Closure types
Primary intent - sutures (w/in 8-24hrs) Secondary intent - pack and let heal on its own Tertiary intent - delayed primary closure
Contusions?
Bruises
- intact skin
No surgery or tetanus or anything
Abrasion
Superficial inj to epidermis a superficial dermis
- tetanus
- abx (maybe)
Punctures
Deeper than wide (usually)
- dont explore these
- heal by secondary intent
Laceration
Injury through dermis to SQ tissue
- primary closure
- close w/in 6-8hrs
If infected can use 2ndary intent
Crush injury
US or MRI to evaluate extend of deeper wounds
Can lead to compartment syndrome
Signs of compartment syndrome?
Pain out of proportion
Intracompartment pressure >30
Tx w Fasciotomy
Monitor UOP
Serial CK/CMP
Extravasation?
Infiltration of caustic substance from IV infusion
Highly caustic substances (extravasation) may need?
Debridement
Inj of antidote
Aspiration
Grafting
Bites
Human - serious joint infection Spiders - brown recluse (cellulitis w sloughing) - may need skin graft Snakes - elapids (cobras/mambas) - vipers (rattle snakes etc)
Elapids cause?
Neurotoxic venum
- tremors, myalgias
- cardiac and pulm manifestations
Vipers cause?
Cytotoxic venom
- tissue necrosis
- hemolyiss
- compartment syndrome -> fasciotomy
High velocity wounds?
Gunshots, explosions
- high kinetic inj
- small entrance wound (deceiving)
Surg indications for high velocity wounds?
- ID underlying tissue
Vessels or organ injury - explore depth, debride and clean
- remove projectile
Amputation can be managed?
Limb salvage
- extensive surg
- yrs of PT and surgeries
Amputation
- often pts prefer this (faster healing etc)
- better functional outcomes if joint is preserved
Wound management overview?
Wear gloves Sterilized site Anesthetize area Copious irrigation Wound closure - based on wound type Update tetanus
What is granulation healing?
Normal healing process
- hyper-granulation can be attenuated w silver nitrate
Wounds closed ___ ___ heal better
Without tension
How to decrease tension to close wound?
Undermine tissue if needed
- elevate skin
- dissect skin
- clean edges
- only undermine as much as needed
- leave some open if needed
- can clsoe w DPC or secondary intent, w or w/o skin graft
A wound vac is an example of?
Negative pressure wound dressing (NPWD)
Slide 17 if you want to see it
Goal of copious irrigation?
Dilute bacteria into extinction
What to do with a surgical site infection?
Investigate and irrigate/debride
- may use NPWD
manage w packing
- gauze
- moist or dry
- cover
- change daily
Wound management of a narrow (puncture) wound
Heal w secondary intent
- insert gauze or packing into wound
- leave tail to retrieve and replace
- cover
- change daily
My wedding was so beautiful
Even the cake was in tiers
