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Etiology of wounds
Terms in this set (113)
A complex and highly organized response by an organism to tissue disruption caused by injury
What is the primary goal of of peri operative care?
Prevention of surgical wound infections
MRSA stands for?
methicillin-resistant staphylococcus aureus
What are the three causes for wounds?
Surgical, traumatic, and chronic
This type of wound is caused by an incision or excision.
This type of wound is caused by mechanical, thermal, or chemical destruction
This type of wound is caused by underlying pathophysiologic condition over time (pressure ulcers, venous leg ulcers)
The result of reduced blood supply caused by the narrowing or blockage of blood vessels, which leads to poor circulation
Caused by immobilization (or difficulty moving) for long periods or failure of the regulating valves in the veins, which leads to blood pooling and failing to flow normally to the heart
Seen commonly in cases of prolonged uncontrolled diabetes mellitus where high blood sugar, derivative proteins and metabolites accumulate and damage the nervous system
When chronic and uncontrolled for long periods of time leading to impairment of the immune system functions, diminishing the circulation and damaging other organs and systems
These wounds can be open or closed
Types of external wounds
Contusions, hematomas, crush injuries, abrasions, lacerations, incisions, punctures, penetrating or gunshot wounds
Common type of sports injury, direct trauma causes damage to tissue, internal organs, or bones; presented as painful bruise that spreads over injured skin
Any injury that damages the small blood vessels and capillaries resulting in blood collecting and pooling in a limited space
Caused by external high-pressure force that squeezes part of the body between two surfaces
In these wounds, skin is cracked open leaving underlying tissue exposed
Shallow, irregular wounds of the upper skin layers due to brushing against a rough surface or smooth surface at high speed
Tear-like wounds with irregularly torn edges; generally caused by trauma or contact with an object
Result of a surgical procedure or skin cut with a sharp object; linear in shape with even edges; can be life threatening if it involves vital organs, blood vessels, or nerves
Small rounded wounds (human or animal bites); severity dependent on size, depth, bleeding, and pain
Caused by any object or force that breaks through the skin to the underlying organs or tissue
Considered to be penetrating wounds caused by bullets
The supply of blood, oxygen, and nutrients is impaired; can cause venous and arterial ulcers, or gangrene
What can neuropathy give rise to?
Diabetic foot ulcers, Charcot or neuropathic joints
The part of the nervous system that controls the muscle of the leg and foot is damaged, leading to improper distribution of force and pressure when performing routine activities; eventually causing joint dislocation, deformity, fracture, or injury
Charcot or neuropathic joints
A weakened immune system decreases the ability of the human body to defend against infection; cause a delay or prevent wound healing
A result from the body's immune response to a foreign material
What is the bodies first response to damage?
When is the proliferative phase of wound healing?
2 days - 3 weeks
What happens during the proliferative phase?
Granulation, contraction, epitheliazation
During this phase fibroblasts lay a bed of collagen, filling the defect and producing new capillaries
During this phase wound edges pull together to reduce the defect
During this phase skin cells cross a moist surface to create a new surface
Can be temporary or permanent, depending on the extent of the wound
Loss of function
What is the primary function of skin?
Act as a barrier and provide protection
What does the skin regulate?
Body temperature and reservoir for Vitamin D
In the skin what are there separate receptors for?
Heat, cold, touch, and pain
What is damage to nerve cells called?
What are the three stages of wound healing?
inflammatory, proliferative, maturation
When does the inflammatory phase take place?
Immediately to 2-5 days
What is the body's natural response to injury?
What happens to blood vessels after initial wounding?
Wound bed contracts and a clot is formed
The wound is rebuilt with new granulation tissue which is comprised of collagen and extracellular matrix; when epithelialization occurs
Final phase of wound healing; involving remodeling of collagen
When does the remodeling phase occur?
3 weeks-2 years
What occurs during the remodeling phase?
New collagen forms which increases tensile strength
Damage causes swelling and increased pressure in the fascia that surrounds muscles, nerves, and blood vessels
Occurs when wounds are created aseptically, with minimum tissue destruction, and postop tissue reaction
Healing through primary intention
Healing by secondary intention is also called
Surgical wounds characterized by tissue loss with an inability to approximate wound edges; takes longer than primary intention healing
Secondary intention (granulation)
What is the scar created by secondary intention called?
The healing process takes place when approximation of wound edges is intentionally delayed by 3 or more days after injury or surgery; may require debridement; retention sutures may be used
Delayed primary closure
What is another name for delayed primary closure?
What are the conditions leading to a decision for a delayed closure
Removal of an inflamed organ, heavy contamination of the wound, hemodynamically unstable patients
How many phases complete wound healing?
This effects wound healing due to reduced elasticity and collagen replacement
This effects wound healing due to an electrolyte imbalance and impaired cellular function; usually in patients with burns or fistulae
The deposition and multiplication of organisms in tissue with an associated host reaction
If the host reaction is small or negligible what is the organism described as?
What drugs reduce healing rates by interrupting cell division or the clotting process?
Immunosuppressive, anti-inflammatory, cytotoxic, and anticoagulants
What nutrient is required for all phases of wound healing; particularly for collagen synthesis?
What is required to transport oxygen?
What nutrient is required for enzyme systems and immune systems
Minerals, zinc, and copper
What vitamins support epithelialization and collagen formation and the inflammatory phase of wound healing?
Vitamin A, B complex, and C
How many classes of surgical wounds are recognized by the American College of Surgeons; allowing for better prediction of the risk of infections and wound healing outcomes?
This wound classification shows no signs of inflammation, doesn't involve the respiratory, GI or GU tracts
Class I - Clean surgical wounds
This wound classification has clean wounds that have a higher risk of infection usually GI, GU, or respiratory cases, any opened wound to remove hardware, ear or GYN cases
Class II - Clean-contaminated
This wound classification is created when an outside object comes in contact with the wound (GSW's or penetrating trauma) or large amounts of GI spillage
Class III - Contaminated
This wound classification includes foreign objects lodged in the wound or any wound that has been exposed to pus or feces
Class IV - Dirty-infected
What is the second most common adverse reaction occurring in hospitalized patients?
Surgical site infections (SSI's)
When can SSI's occur?
2-3 days after surgery until the wound is healed
What provides exits through which air and fluids can be evacuated from the operative site?
What are the two type of drainage systems?
Closed - foley
Simple - penrose
What are surgical needles made of?
What are the three basic parts of a surgical needle?
Eye, body, and point
How many needle "eyes" are there? What are they?
3 - closed, french (split or spring), swaged (eyeless)
Which needle eye is similar to a household sewing needle?
Which needle eye must be threaded because there is a slit inside of they eye at the end of the needle?
French eyed (keith needle)
What is the portion of the needle that is grasped with a needle holder?
What does a good suture technique eliminate?
dead space in the subq and minimize tension
What is the most fundamental technique for wound closure?
What is the benefit of interrupted sutures?
easy to place, greater tensile strength, less potential for wound edema or impaired circulation
What is the disadvantage of interrupted sutures?
leaves a series of crosshatched linear scars, can cause wound inversion
Which suture technique ensures eversion of wounds and minimizes significant wound tension and reducing dead space?
Which suture technique helps elevate the deeper tissues of the wound and evert the epidermis?
Near-far Vertical mattress (usually used if tissue expansion is desired
Which suture technique helps minimize wound tension, closing dead space, and facilitating wound edge eversion?
What suture technique is useful for eyelids, ears, and dorsa of hands?`
What suture technique is used to enhance the cosmetic result, closing wounds with equal tissue thickness with no tension?
What layer is the target layer for a running subcuticular stitch?
What layer is the target layer for a deep dermal stitch?
Which suture technique should enter and exit 3-5mm from the incision line and will require removal?
What suture technique should incorporate the epidermis and dermis, but not the subcutaneous?
What is a vertical mattress stitch considered?
What suture technique is useful in areas under tension to provide good tissue eversion?
Vertical Mattress Stitch
Which layers does the vertical mattress stitch incorporate?
Where should the far portion of a vertical mattress stitch enter and exit?
Where should the near portion of a vertical mattress stitch enter and exit?
Where should the horizontal mattress suture enter and exit?
Which layer should the horizontal mattress suture enter and exit?
What layer takes tension off the subcuticular closure?
Deep dermal stitch
What suture layer should lie in the superficial dermis?
Placing stitches at an equal depth on each side of the wound prevents having 1 side higher than the other
When sewing, it is proper technique to grasp the tip of the needle with forceps
Simple interrupted closure is suitable for wounds under tension?
What is the entry point distance in "mm" for the "far" part of the vertical mattress?
Needles should be loaded next to the swage when suturing?
Where are deep dermal stitches placed?
Deep to superficial
The purpose of the deep dermal stitch is to bring the wound edges together without tension.
The goal of a subcuticular (running) stitch is to bring the wound edges together without eversion
Which stitch is best suited for closure of fragile/friable skin?
The "far-far" portion of the vertical mattress should be in the dermal/epidermal junction
How much of the curvature of the needle should be used for a subcuticular "bite"?
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