Chapter 7: Wound and wound healing Flashcards

Scar
Terms Definitions
3 phases
inflammation, proliferative, remodeling
hypertrophic scar vs keloid
both are overgrowth, one within border, one beyond border
how is wound considered infected?
wound culture of >10K microbes/g
pink scar, able to go back to normal activities?
no, pink scar = not remodel yet
condition to proceed to phase 2 &3?
after epithelialization
_____plays big role in debridement?
tissue matrix metalloproteinase
how does wound look in phase two?
raised, red, hard
wound looks in phase three? dd from phase two?
flatten, pale, supple, crosslinking against shear stress
acute wound? how to close?
surgery, acute trauma
primary intention
chronic wound due to?
venous stasis, arterial atherosclerosis, immobilized, neuropathic
primary intention pros, cons? used in? how wound is healing?
beautiful, infection,
clean wound
epithelialization
2nd intention pros, cons? used in? what involved? how wound is healing?
no infection, ugly, take time,
dirty infected wound: subcut. abscess after I & D, open appendectomy for perforated appendicitis
wet to dry dressings
wound contracture by myofibroblast rather than epithelialization
nutrition affects wound healing?
vit A: increase phase one, Mg for protein synthesis, folate forms collagen, zinc for RNA and DNA polymerase
factors affect wound healing?
nutrition, DM, hyperglycemia, steroids, liver disease, chronic illness, smoking
suture size?
more zeros, smaller size, 9-0
if you wait and then close?
delayed primary closure
what local anesthestics to give to wounded pt?
amide and ester
amide has two "i"
toxic dose of xylocaine?
7mg/kg/hr
what is a clean wound?
<12hr and minimal contamination
suture size for face and neck, how long to let it stay
5-0 and 6-0
4 days
suture size for torso and extremities? what kind? how long let it stay?
3-0, 4-0
monofilament nonabsorbable
7-10 days
which layer is use to close muscle? skin?
fascia, dermis
what should you be thinking when laying down suture esp buried suture?
buried suture = foreign body --> keep it minimum,
use monofilament
def. of infected wound
>10K organism/g
maximum dressing change?
2/day
wound classification and infection rate?
3
8
15
35
common site for pressure ulcer? how to care for those?
bony protrusion: heel (let it float),
sacrum, ischial tuberosity: rotate from side to side, saline-moistened gauze twice/day
what is Wound VAC?
Vacuum Assisted Closure system: porous sponge packed into the wound connected to negative pressure
pressure sore grade 1-4?
1: just red, 4: to the bone, muscle, tendon
2: epiderm and derm
3: subQ
where do you expect to see venous stasis? think of where you usually see varicose vein - do you see it on the foot?
anteromedial leg, not on the foot
what does the redness and edema in long-term venous stasis called? why is it red/ hyperpigmented?
dermatofibrosis
rbc lyses --> hemosiderin deposit
how to care for venous ulcers?
compression
paste bandaid or dry bandaid with topical medication, more layer, more pressure --> better
arterial insufficiency ulcer presentation? why?
toe, infarcted black skin --> blood vessel does reach extremities well: won't feel pedal pulses
how to care for arterial insufficiency? do you sit and wait? apply pressure? why?
mechanical intervention: balloon, angioplasty or bypass, or reconstruction using saphenous vein
chance of limb loss is high
what causes diabetic neuropathic ulcers?
motor neuropathy --> atrophy of muscle --> bony derangement: crushed bone, and dislocated bone --> inappropriate pressure on tissue --> ulcer
what is charcot's foot?
collapse of midfoot, plantar subluxation of ruined bones
plantar sublux of metatarsal head leads to?
clawing of toes
what do you see in diabetic foot ulcer?
ulcer deep to the bone, at metatarsal head, the heel or dorsal surface the rub against a shoe
what is the best way to reduce pressure on foot wound? other options?
wheelchair
casting to immobile foot
minor surgery to fix the bone
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