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35 Cards in this Set
- Front
- Back
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ligate
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tie blood vessels
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approximate
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sew tissues
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Indications for wound closure (WC)
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laceration extending into subQ tissues
decrease helaing time reduce chance of infection decrease amount of scarring repair loss of structure or function improve cosmetic appearance |
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Contraindications
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high likelihood of contamination
after 8 hrs post injury presence of foreign bodies extensive involving tendons, nerves, or arteries |
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Complications of WC
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Infection
Scarring, keloid Loss of fxn or structure Loss of cosmetic Wound dehiscence (margins separate) tetanus |
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Which layer of skin is devoid of blood vessels and nerve endings
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epidermis
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what provides parent layer for new cells during wound healing
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stratum germinivatum
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which layer contains immune cells
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dermis
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which layer contains fat, blood v, and n.
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Superficial fascia
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Langer's lines
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indicate direction of orientation of underlying collagen fibers
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wound that gapes open
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crosses langer's lines at right angles
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wounds that naturally reapproximate
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run parallel to Langer's lines
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Classifications of wounds
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Clean
Clean-contaminated Contaminated Infected |
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Clean wounds
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made during surgery s GI, resp or GU tract
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Clean contaminated
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surgery but c GI, GU, or Resp
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Contaminated
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Surgery c gross spillage
traumatic wounds |
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Infected
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established infection before wound is made or heavily contaminated wounds
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Pt prep for WC
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take hx
do PE include sensory and motor control bleeding irrigate wound anesthetize immunize against tetanus if necessary |
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Characteristics of tetanus prone wounds
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>6hrs old
> 1cm deep Stellate or avulsion configuration Associated with devitalized tissue Contaminate with soil, feces, or saliva From a missile (gun) from a puncture or crush associated with burn or frostbite |
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Which people require immunizations
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Non prone wound, IUTD, last Td >10y ago
Prone, IUTD, last Td> 5y ago Non prone, immunization not UTD = Td Prone, I not UTD = Td and TIG |
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Give children which vaccine
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DTP or DTap
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Which vaccine is safe in pregnancy
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TIG
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Procedure for irrigating and cleansing wounds
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Glove and goggle
60mL syringe, 21G plastic iv cath or blunt needle repeatedly squirt normal saline in short bursts 250-500mL minimally apply cleansing agent to wound edges. Do NOT enter wound. Repeat 3 times Place sterile drape Debride if necessary |
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Absorbable suture for what
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mucosal areas
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Non absorbable classifications
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Monofilamint
Multifilament - braided |
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Advantages and Disadvantage of monodilament
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Adv - passes through tissue more easily
Disadv - less tensile strength |
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Adv and Disavd of multifilament
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Adv - better flexability
Disavd - may harbor organisms |
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Conventional cutting needle
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For skin
three cutting edges: two lateral and one on inner concave surface |
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reverse cutting needle
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tough tissue (ligament)
three cutting edges: two lateral and one on outer concave surface |
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taper needle
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intraoperative and delicate tissue (peritoneum)
circumferentially round with point |
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F/U care and instructions for suture or staple
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keep clean and dry
elevate if applicable re-dress every 2 days cold compress first 48 hrs (20min*5) activity restriction analgesics RTC scars will take 1yr to mature, so avoid strong sunlight atbx |
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Procedure for suture removal
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Inspect for infection
use povadone-iodine cut to minimize dragging can use #11 scalpel if difficult be sure none is left inside leave open to air |
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Staple removal
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align staple remover
squeeze and lift in two distinct movements leave open air |
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F/U for adhesive WC
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Adhesives slough in 5 to 10 days
Don't scratch, rub, or pick Don't soak Don't put anything on it |
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Procedures to re-read
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Instrument tie
Simple interrupted stitch Dog Ear deformity Vertical Mattress Continuous SubQ |
