Wounds, Wound Care, and Wound Healing

Question 1

What is primary healing?

Answer 1

tissue is cleanly incised and anatomically reapproximated

Question 2

What is secondary healing?

Answer 2

wounds left open through the formation of granulation tissue and eventual coverage of the defect by migration of epithelial cells

Question 3

What is delayed primary closure?

Answer 3

wound is left open to heal under a carefully maintained, moist wound healing environment for approximately 5 days and is then closed as if primarily

Question 4

What are the diff stages of wound healing?

Answer 4

Question 5

What type of wound is the result of immobilization?

Answer 5

Decubitus and pressure ulcers

Question 6

What is the management of decubitus ulcers?

Answer 6

• incise and drain any infected spaces or debride necrotic tissue
• Sources of pressure must be unloaded

Question 7

Def of clean wound?

Answer 7

no gross contamination from exogenous or endogenous sources

infection rate is 1.5%

Question 8

Definition of clean contaminated?

Answer 8

Operation on the GI or respiratory tract without unusual contamination or entry into the biliary or urinary tract

infection rate < 3%

(Surgical Recall)

Question 9

Example of contaminated?

Answer 9

operations on the unprepared colon or emergency operations for intestinal bleeding or perforation

may have an infection risk of 5–30%

Question 10

common cellulitis organisms

tx?

Answer 10

strep and staph

rest, elevation, warm packs

oral/IV abx - PCN or 1st gen Ceph

Question 11

Nec Fasc organism?

Tx?

Answer 11

usually involves a mixed microbial flora, often including microaerophilic streptococci, staphylococci, aerobic gram-negative bacteria, and anaerobes, especially Peptostreptococci and bacteroides.

This type of wound should be carefully examined, with the patient under sufficient anesthesia to permit full inspection and debridement of devitalized tissue, including muscle.

Broad spectrum abx and primary surgical intervention

Question 12

Gas gangrene organism

Tx?

Answer 12

Clostridium perfringens

air bubbles on plain radiograph, crepitus

Immediate amputation is necessary when there is diffuse myositis with complete loss of blood supply or when adequate debridement would clearly leave a useless limb.

Question 13

fistula and sinus tracts are result of?

Answer 13

abdominal abscesses contiguous with bowel open to skin

sometimes erode major blood vessels->severe bleeding

Question 14

Post op wound infection info

Answer 14

usually develop btwn 5th and 10th post op day

fever is first sign

14-16% of infections in all hospitalized pts

basic tx is open and drain (abx not necessary unless inf is invasive)

Question 15

Patient factors that influence wound healing:

Answer 15

• DM
• hypoxemia
• hypothermia
• leukopenia
• smoking
• steroids
• malnutrition
• poor skin hygiene
• Nares colonized with S. aureus