1.Understand the concept of Langer’s Lines. What are “two” advantages of using this knowledge when doing minor surgery?
COrespond to collagen fiber orientation in skin - parallel
- Follow the lines to:
- minimize wound tension
- Heal faster/less scarring
- less chance of keyloid
2.What are the “problem areas” of the body for increased risk of scarring/keloids?
Upper chest
back
shoulders
3.How do Kraissl’s lines compare to Langer’s Lines?
Langer’s lines - dead bodies
Kraissls lines - observed in living people
4.When a wound occurs what, essentially, is the body’s only interest?
Survival -
- less concern about beautiy and 100% functionality
5.Be able to list and describe (what is occurring in each stage) of the three phases of healing (Slide #11).
Phase one - inflammation , tumor, dolor, calor, rubor couple days, debridement ; leukocytes, macrophages
Phase 2 - 5-3wk: fibroblasts, myofibroblast, wound contraction, granulation
Phase 3: wound contratction, crosslinking, scars
6.What is the average tissue strength of a healing wound when the sutures are removed at 10-14 days?
2 weeks ; 5-6%
2 years: maybe 95% of strength, it never goes to 100%
7.Understand the difference between clean, clean-contaminated, dirty/contaminated and infected wounds.
Clean: free from organism/surgery, closed by primary closure, done under sterile conditons, not predisposed to infection.
clean contaminated: wound contaminated prior to being seen,
8.Is there a “Golden Period” of time for closing lacerations?
Not anymore, it used to be 8 hours or 12-24 on face
9.What are the four “Goals of Surgery”?
- close the wound
- no infection during healing
- small scar
- no loss of function
10.What factors involving the patient and surgeon affect wound repair?
patient: - age, weight, nutrition status, health, etc doctor - length/direction no fwound - remove necrotic tissue - properly closing - dead space elimination
11.Understand the concept of “Healing by First (Primary) Intention”. What are the goals and outcomes of this method?
Primary: sew it up immediately
- limit infection, scarring,
12.What are the two possibilities that lead to a wound “Healing by Secondary Intention”? Can it be a reasonable choice made by the patient or surgeon? What are its advantages and disadvantages?
- WOund fails to heal by primary intention
- purposely left open, paper cut , skinned knee
- larger scars, takes long time,
- its simle, low risk of infection
13.Describe the steps in “Delayed Primary Closure (DPC)”. When should it be used? What are its advantages?
- decrease infection rates in contaminated wounds
- extream tissue lost
13.Describe the steps in “Delayed Primary Closure (DPC)”. When should it be used? What are its advantages?
1- debride
2- leave open
3. pack with strile dressing
4. cover with support bandage repeat daily
5. granulation - pushes sterile dressing out
6. close when enough healthy tissue develops
14.What are the advantages of using a “running” stitch”? Where on the body is this a good stitch to use?
when you need them in fast:
Theres little or no tension
- eyelid, neck, scrotum….loose skin
Don’t use to close dead space
