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44 Cards in this Set
- Front
- Back
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First Intention |
wound edges brought togethter during closure at the time of surgery |
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Second intention |
wound is left open and heals from the bottom up. Slower healing than 'first intention', creates more scar tissue/granulation |
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Third Intention |
Wound is not initally closed, remains open until granulation bed is formed. then granulated tissue is closed using standard techniques. Useful in infected wounds |
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Clean wound |
a standard aseptic surgical wound |
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clean-contaminated wound |
a clean wound that is contaminated by entry into a viscus resulting in minimal spillage of contents |
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contaminated wound |
a wound that has become infiltrated with contaminates from lacerations, fractures, gross spillage from GI tract, or a break in asceptic technique |
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Dirty-infected wound |
cause by perfourated viscera, abcesses, or prior clinical infection |
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wound care |
within 6 hours of initial colonization, a wound can be infected
ongoing infection at time of surgery may lead to 400% increase in infection rates. |
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Simple Interrupted |
maintains strength and tissue position of one portion fails requires more time and suture material has minimal holding power against stress |
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Vertical Mattress suture |
Tension suture stronger than horizontal mattress time consuming, requires more suture material |
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Cross-mattress |
Tension suture brings tissue into good apposition useful in amputations, rib appostion and abdominal muscle closures |
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horizontal mattress suture |
-tension suture -rapid and involves less suture material -Difficult to apply without excessive eversion -useful in skin of dog, cow, horse |
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Gambee/Crushing |
-useful in intestinal anastomoses -minimal leakage -may reduce fluid passage through the lumen underneath -similar to vertical mattress |
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Simple Continuous |
-Used in lines no longer than 5" -Involves one diagonal pass and one perpendicular pass -creates a good seal -more prone to failure if any portion is broken |
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Running |
Both deep and shallow passes advance Regularity more difficult Slightly faster but weaker than simple continuous pattern |
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Wound Healing |
Skin and fascia are the strongestbut regain tensile strength quite slowly
Stomach and small intestine areweak, but heal quickly |
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3 Phases of Wound Healing
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InflammatoryPhase
Migration/Proliferation Phase MaturationPhase |
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Monofilament Suture
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Monofilament is a single strand
Passes through tissue easily, won’t harbor micro-organisms Ties easily May be weakened by crushing (clamping in forceps or needle holders) Has more “memory” Continues to hold the shape as it lay in the package Good for percutaneous sutures Knots may slip over time due to the slipperiness of the suture |
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Multifilament Suture
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Multifilament is a bundle of strands, like rope
Affords greater tensile strength, pliability, flexibility, and knot security May harbor micro-organisms and “wick” them down the suture Should not be used for percutaneous sutures |
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Absorbable Suture
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Absorbable suture holds temporarily but gradually loses tensile strength and is eventually mostly or completely absorbed
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Lembert Suture |
–Closeshollow viscera
–Providesinversion and creates a good fluid-tight seal |
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Ford Interlocking
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–More stable in the event of partial failure or breakage –Provides greater tissue stability –Uses more suture material
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Halsted
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–Combination mattress and Lembert pattern
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Connell
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Beginwith a single inverting vertical mattress suture
–Continuesfor the length of the incision |
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Cushing–
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Modified Connell where the needle and suture do not enter the lumen
–Provides a better fluid-tight seal than the Connell pattern |
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Parker-Kerr
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–Asingle layer of Cushing covered by a single layer of Lembert
–Usedfor infected uterine stumps and some bowel closures –Providescomplete clamping to prevent leakage during suturing |
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Guard
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–ModifiedCushing
–Closesincisions of the rumen, intestine, and uterus–Needledoes not enter the lumen –Startsslightly higher than start of incision |
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Continuing Everting Mattress
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–Provides increased strength
–Rapid placement |
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Subcticular |
–Doesnot penetrate the surface of the skin
–Rapidand uses little suture material –Usedto close the upper-most layer of the skin incision–Requiresno suture removal |
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Subcutaneous
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–Mayuse simple interrupted, simple continuous, or horizontal mattress
–Simplecontinuous is fast and eliminates dead space |
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Quilted
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–Exteriorized skin suture through plastic tubing to resist excessive tension and stress
–Useful for high-tension closures |
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Far-far, Near-near
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–Tensionpattern –Overlappingsuture pattern provides extra strength but requires extra suture material |
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Mayo Mattress |
Useful for midline abdominal closures, abdomnial hernia repair and secondary clef palate repair |
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Modified Bunnell
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–Usedfor apposing tendons
»Requiresa high degree of closure strength –Usesnon-absorbable suture –Usesa single-armed suture |
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Bunnell |
Used for apposing tendons Requires a high degree of closure strength Uses nonabsorbable suture uses single armed suture |
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Cerclage Wiring
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–Usedfor fracture repair
–Wire/pinplaced in the bone center to hold it together –Wirewinds about the bone under the periosteum |
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Hermicerclage
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Wire goes through holes drilled into the bone |
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Tissue Handling / Technique |
Goalis tominimize trauma
¬Gentle useminimal tension with tissueRetractorsshould be placed to avoid excessive tension ¬Proper use of instruments DONOT CRUSH¬Use Proper Technique ¬Keep Tissue Moist Drytissue is dead tissue ¬Minimize Time |
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Dead Space |
is an opened area in a closed space –Filledwith room air, it prevents tissue apposition, provides a space for blood andother fluid influx, and may harbor micro-organisms7D |
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Problem: Infection |
–Thesource of infection should always be determined
–Beforeclosure of an infected wound the wound should be drained, debrided, and a smallopening or drain left in |
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Problem: Dehiscence |
–Woundreopens
–Mayresult from too much tension on tissue, improper suturing technique, orimproper suture materials |
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Wound Healing Phase 1: Inflammatory |
0- 5 Days canbe prolonged
-inflammatoryand “clean-up” process (plasma,cells, fibrin, blood components ûneutrophils,monocytes) remove debris "trash” -epithelialization/ migration (as early as 48 hours) -clinicallycharacterized by swelling, redness, warmth, pain & discomfort -Scab forms strengthdue to suture age/ material |
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Wound Healing Phase 2: Migration/ Proliferation |
Days 5-14 –Fibroblastsbegin forming collagen fibers in the wound»Beginningof the return of tensile strength–Lymphaticsrecanalize –Bloodvessels bud –Granulationtissue forms –Capillariesdevelop |
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Wound Healing Phase 3: Maturation |
Day 14 until done (can be months ) collagenfibers become oriented along the “stress” line of the incision and formcrosslinks –Tensilestrength continues to improve for as long as one year –Skinregains 70 to 90% of its original strength –Scaris formed which grows paler as new vessel construction tapers off –Woundcontraction occurs over a period of weeks or months |
