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54 Cards in this Set

  • Front
  • Back
Classification of wounds is based on what 3 things?
1) Based on nature of the injury
-Open VS closed
2) Based on time
-Acute VS chronic
3) Based on contamination
What is a closed wound?
Crushing via blunt force trauma without opening of the skin
What is an open wound?
Skin loss puncture
What are 5 types of open wounds?
1) Abrasion
2) Avulsion
3) Incision
4) Laceration
5) Puncture
What is the definition of an abrasion?
Shearing force or blunt trauma
What is the definition of an avulsion?
Tensile force tears tissue (e.g. degloving wound)
What is the definition of an incision?
Controlled, smooth defect created by a sharp object
What is the definition of a laceration?
Irregular wound creating by tearing
What is the definition of a puncture?
Penetrating wound caused by missile or sharp object
What is the controversial "golden Period" of distinguishing b/w acute and chronic wounds?
4-6 hours
-Key is presence of granulation tissue and scar formation
What is the definition of a clean wound?
Surgically created wound w/o penetration into a hollow viscus and no break in sterile technique
What is the definition of a clean-contaminated wound?
A hollow viscus is entered (GI, respiratory, or genitourinary tract)
-No grossly visible spillage or contamination
What is the definition of a contaminated surgery?
Any grossly visible spillage or contamination occurred
OR a traumatic wound < 4-6 hours old (golden period controversy again)
What is the definition of a dirty wound?
Gross contamination of the surgical site w/ an established infection present (e.g. pus, fecal material)
OR a traumatic wound > 4-6 hours old
What type of a surgery (according to degree of contamination) is an ovariohysterectomy?
What type of a surgery (according to degree of contamination) is a one day old bite wound?
What type of a surgery (according to degree of contamination) is a splenectomy?
What type of a surgery (according to degree of contamination) do you call a femoral fracture repair?
What type of a surgery (according to degree of contamination) is an enterotomy with spillage of GI contents?
What kind of a surgery do you call a lung lobectomy?
What are the 4 types of wound healing?
1) Primary wound closure
2) Delayed primary wound closure (1-5 days)
3) Secondary wound closure (>5 days)
4) Second intention healing
What is primary wound closure?
Careful anatomic closure of a defect (i.e. reconstruction) at the time of wounding
-Results in the smallest scar tissue formation
What is delayed primary wound closure?
Closing a defect after a period of 1-5 days- allows for wound debridement and granulation tissue formation
What type of wound healing is it called when a shearing injury is closed on a limb after 3 days of wet to dry bandaging?
Delayed primary wound closure
What type of wound healing do you call most surgical wounds and clean laceration repair?
Primary wound closure
What is secondary wound closure?
Same as delayed primary wound closure but happens >5 days post-wounding so you are closing over granulation tissue
What is second intention wound healing?
Allowing a wound to heal by granulation tissue and contraction and re-epithelialization
-Results in most scar tissue and contracture
When is the contracture and scar tissue formation from second intention wound healing a problem?
When over areas of tension such as joints
What type of wound healing is it when you allow a burn over the dorsum to heal over a period of weeks?
Second intention wound healing
What type of wound healing is it when you do bandange changes for 2 days then suture it closed?
Delayed primary healing
What kind of healing is it when you do bandage changes until it heals?
Second intention healing
What type of healing is it when you use bandages for 14 days, excise the edges and suture it closed?
Secondary closure
What are the 4 phases of wound repair? When does each occur?
1) Coagulation
2) Inflammation
-hours to first few days
3) Proliferation
-Starts within a day or so
-Granulation tissue usually appears
4) Maturation (aka remodeling)
-Starts around day 17-20 and lasts for months/ years
What happens for during the coagulation phase of wound repair?
Vasoconstriction --> vasodilation >>> fibronectin + factor XIII cross link to form fibrin >>> clot/ eschar
What is the order of inflammatory cell arrival during inflammation?
-PMNs early (proteinases & superoxide radicals)
-Macs later (essential for repair, + platelets)
- Mac proliferation is a hallmark of chronic inflammation
-Lymphocytes last to arrive
What are the 4 components of the proliferation phase of wound repair?
1) Fibroplasia
2) Angiogenesis
3) Epithelialization
4) Contraction
What happens during fibroplasia?
Type III collagen first, then type I, deposition levels off after day 1-4 which has not just collagen but also elastic and proteoglycans
What is the angiogenesis phase of wound repair?
New capillary beds follow fibroblasts, bringing blood supply to the wound which supports the cells of wound healing
What is epitheliazation?
Migrates from edges until reach contact inhibition, anoxia or mechanical force
What is contraction?
Fibroblasts>>myofibroblasts until contact inhibition or overwhelmed by tensile forces on the wound
What does the maturation phase of wound repair consist of?
Extracellular matrix remodeling & maturation
-Randomly organized collagen is reorganized along lines of tension w/ concurrent increase in strength
What regulates the rate of collagen degradation during extracellular matrix remodeling & maturation?
Matrix metalloproteinases
How does wound strength vary with time?
Fibrin clot forms as quickly as 6 hrs and is present until day 3-5, rapid rise in strength from day 7-14 as increase in collagen
How strong is a scar compared to the original tissue?
Ultimately only 75-80% of original tissue after months/ years of remodeling
What are 2 physiologic factors that affect wound healing?
1) Oxygen
-Limiting factor for replication & protein synthesis
2) Temperature
-Faster healing at 30 C then room temp
What are 11 endogenous factors that influence wound healing?
1) Hypoproteinemia
2) Anemia
3) Uremia
4) Diabetes
5) Cushings
6) Liver disease
7) Nutritional status
8) Age
9) Infection
10) Tension
11) Dead space
How does hypoproteinemia affect wound healing?
When less than 2mg/dL then decreases the amount of fibrous tissue deposited
How does anemia affect wound healing?
Decreases O2 delivery to tissue; hypovolemia
How does uremia affect wound healing?
Alters enzyme function and decreases wound strength
How does Cushing's affect wound healing?
Glucocorticoids are profound inhibitors of all phases of wound repair
What are 7 exogenous factors that affect wound healing?
2) Corticosteroids
3) Chemotherapy
4) Radiation therapy
5) Presence of foreign material
-including suture or drains
6) Antiseptic/ wound lavage
7) Growth factors
How do NSAIDs affect wound healing?
Decreases early repair
No affect after 14-21 days
Why does can chlorhexidine slow wound healing?
-0.013% is cytotoxic to fibroblasts, use 0.05% or less
Why can povidone and iodine slow wound healing?
Inhibit PMN migration & cytotoxic to macs and lymphocyte