Soft Tissue Surgery

Question 1

What are the 3 phases of wound healing

Answer 1

1. Inflammation (and debridement)
2. Proliferation
3. Maturation

Question 2

In which phase of wound healing does the wound gain the most strength?

Answer 2

The maturation phase

Question 3

What creates the scaffold for repair in the inflammatory phase of wound healing?

Answer 3

Haemorrhage (increased blood flow) and clot formation

Question 4

Which two cell types are primarily involved in inflammation and what are their functions?

Answer 4

Neutrophils: phagocytose bacteria and die
Macrophages: phagocytose debris and release cytokines

Question 5

List the stages of granulation tissue formation

Answer 5

1. Macrophages promote angiogenesis and fibroplasia
2. Fibroblasts arrive at the site
3. Collagen is laid down
4. Granulation tissue forms

Question 6

Define epithelialisation

Answer 6

The migration between dead tissue and granulation tissue to new skin (it forms a new layer on top)

Question 7

List the characteristics of healthy granulation tissue

List 3

Answer 7

1. Highly resistent to infection
2. Has a good nutrient and oxygen supply
3. Has a good base for scar formation (red, flat, moist, epithelialisation present)

Question 8

List 5 factors that promote epithelialisation

Answer 8

1. Healthy granulation bed
2. Absence of infection
3. Absence of nectrotic debris
4. Oxygen present at wound surface
5. Moist wound environment

Question 9

What increases the wound strength in the maturation phase of wound healing?

Answer 9

Collagen remodelling

Question 10

After wound healing, how much of the original strength will the area have?

Answer 10

80%

Question 11

What are the 4 goals of wound management?

Answer 11

To acheive a site:
1. Free from infection
2. Free from necrotic debris
3. Free from devitalized tissue
4. Healthy to promote repair

Question 12

List 3 host factors which may delay wound healing

Answer 12

1. Old age
2. Hypoalbuminaemia
3. Endocrine disease

Question 13

List 3 local factors which may delay wound healing

Answer 13

1. Foregin material
2. Infection
3. Hypoxia

Question 14

List the 4 types of wound closure

Answer 14

1. Primary closure
2. Delayed primary closure
3. Secondary closure
4. Second intention healing

Question 15

For which type of wounds would you use primary closure?

Answer 15

Surgical wounds, or wounds less than 6 hours old

Question 16

For which type of wounds would you use delayed primary closure?

Answer 16

Moderate tissue trauma
Grossly contaminated wounds
When there is bacterial colonization

Question 17

When would you perform delayed primary closure?

Answer 17

2-5 days after the injury

Question 18

For which type of wounds would you use secondary closure?

Answer 18

On wounds where granulation tissue has formed

This would be after 5 days or more

Question 19

For which type of wounds would you use secondary intention healing?

Answer 19

Grossly contaminated wounds unsuitable for closure

Question 20

When does epithelization start?

Answer 20

At the end of the proliferation phase, and it continues into the maturation phase

Question 21

List the 3 steps in open wound management

Answer 21

1. Initial assessment & preparation
2. Debridement (inflammation)
3. Granulation

Question 22

What is your main objective in the initial assessment and preparation for wound management?

Answer 22

Prevent further contamination

Question 23

Describe what you need to lavage a wound

Answer 23

1. Use a high volume of sterile saline
2. 18-19 gauge needle & 35mL syringe
3. • 3 way tap connected to a fluid bag
4. Moderate pressure (this is what pushes the bacteria out)

Question 24

What is the objective of continued debridement?

Answer 24

To advance the inflammatory phase and move the tissue into the proliferative phase quicker

Question 25

Describe a wet-to-dry dressing for wound debridement

Answer 25

Primary layer: sterile swab soaked in saline is placed on the wound as the contact layer Secondary layer: dry swap is placed on top to absorb the fluid from the contact layer

Question 26

What do you want to do between changing a wet-to-dry dressing?

Answer 26

Lavage the wound

Question 27

How often should you change a wet-to-dry dressing?

Answer 27

At least every 24 hours (usually every 12-24 hours) or before the dressing is saturated (moisture gets to the outside of the bandage)

Question 28

When do you want to move from using a wet-to-dry dressing to a non-adherent dressing?

Answer 28

Once all necrotic tissue is removed, exudate reduces and granulation starts | Wet-to-dry can be traumatic, so you only want to use at the start

Question 29

What are 2 types of autolytic debridement?

Answer 29

1. Hydrogel 2. Honey dressings

Question 30

Which type of dressing do you want to use for a wound in the granulation phase?

Answer 30

Moist, non-adherent dressing

Question 31

What is your primary goal in managing a wound in the granulation (proliferation) phase

Answer 31

Acheive a moist wound environment

Question 32

List 2 dressing options for a wound in the granulation phase

Answer 32

1. Hydrocellular foam 2. Hydrogel | Both non-adherent

Question 33

What are the 3 layers of a bandage?

Answer 33

1. Priamary (contact) layer 2. Intermediate layer 3. Tertiary layer

Question 34

In which wound types is abx indicated?

Answer 34

Traumatic or open wounds

Question 35

List a pro and con of topical abx for open wounds

Answer 35

Pro: acheive high concentrations at wound surface and avoid systemic use Con: have the potential to impede granulation and epithelization

Question 36

List 3 topical abx options for open wounds

Answer 36

1. Silver sulfadiazine (bactericidal) 2. Silver dressings (bactericidal) 3. Honey dressings (anti-oxidants)