Test 3 sur 100
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Created by:
Aisha-Robbie on November 16, 2011
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114 terms
Terms | Definitions |
|---|---|
 Incisional | cut through intact tissuse to expose or excise underlying structrues |
| Excisional | remove of tissue |
| six types of traumatic woinds | open, closed, simple, clean, complicated, contaminated |
| Closed wounds- Blunt Trauma | skin remains intact, underlying tissue damaged, Hermatoma may be developed |
| examples of blunt trauma- closed wounds | contusion, torn ligament, closed fracture, lacerated liver |
| Open Wound | Intergrity of the skin is destroyed |
| Examples of Open wounds | Abrasion, Laceration, Penetration, Compound fracture |
| Smiple Wound | Integrity of the skin is destroyed, No loss or destruction of tissue, No forgie body in wound |
| Examples of Simple wound | Laceration |
| Complicated Wound | Tissue is lost or destroyed, foreign body in the wound |
| Examples of Complicated Wound | Crush injury, Burn, Silver |
| Clean Wound | Wound edges can be approximated and secured, wound is expected to heal by first intention |
| Examples of Clean Wound | Surgical Wound/Class 1 laceration |
| Contaminated Wound | Contaminated object penetrates skin, can become infected with 4-6 hours, Debridement is necessary |
| Contaminated Wound | Wound may be left open to heal by second intention |
| Contaminated Wound | delay primary closure may be performed |
| Contaminated Wound | Skin graft may be necessary |
| Examples of Contaminated Wound | compound fracture, gunshot wound |
| Chronic Wound-non healing | Wound persists for extented period of time |
| Chronic Wound -non healing | tissue necrosis and / or infection may be present |
| Chronic Wound-non healing | causes, debilitating condition (diabetes) radiation therapy |
| Examples of Contaminated Wound | Decubitus |
| Class I | clean |
| Class II | clean contaminated |
| Class III | contaminated |
| Class IV | Dirty and infected |
| Class I - Clean | wound created under ideal conditions |
| Class I - Clean | No break in sterlie techinque |
| Class I - Clean | No drain necessary |
| Class I - Clean | Wound is primarly closed |
| Class I - Clean | Infection rate les than 1-5% |
| Class II - Clean Contaminated | Wound is primarly closed.. |
| Class II - Clean Contaminated | drain may be placed |
| Class II - Clean Contaminated | minor break in sterile techinque |
| Class II - Clean Contaminated | Controlled entry into aerodigestive or GU tract |
| Class II - Clean Contaminated | Infection rate 8% - 11% |
| Class III - Contaminated | Open tramatic wound - less than 4 hours old |
| Class III- Contaminated | major break in sterile technique |
| Class III - Contaminated | Inflammatory present |
| Class III - Contaminated | Entry into aerodigestive or GU tract |
| Class III - Contaminated | Infection 15% - 20% |
| Class IV - Dirty and Infected | Open tramatic wound - greater than 4 hours old |
| Class IV - Dirty and Infected | Infection present prior to procedure |
| Class IV - Dirty and Infected | Perforated Viscera |
| Class IV - Dirty and Infected | Infection rate 22% - 40% |
| First Intention | Most desired method of healing, No infection present |
| First Intention | No separation of wound edges, minimal scar formation |
| First Intention | Wound heals from side to side |
| First Intention | healing occurs in three phases |
| Phase I "Lag" | Inflammatory response Phase |
| Phase I "Lag" | Begins within minutes of injury and last approximately 3 to 5 days |
| Phase I "Lag" | fibrin weakly holds wound edges together, |
| Phase I " Lag" | As fibrin dries out a scab forms |
| Phase I " Lag" | fibroblasts and epithelia cells migrate to area |
| Phase I " Lag" | WBC's produce enzyme to dissolve and remove tissue debris |
| Phase II | Healing phase - Proliferation phase |
| Phase II | Begins approximately the 3rd postoperaative day and continues for up to 20 days |
| Phase II | fibroblast multily rapidly |
| Phase II | Collegen is secreted by fibrolast and formed into fibers resulting in a gain in tensile strength of wound 25 -30% of orginal tensile strength |
| Phase III | Maturation or Differentiation |
| Phase III | fiber pattern re- forms and meshes to increase tensile strength |
| Phase III | as collegen density increases, vascularity decreases, scar grows pale |
| Phase III | begins on the 14th postoperative day and lasts up to 12 months |
| Second Intention | Graulation |
| Second Intention | Wound fail to heal by primary union |
| Second Intention | infection causes breakdown of a suture wound |
| Second Intention | Large wounds cannot be approximated, risk of infection is great, Decubitus |
| Mechanism of healing in Second Intention | wound contraction, rather than primary union Grandulation tissue containing fibroblasts forms i defect and closes by contraction with secondary growth of epithelium |
| Features of Second Intention | heals from the bottom up, healing is delayed |
| features of Second Intention | Packing may be placed in wound many times |
| weak union conducive to herination later | Second Intention |
| Excessive scaring | Second Intention |
| Graft may be necessary during healing | Sceond Intention |
| Occurs when two granulated surfaces are approximated | Third Intention |
| Third Intention | Suturing delaying 4 -6 days |
| Deep, wide scar can occur | Third Intention |
| Classsified in the ClassIII and IV surgical wound | Third Intention |
| Anemia | low RBC, result i tissur hypoxia, which affects synthesis of collegen: low hemaocrit |
| key factor in wound healing | Early ambulation after surgery; recovery |
| Cicatrix | normal scar |
| Hypertrophic Scar | Result of excessive fibrin within border of scar; too much tension on wound |
| Keloid Scar | Extendes beyond the border of the cicatrix, continues to grow; can be painful,itchy, prone to bleeding |
| overacting healing due fibroblast proliferation | Keloid Scar |
| Adhesion | United two structures that normally are separate |
| Proud Flesh | excessive granulation tissue: may extend ablove skin margins |
| Tensile Strength | amount of pull a knotted strand of suture can withstand; usually decreases as diameter decreases |
| Gauge | size(diameter) of a strand; ranges from 5 (largest) to 11-0 (smallest) |
| Monofilament | one strand |
| Multifilament | more than one strand; braided or twisted |
| Ligature reel (tie) | suture material on a reel used to tie off blood |
| Instrument tie | a strand of suture loaded on and instrument such as a right angle - tie on a passer |
| suture ligature | stick tie |
| suture ligature | suture on a noncutting needle used to anchor the suture into the surrounding tissues prior to tying |
| Free tie | strand of suture placed into a surgeon's pronated, cupped hand |
| Anastomosis | creation of an opening between two formerly separated structures such as a vessel or intestine; joining two structures by suturing |
| absorbable suture | is used for rapid ly healing tissue -mucous membrane |
| Non absorbable suture | for slowly-healing tissue -tendons, fascia |
| Surgical gut | digested by enzymes; derived from intestinal mucosa of sheep; packed in alcohol; should be rinse |
| Synthetic absorbable suture | Absorbed by hydrolysis; inert little on no tissue reaction; packed dry |
| types of Synthetic absorbable sutures | Polydioxanone -PDS and PDS II Polyglecaprone-Monocryl Polyglyconaten- Maxon (suture) Polyglactin 910 -Vicryl Polygycolic acid - Dexon |
| PDS/ PDS II | monofilament; used in slow healing;extended wound support when needed or in presence of infection; |
| PDS/ PDS II | 70% tensile strength in 2 weeks; completely absorded in 6 months |
| silver package, violet or clear opthamlic use | PDS / PDS II |
| Moncryl | polyglecaprone; monofilament; used in soft tissue subcutilar closures |
| 50% tensile strength remains after one week; clear or voliet clear | Moncryl |
| A monofilment used in soft tissue except neural, ophthalmic, or cardivascular tissue | Maxon suture |
| 70% tensile strength remains after 2 weeks and absorbed in 6 months; with a green or clear in color | Maxon suture |
| An uncoated monofilament; dyed violet coated multifilament or undyed; has a smooth passage through tissue and precise knot | Vicryl ( polyglatin 910) |
| Vicryl | 50% percent strength remains after 2-3 weeks; absorbed within 90 days |
| uncoated multifilament: dyed in green in a gold package and undyed | Dexon ( Polyglycolic acid) |
| coated for smooth passage through tissue and good knot security | Dexon |
| 50% tensile strength remains after 2-3 weeks; absorbed in 90 days; | Dexon |
| Other Synthetic absorables | Polysorb and biosyn |
| Natural nonabsorbable suture | surgical silk; virgin silk- for ophthalmic surgery; dermal silk- coated |
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