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257 Cards in this Set
- Front
- Back
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At what age does the chance of morbidity and mortality increase greatly?
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70
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what is considered a poor excercise capacity?
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inability to walk 4 blocks or climb 2 flights of stairs
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Is obesity alone an independent risk factor for most major post-op adverse outcomes?
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no, except for DVT.
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What are the 3 proteins that are usually measured pre-op to determine whether they are healthy for surgery?
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serum albumin, transferin, prealbumin. serum is more of a long term marker. The other two are more for acute malnutrition
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what cardiovascular meds need to be stopped before surgery?
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plavix- 7 days before, becuase it irreversiblay affects platelets.
Stop diuretics, ACE inhibitors, and A2 antagonists the morning of. The rest of them can be continued just fine. |
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what do you do with pulmonary meds prior to surgery?
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continue them (thyophilline and the inhaled drugs)
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what complication is hormone replacement therapy associated with peri-operatively?
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Venous Thrombus embolism, not a problem though if you prophylax.
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what about anti-depressents?
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continue them
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what about aspirin? why?
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stop 7-10 days before because it permantly inhibits platelet cyclooxygenase.
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what about NSAIDs? why?
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stop 3 days before because the REVERSIBALLY inhibit platelet cyclooxygenase. Except for Celebrex, doen't need to be stopped, nor other Cox 2 drugs.
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what about warfarin?
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for prosthetic valve pts, keep the INR up around 2. If not, keep it around 1.5. Reverse the warfarin with vitamin K, for elective surgery stop warfarin 3-4 days before
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How do you bridge anticoagulations peri-operatively?
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heparin or enoxaparin 36 hours after you stopped the warfarin. It is only used on high risk patients.
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What excludes people from bridge therapy?
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really fat, pregnant, allergy, heparin induced thrombocytopenia, GI bleeds within the last 10 days
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CBC?
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usually not needed except for with older patients or if you know that they already have a problem that would effect it.
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what relevance is the PTT?
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coagulation test that measures the efficacy of the intrinsic pathway.It monitors abnormal clotting and also HEPARIN therapy. Normal numbers are 25-39 sec.
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what relavance is the PT?
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coagulation test for the extrensic pathway. Measures 2,5,7,10 and fibrinogen. The number is affected by vit K. Normal value of 12-15 sec.
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when is electrocardiogram important?
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men>45, women>55, cardiac disease, if evaluation suggests it, risk for electrolyte abnormalities, anyone undergoing a major surgery
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when do you order a chest x-ray
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>50 undergoing major surgery, or suspicion of cardiac, pulmonary disease
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what do you do with diet controlled type 2 diabetes peri-operatively?
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usually nothing, maybe a little bit of insulin if needed. Check their glucose levels pre and post-op.
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what do you do with diabetic patients that are treated with an oral hyperglycemic.
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stop the medicine the morning of surgery, and resume them post-op. Use a sliding scale of insulin if levels get too high.
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what about insulin dependant diabetics?
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continue with subcutaneous insulin perioperatively with basic surgery. Avoid the use of short acting insulin with longer surgeries. Better to use the long lasting insulin.
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What about patients with RA?
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do x-rays of back and neck both flexed and extended. Extended corticosteroid use can cause issues as well.
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what about for smokers?
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stop 8 weeks before. It will decrease and delay wound healing
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when do you prophylact?
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60 minutes before with ansef
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do you shave patients pre-operatively?
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no, only can use an electric type razor. Actually shaving has been associated with an increase in chance of infection.
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What about peri-op temperature?
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keep it cold
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surgical wound classifications?
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1-clean
2-clean contaminated 3-contaminated 4-dirty |
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ASA chart?
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1-healthy
2-mild systemic disease 3- severe systemic disease, results in functional limitation but not deabilitating 4- severe incapacitating diseasethat is a constant threat to life 5- not expected to survive more than 24 hours with or without the surgery. |
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goals of anesthesia?
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amnesia, analgesia, neuromuscular blockade, maintenance of hemostasis
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what is malignant hyperthermia?
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increase in temperature due to exposure to a gas that causes their temp to rise. Treat with Dantroline
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what are some mechanisms used to maintain hemostasis peri-operatively
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anatomic dissection
tourniquet epinephrine surgicel topical thrombin gelfoam |
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how do you avoid post-op vomiting?
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best to prevent rather than to treat. Promethezine, and other drugs.
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most common source of surgical site infection is thought to be what?
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direct inoculation of endogenous patient flora, usually Staph Aureus or strep.
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what are the most important factors in preventing a post-op infection?
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the general health of the patient, meticulous operative techniques, timely administration of pre-op antibiotics
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what besides an infection can cuase a fever?
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during or right after surgery- medications, malignant hyperthermia, trauma,infection already present.
acute (within 3-5 days)- surgical site sub-acute- drug reactions, DVT, PE |
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most common causes of post-op fever?
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infection, pneumonia, UTI, catheder
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how do you treat post-op fever?
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check for pneumonia, UTI, surgical site, give them acetometophin, find out the cause.
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How do you test for a DVT?
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swelling, pain, discoloration in the calf, dorsiflex the foot and squeeze the calf and check for pain. Duplex doppler ultrasound
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High risk for DVT?
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over 40, anesthesia for more than 30 minutes, inhibitor deficiency state,
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Hematomas?
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blood filled in dead space. Creates scarring, pain and increased risk of infection.
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White toe post-op?
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loosen the dressing, put them in the trendelburg position, warm it, local anatsthetic, nitro paste, loosen or remove the k-wire
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what is anesthesia?
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a state characterized by a state loss of sensataion by pharmicological depression of nerve function. Analgesia, amnesia, loss of consiousness, inhibition of sensory and autonomic reflexes, and skeletal muslce relaxation
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regional anesthesia?
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local anesthetics, topical , infiltrative blocks, feild blocks, spinals, epidurals
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MAC?
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monitored anasthesia care. intravenous sedation with regional.
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common drugs used anciently?
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diethyl ether, chloroform, Nitrous oxide, thiopental, curare, halathane
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anasthesia risk classifications 1-5?
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1- healthy
2- mild systemic disease (mild hypertension) 3- severe systemic disease that limits activity but is not incapacitating (stable coronary disease) 4- incapacitating disease that is a constant threat to life (recent MI) 5- patient not expected to surivive 24 hours with or without surgery |
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stage one of anesthesia?
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State of Analgesia
early- analgesia w/o amnesia late-analgesia w/ amnesia |
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stage 2?
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State of Excitement.
delirious and excited, amesia, irregular resper volume, possible vomiting, |
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stage 3?
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State of Surgical Anesthesia.
return of normal respiration to complete cessation. 4 planes of description: ocular movements, eye reflexes, and pupil size |
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stage 4?
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State of Medullary Depression.
begins when the spontaneous breathing ceases. severe depression of vasomotor region of the medulla. Patient requires full circulatory and respiratory help. |
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advantages of general anesthesia?
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analgesia, amnesia, unconsiousness, and paralysis
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disadvantages for general anasthesia?
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expensive, higher risks
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when do we use genreal anesthesia?
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rearfoot, trauma, infection, if patient requests it
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what is the difference between a spinal and an epidural?
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epidural stops before the dura mater and the local is deposited. It is a sympathetic sensory block only. Longer onset, and cannot cause headaches
spinal punctures the dura mater and stops sensory, motor, and autonomic. Has more complications- hypoTN, headache, palsies, cauda equinus syndrome and infection |
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what does a patient have to do before leaving the hospital after recieving a spinal?
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void.
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what is a bier block?
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two tourniquets- one above the knee and one below the knee. but lidocaine in the vein between the two. inflate distal tourniquet. Let out the proximal tourniquet and 20-30 minutes later deflate the distal tourniquet slowly.
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most common form of block we do?
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infiltrative block- missed blocks are usually becuase of poor technique or bad understanding of anatomy
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how do local anesthetics work?
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prevent sodium migration through the nerve membrane, preventing depolarization of the nerve.
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what happens if you inject a local into an acidic area (an area of infection)
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less potent
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how are esters hydrolized?
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in the blood by plasma pseudocholinesterases
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how are amides hydrolyzed?
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in the liver by CYP 450
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is there a cross sensitivity to them?
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no
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what is the most toxic ester?
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procaine
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what ester has the longest duration?
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tetracaine
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most common amide?
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lidocaine-very short duration, but works very quick?
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which amaid should not be used in renal patients?
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mepivacaine
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which amide is the most cardiotoxic?
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bupivacaine (marcaine), don't use in kids younger than 12.
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what is the onset and duration of procaine?
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1-2 minutes onset, 30 minute duration
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onset and duration of lidocaine
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1-2 minutes, 2 hours duration
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onset and duration of bupivacaine?
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5-10 minutes, 8 hour duration
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how do you avoid toxicity when giving an anesthetic?
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aspirate before you inject. Do not inject if you see blood flow into the syringe. Redirect.
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CNS toxicity symptoms?
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tinnitus, lightheaded, confused, tonnic-clonic convulsions, unconsiousness, CNS depression, respiratory arrest
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CVS toxicity symptoms?
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HTN, tachycardia, myocardial depression, decreased CO, HypoTN, peripheral vasodilation, sinus bradycardia, arrythmias, circulartory collapse
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whatis the toxic dose of lidocaine plain and mixed with epinephirne?
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300 mg, 500 mg
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and for bupivacaine?
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175 mg, 225 mg
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what does epinephrine do to vessels?
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vasoconstrictor, often used for hemostasis. DO NOT use with patients that have microvascular disease, they won't heal.
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what is the most popular form of anesthesia in the last few years?
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Monitored anesthesia care (MAC)- 3 drug cocktail that causes sleep, amnesia, and mild anesthesia. Then the local is given.
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what are the 3 drugs used in MAC?
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midazolam, fentanyl, propofol. Propofol is usually given on the table. the other two are given before.
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combination of which two gives you amnesia?
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midazolam, propofol
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As the number of zeros increas in the type of suture material, what happens to the diameter?
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decreases
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what can accelerate the absorption of absorbalble sutures?
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fever, infection, or protein deficiency, or if it gets wet during handling.
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what is another name for polyglyactin 910?
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Vicryl
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when is tensile strength lost with vicryl?
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60 days
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What is vicryl coated with?
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calcium stearate and polyglactic 370
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how much tensile strength is left after 28 days?
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8%
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is it absorbable?
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yes
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what was the first synthetic absorbable suture?
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dexon
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what is the tensile strength after 28 days with dexon?
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5%
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when is tensile strength lost completely with dexon?
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90-120 days
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Is dexon absorbable?
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yes by hydrolysis
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which suture has superb knot tying ability?
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dexon
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what is PDS?
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paradioxanone
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what is the tensile strength after 28 days with PDS?
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58%
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When is PDS lost all tensile strength and has been absorbed?
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180 days
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Which suture is best when extended wound tensile strength is required?
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PDS
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what is the down side of PDS?
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difficult to use becuase it is stiff, hard to tie down. Because it is a monofilament suture.
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Which suture is best for short term tensile strength?
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monocryl. Dyed tends to have 10% more tensile strength than the un-dyed at equivelant intervals
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how much tensile strength does monocryl have after 28 days?
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0
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What is the absorbable suture of choice?
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Maxon
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Why is Maxon the absorbable suture of choice?
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it is stronger than PDS and Vicryl and lasts for 180 to 210 days, then is absorbed
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what is the popular gauge used in podiatry in regards to stainless steel non absorbable sutures?
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28
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which non-absorbable suture degrades at a rate of 15-20% per year by hydrolysys?
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Ethicon Nylon
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which non-absorbable suture is best for running intradermal closure?
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Prolene
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what do we need to know about prolene when it comes to holding the knots?
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one of the better synthetic non-absorbable sutures when it comes to holding knots, but extra throws are required brecause of the extreme smoothness of the suture
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describe the plasticity of prolene?
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will stretch for swelling, but will not shrink when swelling subsides
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when are prolene sutures recommended?
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when minimal reaction is desired, with contaminated and infected wounds.
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what are keith needles and what are they used for?
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straight needle with cutting edges, used for abdominal skin closure and tendon repair
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what is the main difference between novafil and prolene?
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novafil and prolene will both stretch with edema, but novafil will maintain its tension after the swelling subsides
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describe the absorption of silk sutures?
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loses most of its tensile strength after one year, and is completly gone after 2 years.
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what is the main difference between the nurulon nylon and the other previously mentioned non-absorbable sutures so far?
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multi-filament
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what was the first multifilament synthetic suture to last indefinitely in the body?
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Merseline, not coated, so it has a lot of resistance
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why is ethibond not used often?
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too expensive
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what is the difference between a conventional and a reverse cutting needle?
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the direction in which they cut as they pass through the skin. The conventional cuts on the inside of the needle curve. The reverse cutting cuts on the outside of the needle curve.
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which one works better when extra tension is put on a suture at maintaining the suture, a conentional or a reverse cutting needle?
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reverse
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what is the shape of a tapered needle?
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rounded so it has no cutting edges
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what are precision point needles used for?
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plastic surgery
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what kind of needle is used on high risk patients?
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blunt point needle (good for HIV patients)
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what needle is recommended for use in the deep tissue layer like the capsule?
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a cutting needle with 3-0 material
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what needle is recommended for use in the subcutaneous tissue?
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a taper needle with 4-0 material
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what needle is recommended for use in the dermal layer?
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precision needle with 5-0 material
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what sutures are most likely to be used in the fascia layer?
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prolene,PDS 2 in healthy individuals
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what sutures are most likely used in muscle/
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PDS 2, vicryl, prolene
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what cautions must you consider when doing sutures in the muscles?
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patients may feel the knots under the skin when using prolene
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what suture is best to use in the subcutaneous fat layer
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vicryl
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what suture is recommended in the sub cuticular region?
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clear monocryl or vicryl
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what suture is recommened to be used in the skin?
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silk, nylon, or polypropoylene
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what suture is recommended when in tendons?
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prolene, ethibond, nylon, other polyesters
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what suture is best to be used in bone?
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surgical stainless steel
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what sutures are best and what method needs to be done in tissue that is infected, or with a contaminated wound?
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non-absorbable monofilament or nylon. Placed in the tissue, but not tied down
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what are the sutures recommended to podiatrists for use in the capsule?
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2-0 to 3-0 vicryl
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for the subQ layer?
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4-0 vicryl
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for the skin layer?
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4-0 nylon or prolene clear
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for the sub cuticular layer?
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5-0 vicryl clear
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what are the advantages of single interupted suture technique?
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provides more secure closure because if one strand breaks, the remaining sutures still hold the wound edges in approximation, and microorganisms are less likely to travel along interupted sutures
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what is a verticle matress suture?
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start with the simple interupted, but don't tie it and then pass the needle in the reverse direction deeper to the first, then tie it.
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what is the horizontal matress suture?
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start with the single interupted suture, don't tie it and then do in reverse farther down the incision and then tie it off where you started?
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if the sutures are going parallel to the incision line, what type of stitch is it?
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horizontal matress
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if they are going perpendicular to the incision line but do nor cross the incision what stitch is it?
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vertical matress
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what type of suture runs diagonally across the incision?
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continuous suture
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what are the advantages of a continuous running suture?
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tensile strength is stretched along the entire suture. And it is quicker
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what are the disadvantages?
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if it breaks, it compromises the entire suture. Microorganisms can grow along the entire suture
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what are the advantages of the continuous locking suture technique?
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water tight and hemostatic
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where are the subcuticular sutures located?
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in the dermis.
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what is the bunnell stitch used for?
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to approximate two tendons
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what are the advantages of using surgical staples?
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quickly placed, very easy to use, cost effective
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disadvantages?
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hurts to remove, causes an ugly scar
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How are surgeons normally graded?
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on the scar.
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what can you use other than sutures on subcuticular cuts?
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steri strips
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what is dermabond?
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liquid skin adhesive to approximate skin edges
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what are the advantages of using dermabond?
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wound closure time is shortened by 20-50%, easy to apply and is inexpensive, no need for suture removal, no needle stick risk, comparible to 5-0 suture
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disadvantages?
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only to be used in areas that won't swell, and not over joints, can wash off, really weak during the first day
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what is an ulcer?
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complete erosion of the epidermal and dermal layers. Exposure of teh underlying subcutaneous tissue muscle and bone.
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define the wound bed?
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the epidermal and dermal erosion
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define the wound border
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the rim of hyperkeratotic tissue around the ulcer
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define the peri-wound area
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the surrounding viable skin
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what are the five different types of ulcers?
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1- nuerotrophic
2- pressure 3- venous insufficiency 4- arterial insufficiency 5- other |
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describe a neurotrophic ulcer?
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a neuropathic or diabetic foot ulcer. Also called a Mal Perforans ulcer, the result of constant microtrauma. Usually over bony prominiences, blood supply is still good.
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what is the largest cause of non-traumatic amputations in the united states?
|
diabetic foot ulcer
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describe the relationship between charcot foot and the vasculature?
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usually has really good, almost too good blood supply, causing bounding pulses. Vasodilation causes the bone to thin and you get microfractures in the bones. Usually treat by keeping it non-weight bearing
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how do you treat the neurotrophic ulcers
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1. corrrect neuropathy if possible
2- reduce the microtrauma 3- remove the deformity 4. wound conversion (debride and bacteria control) 5.systemic support (control the diabetes) |
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what are the wagner diabetic ulcer classification levels?
|
0-partial dermal erosion
1- full thickness dermal erosion 2- subcutaneous involvement 3- extends to tendon, capsule, bone 4- local gangrene 5- gangrene of the entire foot |
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what is an ulcer?
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complete erosion of the epidermal and dermal layers. Exposure of teh underlying subcutaneous tissue muscle and bone.
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define the wound bed?
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the epidermal and dermal erosion
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define the wound border
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the rim of hyperkeratotic tissue around the ulcer
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define the peri-wound area
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the surrounding viable skin
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what are the five different types of ulcers?
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1- nuerotrophic
2- pressure 3- venous insufficiency 4- arterial insufficiency 5- other |
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describe a neurotrophic ulcer?
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a neuropathic or diabetic foot ulcer. Also called a Mal Perforans ulcer, the result of constant microtrauma. Usually over bony prominiences, blood supply is still good.
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what is the largest cause of non-traumatic amputations in the united states?
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diabetic foot ulcer
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describe the relationship between charcot foot and the vasculature?
|
usually has really good, almost too good blood supply, causing bounding pulses. Vasodilation causes the bone to thin and you get microfractures in the bones. Usually treat by keeping it non-weight bearing
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how do you treat the neurotrophic ulcers
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1. corrrect neuropathy if possible
2- reduce the microtrauma 3- remove the deformity 4. wound conversion (debride and bacteria control) 5.systemic support (control the diabetes) |
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what are the wagner diabetic ulcer classification levels?
|
0-partial dermal erosion
1- full thickness dermal erosion 2- subcutaneous involvement 3- extends to tendon, capsule, bone 4- local gangrene 5- gangrene of the entire foot |
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describe the UTHS classification?
|
0- pre or post ulcerative site
1- to the subcutaneous level 2- to tendon or capsule 3- to bone or joint A- Clean B- Non-ischemic infected C- Ischemic D- Ishemic infected |
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what type of ulcer is 100% preventable?
|
pressure ulcer, or a decubitus ulcer
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describe the pressure ulcer classification
|
stage 1- non blanchable erythema of contact skin
2- skin loss of epidermis and dermis 3- loss to the subcutaneous and, but not through the fascia 4- necrosis of bone, muscle and supporting tissues unstagable- no break in the skin yet |
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how do you treat pressure ulcers?
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remove the pressure
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where are venous insufficiency ulcers usually found?
|
medial ankle, very high recurrence rate
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how do you treat the venous insufficieny ulcer?
|
reduce the venous hypertension, improve the venous return. Treat the damaged veins, elevate leg, compression therapy, and wound conversion
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what is anothername for an arterial insufficiency ulcer?
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ischemic ulcer
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where are arterial insufficiency ulcers usually found?
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most distal part of the foot.
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how do you treat an arterial insufficiency ulcer?
|
increase perfusion,
surgical revascularization wound conversion |
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describe the inflammatory phase of wound healing?
|
0-3 days
recovery from wound conversion |
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describe the proliferative phase of wound healing?
|
3 days to healed wound
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what are the 2 most common causes of DVT?
|
hospitalization and nursing homes (59%)
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what percentage of patients with that have a pulmonary embolism are also found to have DVT?
|
80%
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what is virchow's triad?
|
3 factors that lead to a DVT:
1. venous stasis 2. vein endothelial damage 3. hypercoagulable state (decrease in antithrombin 3) |
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what are other risk factors that can lead to a DVT?
|
malignancy
CHF trauma central venous cathedar pacemaker superficial VT >30 min surgery >3 days immobilization vericose veins pregnancy smoking obesity drugs prior DVT |
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of the previous factors, which one is considered to be the worst factor?
|
prior DVT
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what factors will give you one point when quantifying risk factors for DVT?
|
age 41-60
prior post-op DVT family history >12 hr immobilization >2 hr surgery edema MI/CHF ulcers vericose veins |
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what factors will give you two points when quantifying risk factors for DVT?
|
age 61-70
prior idiopathic DVT major surgery malignancy multiple trauma spinal cord injury with paralysis |
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what factors will give you three points when quantifying risk factors for DVT?
|
age > 70
prior PE thrombophilia either kind. |
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how do you diagnose a DVT?
|
high index of suspicion
H & P Homan's test sudden swelling in one extremity |
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what is Homan's test
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dorsiflex foot and squeeze the calf and check for pain response, if so start suspecting DVT.
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what is considered the golden standard for testing for a DVT?
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invasive testing by contrast venography
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what is the method that is usually used to check for a DVT?
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doppler exam
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what is wrong with this kind of test?
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it's efficacy is highly dependant on the skill of the technician.
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what is impedence plethysmography?
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another non-invasive test. Cuffs are put on thigh and calf. Thigh is deflated and then check pressure over time in calf. Delayed drop in BP can indicate DVT.
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with the D-dimer blood test for DVT, why is it not used very often?
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It can only be used on your low risk patients, but good for those in the low risk category, can rule it out quickly.
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what are the forms of prophylaxis used to prevent DVT's?
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Heperin
LMWH intermettint compression devices TED hose |
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what is LMWH?
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low molecular weight heperin. It is man-made and is called enoxaparin (levonox). 40mg once a day in pill form. Gets people out of the hospital faster.
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what prophylaxis technique is used for low risk patients?
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early ambulation
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what prophylaxis technique is used for lmoderate risk patients?
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heperin every 12 hours, or Enoxaparin, or SCDs
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what prophylaxis technique is used for low risk patients?
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hepirin every 8 hours, Enoxaparin, or SCDs
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what prophylaxis technique is used for very high risk patients?
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Enoxaparin, Warfarin, or IV heparin drip.
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When would you not prophylax?
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actuve bleeding
severe bleeding predisposition <20,000 platelet count neuro or occular surgery |
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when would prophylaxis be a concern that you have to consider on a pt by pt basis?
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mild bleeding predisposition
20-100,000 platelet count abdominal surgery or bleeding endocarditis malignant hypertension |
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when do you avoid using LMWH?
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fat patients and renal patients because it isn't reversible
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what is the heparin normal dose? what is it's MOA?
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5000 units subQ every 8-12 hours and 1-2 hours pre-op. it binds to antithrombin 3 inhibiting platelet function.
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what is the LMWH normal dose? what is it's MOA?
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30 mg subQ twice a day or
40 mg subQ once a day. It inhibits activated factor Xa. |
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what do you monitor to watch your enoxaparin levels?
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platelet count and hematocrit
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what do you need to do if the platelet count drops below 100,000?
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stop the enoxaparin and give protamine
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what do you do with a patient that is on warfarin therapy with a fully elective surgery?
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withold warfarin about 3-4 days prior to surgery to get the INR down to 1.5-2.
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what do you do with a patient that is on warfarin therapy with a semi-urgent surgery?
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reversal in 1-2 days, withold warfarin with a small dose of IV vit. K
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what do you do with a patient that is on warfarin therapy with an urgent surgery?
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reversal in less than one day, withold warfarin with a large dose of IV vit K
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what do you do with a patient that is on warfarin therapy with an emergency surgery?
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fresh frozen plasma in addition to the vitamin k
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If your patient is on warfarin and has an INR between 2-3, when do they need to stop?
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stop 5 days before and start enoxaparin 36 hours after the last dose of warfarin. Take the last dose of enoxaparin 24 hours before. Resume enoxaparin and 5mg of warfarin 24 hours after surgery and discontinue the enoxaparin when the INR gets back to between 2-3 for two consequetive days.
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what is a normal hematocrit for males and females?
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females= 11-16
males= 12-17 if low it is considered anemia |
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what are the normal hematocrit levels in males and females? what disease usually causes an increase in the hematocrit levels in patients?
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females= 35-47
males= 43-53 polycythemia vera |
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when is a CBC relevant?
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patients older than 65 undergoing major surgery, or a surgery that normally cause significant blood loss or if you think they might have anemia.
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what diseases would cause you to use a PT/PTT before performing a surgery?
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malnutrition
liver disease hemophilia vitamin or clotting deficiency |
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what are the 3 steps involed in the hemostasis phase of wound healing?
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platelet aggregation
activation of cascade fibrin deposition |
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what is the 2 phase of wound healing?
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inflammation- increased vascular suipply, and migration of macrophages, release of the cytokines and growth factors.
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what is the third step of wound healing
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proliferization- proteoglycan production, fibroblasts, collagen deposits, revascularization, re-epithilization
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what is the 4th stage of wound healing?
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remodeling- cross linking of the collegen and scar maturation
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what factors can affect wound healing?
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infection
foreign body eschar desication' edema pressure and friction systemic disease corticosteroids vascular disease age immune suppressed nutritional status |
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how many bacteria per gram of tissue is considered infected?
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10 to the 5th.
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what is a primary closure in relation to wound healing?
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surgical incision, close with sutures, minimal tissue loss, minimal granulation, minimal inflammation, proliferative phase is mostly fobroblasts
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what is a secondary closure in relation to wound healing?
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an open wound with tissue loss, wound remians open, alot of inflammation and granulation, contraction of the wound with epithilization
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what causes the tissue contraction with the secondary closure in relartion to wound healing
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myofibroblasts
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what is a delayed primary closure in relation to wound healing?
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wound is allowed to stay open to monitor infection, then close the wound later when it appears that it is no longer infected.
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what is a partial skin graft include?
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part of the dermis
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wht is a full thickness skin graft include?
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it includes all of the dermis
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describe the process of the skin graft "taking"
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inbibition- 24-48 hours after put on, the graft is "glued" on with fibrin.inosculation- capillary ends line up with eachother to get it vascualrized
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what kind of graft has a better chance to take?
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thinner
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what kind of graft has a greater initial contracture?
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thicker
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what kind of graft will have the greatrest amount of secondary or latent contracture?
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thinner
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what is a hypertrophic scar?
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raised fibrotic scar that usually remains at the incision site. Raised, red, itchy, udergo spontaneous resolution and are associated with contracture. Has nodules. Increased collagen, decreased collagenase. Treated well with pressure, or silicone sheeting.
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what is a keloid?
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aggresive scarring beyond the site of original incision or insult. They can be deforming because they like to contract.
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what is the human dermal fibroproliferative disorder?
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familial disposition to have a keloid or hypertrophic scar. Increased cytokine production leads to too many fibroblasts.
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what methods are used to replace injured cartilage?
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marrow stimulation
autologous tissue tissue engineering joint prosthetics osteocartilaginous graft. |
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what is primary bone healing?
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a cutting cone- advancing column of large multinucleated cells lined with osteoclasts with blood supply and osteoblasts in the tail of the cone.
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what is secondary bone healing?
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natures way of creating internal fixation. Callus and cartilage tissue is layed down in the soft stage and later is changed to bone.
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what is osteogenesis?
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the ability of cells to create bone
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what is osteoinduction
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the process of inducing bone formation
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what is osteoconduction
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scaffolding that allows bone to grow
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what is osteointegration?
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integration of an implant into the body without a fobrous layer.
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what 3 people can make up the anesthesia team?
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anesthesiologist- MD or DO with residency anesthesia training.
CRNA- registered nurse that has completed an anesthesia program AA- PA that has completed an anasthesia program. |
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the suture material is at least as strong as......?
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the tissue in which they are placed.
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what are the advantages of using a monofilament suture?
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they encounter less resistance as they pass through tissue. They resist harboring organisms. They tie down easily.
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what are the advantages of using a multifilament suture?
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greater tensile strength, pliability, and elasticity. Usually coated to help pass through tissues.
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when do absorbable sutures lose their tensile strength?
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by 60 days.
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Is vicryl a monofiliment or multifiliment suture?
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comes in both forms
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which form of dexon suture is easier to handle, the mono or multi-filament form?
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multifilament is easier to handle.
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hich form of Dexon is easier to use and has better knot tying ability Duxon 2 or Dexon plus?
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dexon 2
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which type of dexon is uncoated?
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dexon S
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All dexons provide good wound closure for how long?
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3 weeks
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with the non-absorbable suture ethilon nylon, why are more knots required with the monofilament in comaprison with the braided?
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because it has a higher amount of memory, or tendency to return to the original straight state.
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what kind of needle has the thread attached to it?
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swaged
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