Wound Management Flashcards Preview

Principles of Science > Wound Management > Flashcards

Flashcards in Wound Management Deck (31)
Loading flashcards...
1
Q

What are adnexia?

A

Glands, hair etc. present in healthy skin tissue

2
Q

What is the objective of care of accidental wounds?

A
  • convert an open wound to a surgically clean than can be closed (ideally within 6-12hours)
  • minimal scarring, normal function and no infection
3
Q

What are the 2 broad categories of wound? What else should be thought about?

A
> Closed - crushing and contusion injuries eg. mm. avulsion, fx
> Open - skin lacerations or loss 
- duration
- degree of contamination
- aetiolgogy
- depth of tissue damage
4
Q

Why is duration of wound exposure important?

A

bacteria multiply quickly

- “golden period” after which wound cannot be sutured as clean

5
Q

What are the classes of wound duration?

A
  1. clean lcerations 0-6 hours with minimal contamination
  2. wounds 6-12hrs duration with significant contamination
  3. wounds 12hrs + with gross contamination AND bite wounds even if fresh
6
Q

What are the majority of wounds classified as?

A

2

7
Q

How is degree of contamination defined?

A
  • clean
  • clean contaminated
  • contaminated
  • dirty
8
Q

What is a dirty wound defined as in a lab?

A

> 10^5 organisms per gram of tissue

9
Q

What are potential wound aetiologies?

A
  • abrasion
  • avulsion/degloving
  • incision
  • laceration
  • puncture
  • crushing
  • burns
10
Q

What may discolouration around a seemingly small wound indicate?

A

underlying trauma

11
Q

What trauma are we most worried about with neck wounds?

A

laryngeal and tracheal trauma

12
Q

How should accidental wounds be managed first aid

A
  • control haemorrhage using pressure not tourniquet
  • fresh steril pressure bandage
  • topical Abx (tetracycline or neomycin &bacitracin in 0.9% saline)
  • chlorhexidine v dilute 0.05% can be sued but is damaging to fibroplasia
13
Q

What is the first thing that should be done to accidental wounds?

A

DO NOT PROBE

  • fill with KY jelly
  • clip hair around wound
  • prepare aseptically
  • irrigate
14
Q

Should accidental wounds be lavaged under pressure?

A

No

  • effect is proportional to volume
  • do not drive debris further into tissues
  • no need for ABx added
15
Q

What guage needle should be used to prevent too much pressure being applied when lavaging a wound?

A

19G

16
Q

How may wounds be debrided?

A
  • surgery gold standard
  • bandages - wet-dry, dry-dry, wet-wet (adjubnct to surgery or when debridement not possible)
  • Hydrogel and enzymes improve effects of debriding bandage
17
Q

How can you decide which muscles to remove when debriding a wound?

A

if it does not twitch or bleed when touched it can go

18
Q

What are the 2 main types of dressings?

A

> passive
- adherent/absorbent/non-adherent/vapour permeable/barrier films
- protection and environment to support healing
active
- hydrocolloids/hydrogels/alginates/collagens/skin substitutes
- provide cytokines and alter wound environment to ^ healing

19
Q

When is vacuum assisted wound closure commonly used?

A

abdo and thoracic wounds

^ quality of granulation tissue

20
Q

What are the advantages of adherent passive dressings?

A
  • excellent debridement
  • wide mesh allows dessication and tissue adherence
  • good at combatting infection
  • cheap
21
Q

What are the disadvantages of adherent passive dressings?

A
  • painful to remove
  • changed frequently q24hrs
  • delay fibroplasia and epithelialisation
  • detrimental if used after debridement period
22
Q

What are the differnet types of adherent passive dressings called? When are they indicated?

A

dry - dry (if wound effusive)

wet - dry

23
Q

What sare the different wound closure options?

A

> 1* intention (incisions)
delayed 1* closure (leave 24-48hrs for necrosis then debride and close)
2* closure (leave granulation tissue to form then remove all)
2* intention (contraction and epithelialisation)
- may need a combination and can change your mind

24
Q

If in doubt,should you close the wound?

A

No

25
Q

Which wound should you specifically not close early?

A

Puncture wounds, infected wounds, under tension

26
Q

What causes impairment of granulation tissue formation?

A
  • necrotic/devitalised tissue in wound
  • infection
  • movement
  • poor blood supply
  • mechanical abrasion
27
Q

Tx of granulation tissue

A
  • further debridements
  • excision of old granulationtissue bed
  • enhance blood supply (mm. omentum, vascular skin)
  • reconstruct using tissue with good blood supply
  • support and immobilisation (as with bone healing)
28
Q

What causes impairment of epithelialisation?

A
  • necrotic tissue
  • infection
  • eschar
  • movement
  • poor bloodsupply
  • mechanimal abrasion surface trauma
29
Q

Tx of delayed epithelialisation

A
  • debridement
  • tx infection
  • enhance blood supply
  • protection
30
Q

What causes inhibition of contraction? Tx?

A
  • tension
  • lack of local skin
  • restrictive fibrsosis
  • tight bandages
    > excise restrictive scar
    > reconstruct with skin flap or graft
31
Q

Tx of indolent pocket wounds?

A
  • ID cause
  • control infection
  • excise wound
  • tension free closure
  • manage dead space
  • enhance local vascular supply (omentalisation)