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59 Cards in this Set
- Front
- Back
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Classification and example of a clean wound?
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aseptic technique with no structure containing bacteria
-spay |
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Classification and example of a clean contaminated wound?
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surgical created wound but hollow viscus or organ normally containing bacteria
small breaks in aseptic technique -endoscopy |
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Classification and example of a contaminated wound?
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surgical wound but hollow viscus is open or major break in aspetic technique
-bile spill |
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Classification and example of a dirty wound?
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contains pus, contents of perforated hollow viscus
-peritonitis |
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What is the incidence of infection with a clean, clean contaminated, contaminated and dirty wound?
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clean 0-4.4%
clean contaminated 4.5 - 9.5% contaminated 9.5 - 28.6% dirty - implies infection |
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What are factors that affect development of post operative infections?
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-adequate nursing care practices
-wash hands between patients -protect incision line -remove catheter and drains as soon as no longer needed |
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How does anesthesia time, surgical time and body temperature affect incidence of post operative infections?
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-risk of infection doubles with each hour of surgery
-time = trauma |
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What are prophylactic antibiotics?
preventative? therapeutic? |
prophylactic - administering prior to wound contamination
-preventative - administering after exposure to contaminant but before infection -therapeutic - administer after infection is present |
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What are indications of prophylactic antibiotics?
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risk of infection or infection with catastrophic results
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What are the guidelines for prophylactic antibiotics?
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-administerd prior to induction when catheter is placed
-given 30 minutes before skin incision -not given any longer than the first 24 hours after surgery -should be a 1st generation cephalasporin - cefazalin can be a 2nd generation - cefoxitin - GI tract |
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How might closed wounds become surgical wounds?
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if there are instances with excessive edema, internal hemorrhage or times of skin necrosis
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Why are traumatic wounds at best classified as contaiminated?
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because there is gross spillage, break in aseptic barrier which can be due to foreign objects
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What is an iceberg wound?
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a wound that is bigger underneath that it looks superficially
-seen in punctures due to dog fights |
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What are criteria used to decide whether to treat a bite wound?
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-size and number of wounds
-location of wounds -clinical assessment of severity of trauma |
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What is a degloving injury?
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an injury due to shearing forces that sever cutaneous vessels supplying skin
can be physiologic - skin is devitalized but sill in place or anatomic in which the skin has been removed |
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What is a fistulous draining tract?
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communication between two epithelial surfaces in which the fistula is lined by epithelium
-oronasal fistula |
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What is a sinus draining tract?
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connection between mesothelial surface and skin, usually one opening, associated with foreign body migration
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What is the gold standard for diagnosing foreign bodies?
What else can you use? |
*ultrasound*
radiographs take dye, methylene blue, to follow draining tract intraoperatively |
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What factors affect severity of tissue trauma associated with gunshot wounds?
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shape of the bullet
caliber *velocity* velocity determines injury |
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Is it necessary to remove lead fragments?
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-it is unnecessary unless it lies within a joint or any other area with high enzymatic activity like the GIT
-Lead fragments in soft tissue are relatively inert and usually become walled off. |
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What are common sources of contamination in wounds?
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patients own flora
accident site hospital - nosocomial infections |
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How do you prepare a patient for examining traumatic wounds?
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-assess pain
-protect wound from further contamination -examine penetration wounds when animals is stable -wound lavage |
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How is wound lavage performed?
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using tap water, balanced electrolytes or antiseptic solutions under moderate pressure to remove bacteria
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What are advantages to adding antibiotic/antiseptics to wound lavage solutions?
Disadvantages? |
advantage
-long acting -control/avoid infection -debridment disadvantage -hypersensitivity -tissue damage (not with granulation) -not effective dosing |
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When should antibiotics/antiseptics be discontinued?
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when wound is out of lag phase
-granulation |
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How can wounds be debided?
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surically - most common
-enzymatically - when surgery may damage important structures or in poor anesthetic risk patients -mechanical - devitalized tissue and foreign body trapped in primary bandage indicated for heavy contamination |
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What are the affects of negative pressure therapy?
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promotes granulation tissue after surgical debridment
improves local environment to enhance second intention healing -decreases bacterial burden and removes inflammatory cytokines -less bandage changing negative -can cause pads to become incorporated into wound and need for surgical debidement |
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What are the types of wound closure?
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primary
delayed primary secondary contraction - epithelialization |
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What are reasons for contraction to cease?
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-wound has healed
-tension in surrounding skin exceeds pull of myofibroblasts -collagen deposition in chronic wound interferes with pull of myofibroblasts |
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What are complications of second intention healing?
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-The length of time needed for complete healing to occur
-Contraction and epithelialization may cease before the wound is closed -Wound contraction can interfere with normal function (wound contracture) |
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What is the importance of knowing skin tension lines?
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running parallel to tension lines aids in faster healing, less scar formation
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What are principles for undermining skin to facilitate closure?
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-blunt dissection
-undermine cutaneous structures -preserve cutaneous vessels |
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What are walking sutures?
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special kind of SQ suture used to advance skin that has been undermined across the surface of a wound
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What are the advantages of walking sutures?
disadvantages? |
Advantages:
-Help closed skin defects too large to close by direct apposition of skin edges w/out excessive tension -Takes advantage of both the loose attachment and inherent elasticity of the skin -Helps decrease the dead space and distribute tension over the entire surface of the wound Disadvantage: -sutures must engage the dermis and fascia otherwise they will likely pull out when the knot is tied -Compromise of the direct cutaneous vessels by penetrating them with sutures |
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How do you enhance local movement of skin?
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expanders
skin stretching presuturing multiple punctate relaxing incisions adjustable sutures - vertical mattress sutures |
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When is a Z plasty indicated?
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when loose skin is available perpendicular to the direction of wound closure
maximizes gain in length while still allowing good mobility of flaps |
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When are drains indicated?
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dead space that can not be obliterated
fluid accumulation infection -increased likelihood of secondary infection |
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What are the principles of drain management?
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drains should never exit through an incision line
drains should not line under the suture line |
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Describe passive drains and their uses.
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placed using gravity to let a wound drain
apply bandage to absorb fluid use one exit instead of two |
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Describe active drains and their uses.
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fluid is sucked out of a wound
decrease drainage around the skin can use smaller fenestrations -enhances wound healing -needs to be air tight |
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What is an ingress/egress system?
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used to perform wound lavage where ingress drain has a separate access for putting solutions in to be drained out another hole (egress)
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What is a skin flap how does it differ from a skin graft?
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flap - maintained or immediately re-established when skin segments is moved to a new position
graft - blood supply is severed and new vessels must grown in from recipient site |
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What are skin flap classifications?
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Type of blood supply
-subdermal plexus -axial pattern flap -re vascularized Distant from wound -local - flaps that rotate -distant |
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What is a rotational flap?
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used for triangular wounds where an arching incision 2.5 times the side of the defect is undermined and advanced to close the defect
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What is a transitional flap?
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a flap used in ares of loose skin are in the opposite direction of the wound
used on ears, head and tails |
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What is a single pedicle flap?
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flap were loose skin is advanced forward
lose skin is in same direction as the defect |
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What is an axial pattern flap?
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a transitional flap that incorporates a direct cutaneous artery and vein
used for thoracodorsal and caudal superfical epigastric which can be ipsilateral or contralateral |
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What is a bridging incision and when are they used?
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used to connect donor site and wound
tubing, need a second surgery to cut free can be a pouch or single pedicle |
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What are complications of bridging flaps?
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-seroma
-flap edema -infection -patrial dehiscence -vessel thrombosis |
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What are indications for grafts?
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skin defects on the extremities
excessive burn wounds -adjudicative to other reconstructive procedures |
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What is an autograft?
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grafts that are transferred from donor site to recipient site from the same patient - most successful
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What is an allograft?
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grafts transferred between individuals of the same species
used for burns - will eventually reject |
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What is a xenograft?
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graft transferred from once species to another
indicated for temporary biological dressing |
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How do you know granulation tissue is ready for grafting?
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when tissue is pink and glistening, it is a smooth surface and wound contraction and epithelial migration is visible at wound margin
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What is a full thickness graft?
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a graft in which the epidermis and entire dermis is present and contains all adnexal components and is more likely to resemble normal skin - includes hair follicles
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What is a split thickness graft?
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a graft that has epidermis and various dermal portions
used in Large animals used for burns when donor sites are limited |
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What is a mesh graft?
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a full of split thickness graft that has parallel rows of staggered slits to allow larger coverage over deficits
allows drainage from underneath graft |
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What is a punch/seed graft?
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a full thickness graft with plugs of skin are placed in granulation bed
indicated for poor Ax candidates, grafting of contaminated or affect wounds has poor cosmetic appearance |
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How do you manage grafted skin post op?
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-cover graft with non-adherent pad and apply moderate pressure
-apply antibiotic ointment under pad -immobilize especially in areas with joints affected -change bandage every other day the first ten days and as needed for two weeks -remove sutures in 10 days |
