Soft Tissue

Front 1

Secondary Complications

Back 1

•Local / systemic infections-abx
•Hypoproteinemia-protein for healing
•Hypothermia
•Sequelae related to tissue necrosis

Front 2

Wound Healing

Back 2

•Hemostasis and Inflammation
•Cell migration and Proliferation
•Remodeling

Front 3

Types of Wounds-know difference

Back 3

•Contusion
•Crush
•Hematoma
•Abrasion
•Avulsion
•Laceration
•Puncture Wound
•Bites
•Amputation

Front 4

Contusion def

Back 4

bruise

Rupture of sq vessels and extravasation of erythrocytes

Front 5

Contusion signs

Back 5

•No break in skin
•Bruising
•Swelling
•Pain
•Hematoma

Front 6

Hematoma def

Back 6

big bruise

Rupture of a deeper and larger vein or artery
•Fluid fluctuance / doughy mass

usually benign depending on location

Front 7

Crush Injury

Back 7

•Composite injury involving 2 or more tissue types

usually involves bones

Front 8

•Assess ___ in crush injuries

Back 8

neuro/circulation status and function

Front 9

------ can develop in crush injuries

Back 9

Compartment syndrome

hours later

Front 10

Abrasion

Back 10

•Friction
•Superficial or deep
•Partial / full thickness
•Contaminated-debride

benign-leave open unless deep

Front 11

Avulsion

Back 11

•Stretching or tearing away of the soft tissues, creating a full thickness loss

flapping of skin

Front 12

•Avulsion

Shearing forces
•May appear viable on admission

Back 12

•48-96 hours later will declare themselves

Front 13

•Degloving

Back 13

avulsion to extreme-torn completely away

underlying tissue too

Front 14

Laceration

Back 14

•Trauma w/ sharp object
•Halo of erythema
•Will gap if muscle is involved
•Superficial – dermis and epidermis
•Deep-more concerned when in muscle or getting close to bone

Front 15

Puncture

what to do

Back 15

*Heightened risk of infection-wood more than bullet/glass
•Do not close-dont enclose infection
•Do not remove Impaled objects

•debride

Front 16

Bite

Back 16

•Puncture
•Crush injury
•Grossly contaminated-RATS-rabies, abx, tetanus, soap

Front 17

Amputation

Back 17

•Digits
•Distal foot
•Leg
•Hand
•Forearm
•Arm
•Ears
•Nose
•Penis

Front 18

Reimplantation factors

Back 18

Sharp, guillotine like > crush/avulsion
•Upper > lower extemity
•Children > adults
•Age
•Occupation
•Motivation
•Physical condition

Front 19

Determinants of Wound Healing

Back 19

•Age
•Oxygen-acidation dec healing
•Perfusion
•Anemia
•Infection Smoking / Temp
•Pain
•Stress
•Nutrition-protein
•Electrolyte / Acid-Base Balance
•Preexisting Health Conditions

Front 20

Wound Assessment

Back 20

•History
•Exam-tunneling? cavetation? circulation bilaterally?
Resuscitation, critical care, rehabilitation

Front 21

Wound Management

Back 21

•Systemic support
•Perfusion and oxygenation
•Nutrition-TPN
•Infection control / antibiotics
•Progressive physical activity
•Wound closure and debridement

Front 22

Dressings

Back 22

•Primary closure-stitches or dermabond
•Partial thickness-wet to dry dressing
•Deep partial thickness / full thickness-wound vac-inc granulation
•Grafts
•Flaps
•Biosynthetics

Front 23

Alterations in Healing

Back 23

•Keloids / excess scarring
•Scar contracture
•Pressure ulcer

Front 24

Fingertip Injuries

Back 24

•Crush – distal phalanx
•Fracture
•Subungual hematoma
•High pressure pain / grease gun

Front 25

GSW

Back 25

•Unpredictable path
•Appearance not always reflection of injury

Front 26

Compartment Syndrome when

know

Back 26

•6-8 hours – 48-96 hours

Front 27

Compartment Syndrome

signs
know

Back 27

•pain not relieved by narcotics
•Pain w/ flexion, decreased mobility of digits
•Paresthesia
•Coolness
•Pallor
•Tense skin
•Pulses
•High index of suspicion for comatose patient

4-6hrs to intervene before loose extremity

Front 28

Compartment syndrome

pressure _______ require fasciotomy

Back 28

Pressures > 30-60 require fasciotomy

Front 29

Strain def

Back 29

•Overstretching at point of attachment to tendon
•1st
•2nd
•3rd-may need surgery

Front 30

Sprain def

Back 30

•Joint exceeds normal limit and damages ligaments
•1st minor pain
•2nd week to heal more edema bruising
•3rd lots edema no walking on it, may need surgery

Front 31

compartment syndrome

_______intervene before loose extremity after signs show up

Back 31

4-6hrs to intervene before loose extremity