Wounds

Question 1

Types of wounds

Answer 1

1. Clean
2. Clean-contaminated
3. Contaminated
4. Dirty

Question 2

Clean wounds, infection rates, type of operations, healing

Answer 2

1. 2% infection rate
2. No opening of bowel
3. GU surgery
4. Respiratory
5. Healing through primary closure

Question 3

Clean-contaminated, infection rates, type of surgery, healing

Answer 3

Infection rate: 3-4%
Primary closure
1. bowel, GU, resp opened.
2. Minimal contamination, no active infection.
3. Cholecystectomy, appendectomy, bladder surgery

Question 4

Contaminated, infection, type of surgery, healing

Answer 4

1. Major contamination of wound during procedure
2. Spillage of stool, infection of biliary/resp/GU system
3. Fresh traumatic wounds
4. Bowel obstruction w/ enterotomy,
   acute cholecystitis w/ spillage of pus

7-10% infection
Wound left open

Question 5

Dirty and infection, infection rate, type of surgery

Answer 5

1. Established infection
2. Appendiceal abscess, traumatic w/ contaminate deviatlised tissue
   and perforated viscus

30-40% infection rate

Question 6

Acute wound care

Answer 6

1. Hemostasis- must be acheived before closure or else inflammatory phase will persist
2. Cleansing- removal of nonviable tissue, foreign bodies, gross infection. Irrigate with
   normal saline under pressure

Question 7

Phases of wound healing

Answer 7

1. Coagulation phase
2. Inflammatory phase
3. Proliferative
4. Wound healing

Question 8

Describe inflammatory

Answer 8

1. Mediators
Injured cells, PLTs,
Inflammtory mediatirs
TGF, PDGF, fibroblasts
2. Vascular
Hypoxia-->angiogenesis
Mediator influx, permeability
vasodilation
Erythema and swelling
3. Cellular
\+vascular permeability, chemokines, +PMN
Removal of necrotic tissue
Macrophages at 24-48 hours
Fibroblasts
Epithelial migration
Bridging of fibrous tissue
48-72 hours- epithelialized

Question 9

Describe proliferative phase

Answer 9

fibroblasts ++collagen
Myofibroblasts make the
wound smaller
\+collagen occurs for
3 weeks, then returns to normal
levels

Question 10

Describe wound healing stage

Answer 10

3 weeks post wound is healed
New collagen generated in
more uniform
90% original tissue strength of original tissue
acheived in 6 weeks

Question 11

Methods of wound closure

Answer 11

1. Primary intention
2. Secondary intention
3. Delayed primary
4. Skin grafts
5. Flaps

Question 12

Primary closure

Answer 12

clean, clean contaminated and
minimally contaminated- wound edges approximated
shortly after wound incurred.

Question 13

Secondary closure

Answer 13

high risk of infection and
wounds already infected
Left open and allowed to
heal by epithelisation and
wound contraction

Question 14

Delayed primary closure

Answer 14

delayed primary closure-wounds heavily contaminated (perforated appendix), left open
After 3-5 days, wound is primarily
closed.

Question 15

Skin graft

Answer 15

spit thickness-
epidermis +part of
dermiis. Used on well-
granulating, noninfected
nonepithelialised superficial
wounds

Question 16

Flaps, rotation, free

Answer 16

when underlying
tissue taken as well as epidermis
Requires vascularisation
1. Rotation flap retains blood supply,
but mobilised to different location
2. Free flap Tissue removed from normal blood supply and moved to another area of the body
blood vessels reanastamosed to local blood supply

Question 17

Wound dressings in sutured

Answer 17

Takes 48 hours for epithelial cells to migrate across, needs dressing to absorb

Question 18

Wound dressings for open w/ necrotic

Answer 18

Wet-dry technique-
will debride necrotic +
healthy tissue

Question 19

Wound dressing for clean-open

Answer 19

wet to wet-->
does not remove 
healthy tissue. 
Removes exudate and
enhances wound healing.

Question 20

Wound dressing for large open dermal

Answer 20

heal by epithelial
migration
need dressing
protecting underlying
dermis and promotes epithelial
migration
Non-adhering, petroleum base
impregnated gauze