Wounds Flashcards
(40 cards)
What is an acute wound?
Pass through the normal healing process. Eks are cuts, abrasions, lacerations, contusions, puncture, skin flap, bites
Chronic wounds
Fail to passthrough normal healing process. Any wound >3m are considered a chronic wound.
What are the healing phases?
- Hemostatis 2. Inflammatory 3. Proliferative 4. Remodeling
What is happening in hemostasis phase?
Seconds to hours. Vasoconstriction, plot aggregation, leukocyte migration.
What is happening in inflammatory phase?
Hours to days. Early neutrophil chemoreactant release, late macrophages, phagocytes and removal of foreign body.
What is happening in proliferative phase?
Days to weeks. Fibroblast proliferation, collagen synthesis, ECM reorganization, angiogenesis, granulation tissue formation, epithelialization.
What are the healing intentions?
1st, 2nd and 3rd intention
1st intention
Able to bring together edges of a wound and hold them in place. Can be held together w sutures, staples, steer strips. Wound is easily closed and dead space is eliminated.
2nd intention
When there is loss of tissue. Wound requires gradual filling of dead space w connective tissue. Blod clot -> granulation tissue -> large scar
3rd intention
Delayed primary closure. Wounds are intentionally left open for several days for irrigation or debris removal. Once debris has been removed and inflammation subsides, the wound can be closed by first intention.
What is the aim of Mx of acute wound
Healing w/o complications such as inf and disfiguring
How do you Mx an acute wound?
1) Remove foreign bodies 2) Dry or wet dressing to cover the wounds 3) Suturing if acute 4) Bites = prophylaxis
Steristrips
Holds edges of the wound. Can be removed after 5-7 days.
Medical glue
Forms part of the scar. No need to be removed, fall of in 10days
ABs
Only indicated if contaminated/ evidence of inf (redness, warmth, swelling, tenderness, local lymphadenopathy)
Abscess
If large = drain. Small= ABs, butadiene, hydrogen peroxide, saline
When is the wound chronic?
Wound does not follow normal trajectory it may become stuck in one of the stages and bc chronic. May fail to heal due to local and systemic causes, lasting >3m, may appear at different colors.
What are the local factors impending wound healing?
1) Inadequate blood supply 2) poor surgical apposition 3) poor venous drainage 4) excess local mobility (joint) 5) increased skin tension, 6) wound dehiscence (?), 7) presence of microorganisms and infection.
Systemic factors impeeding wound heal
- Increased age and general immobility
- Malnutrition
- Def of vitamins
- Shock of any cause
- Chemo/ radio tx
- Inherited neutrophil disorders, leukocyte adhesion, def
- Obesity
- Smoking
- Systemic malignancy and terminal illness
- Imm. supp. drugs, corticosteroids, anticoagulants
- Diabetes
What kinds of tissue can be seen in a chronic wound?
- Black = necrotic tissue
- Red = granulation tissue
- Yellow = sloghy tissue
- Pink = epithelial tissue
Necrotic wound
Dead tissue, when dry and hard = eschar. Mask the true size and staging. Prevents ABs to reach site. Prevents wound healing, removal is necessary, may lead to inf., Once removed healing starts. Fails to heal.
How do you care for a necrotic wound?
Mechanical debridement and wet to dry dressing. Autolytic- occlusive dressings and wound exudate will debride by enzymatic relation. Emzymatic is softening slough by using enzymes (Iruxol and Papaya). You can also use biological therapy w maggots, or surgical w blades
Sloughy wound
Cannot be removed by washing. Not necessarily indicative of clinical inf. Can be found as patches across wound bed. Exposed tendon may be mistaken for slough. Delay healing, predispose to inf and prevents AB tp reach site. Should be removed to enhance granulation.
Granulating wound
Granulation tissue fills the wound as it is healing. Tops of capillary loops make the wound appear red and granular. Firm to touch, painless and does not bleed easily. Bright red granulation tissue bleeds easily, and may indicate inf.
