner surface of the lid, (2) wounds across lid margins, (3) injuries to the lacrimal duct, (4) wounds associated with ptosis, or (5) injuries extending into the tarsal plate
6-0 or 7-0 nonabsorbable monofilament for simple interrupted percutaneous sutures.
Avoid deep penetration of the needle through the lid and into the underlying globe.
Do not use tissue adhesive near the eye, as adhesives may abrade the cornea or bond the lids together
What is the managment of a nose injury
really important to evaluate the thickness because there can be a pathway to the brain
look for septal hematomas
complications = erode septum, saddle deformity, obstruction
check for clear fluid (CSF)
what is a through and through managment of nose
With extensive wounds, consider a loose anterior nasal pack with antibiotic-impregnated gauze to prevent scar contracture.
what is the managment of superfiscial nose injury?
Superficial lacerations to the skin layer: 6-0 nonabsorbable monofilament simple interrupted sutures.
preserve cartilage
Management of ear closure
close superfisical layers with 6-0
do not remove cartilage
do not debride edges of aurical laceration
when do you not need to lacerate?
Mucosal lip lacerations may not need to be sutured if they are isolated and the wound edges spontaneously approximate.
the wet part of your lip
when should you use absorbable vs non absorbable sutures for lips
absobable for wet part
non for dry part
both with 5-0 because it is
first stitch is at the vermilion border
remove in 5 days - do not bite or play with it
