What is primary healing?
tissue is cleanly incised and anatomically reapproximated
What is secondary healing?
wounds left open through the formation of granulation tissue and eventual coverage of the defect by migration of epithelial cells
What is delayed primary closure?
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
What are the diff stages of wound healing?
What type of wound is the result of immobilization?
Decubitus and pressure ulcers
What is the management of decubitus ulcers?
- incise and drain any infected spaces or debride necrotic tissue
- Sources of pressure must be unloaded
Def of clean wound?
no gross contamination from exogenous or endogenous sources
infection rate is 1.5%
Definition of clean contaminated?
Operation on the GI or respiratory tract without unusual contamination or entry into the biliary or urinary tract
infection rate < 3%
Example of contaminated?
operations on the unprepared colon or emergency operations for intestinal bleeding or perforation
may have an infection risk of 5–30%
common cellulitis organisms
strep and staph
rest, elevation, warm packs
oral/IV abx - PCN or 1st gen Ceph
Nec Fasc organism?
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
Gas gangrene organism
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.
fistula and sinus tracts are result of?
abdominal abscesses contiguous with bowel open to skin
sometimes erode major blood vessels->severe bleeding
Post op wound infection info
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)
Patient factors that influence wound healing: