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