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35 Cards in this Set

  • Front
  • Back
tie blood vessels
sew tissues
Indications for wound closure (WC)
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
high likelihood of contamination
after 8 hrs post injury
presence of foreign bodies
extensive involving tendons, nerves, or arteries
Complications of WC
Scarring, keloid
Loss of fxn or structure
Loss of cosmetic
Wound dehiscence (margins separate)
Which layer of skin is devoid of blood vessels and nerve endings
what provides parent layer for new cells during wound healing
stratum germinivatum
which layer contains immune cells
which layer contains fat, blood v, and n.
Superficial fascia
Langer's lines
indicate direction of orientation of underlying collagen fibers
wound that gapes open
crosses langer's lines at right angles
wounds that naturally reapproximate
run parallel to Langer's lines
Classifications of wounds
Clean wounds
made during surgery s GI, resp or GU tract
Clean contaminated
surgery but c GI, GU, or Resp
Surgery c gross spillage
traumatic wounds
established infection before wound is made or heavily contaminated wounds
Pt prep for WC
take hx
do PE include sensory and motor
control bleeding
irrigate wound
immunize against tetanus if necessary
Characteristics of tetanus prone wounds
>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
Which people require immunizations
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
Give children which vaccine
DTP or DTap
Which vaccine is safe in pregnancy
Procedure for irrigating and cleansing wounds
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
Absorbable suture for what
mucosal areas
Non absorbable classifications
Multifilament - braided
Advantages and Disadvantage of monodilament
Adv - passes through tissue more easily
Disadv - less tensile strength
Adv and Disavd of multifilament
Adv - better flexability
Disavd - may harbor organisms
Conventional cutting needle
For skin
three cutting edges: two lateral and one on inner concave surface
reverse cutting needle
tough tissue (ligament)
three cutting edges: two lateral and one on outer concave surface
taper needle
intraoperative and delicate tissue (peritoneum)
circumferentially round with point
F/U care and instructions for suture or staple
keep clean and dry
elevate if applicable
re-dress every 2 days
cold compress first 48 hrs (20min*5)
activity restriction
scars will take 1yr to mature, so avoid strong sunlight
Procedure for suture removal
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
Staple removal
align staple remover
squeeze and lift in two distinct movements
leave open air
F/U for adhesive WC
Adhesives slough in 5 to 10 days
Don't scratch, rub, or pick
Don't soak
Don't put anything on it
Procedures to re-read
Instrument tie
Simple interrupted stitch
Dog Ear deformity
Vertical Mattress