Wounds

Question 1

Clean wound

Answer 1

• Surgical prep
• GI tract not entered
• Primary closure
• No abx

Question 2

Clean- contaminated wound

Answer 2

• Surgical prep, enter GI tract
• Primary closure
• Cefazolin abx

Question 3

Contaminated wound

Answer 3

• Trauma with foreign material or spillage of GI contents
• Debridement, irrigation
• Secondary closure
• Oflaxaxin abx

Question 4

Dirty and infected wound

Answer 4

• Pus at site
• Necrosis
• Debridement, irrigation, secondary closure
• Augmentin

Question 5

First intention healing

Answer 5

• Suturing or other closure of wound
• Wound to MD in 12 hrs
• Best aesthetic and fxn outcome

Question 6

Second intention healing

Answer 6

• Healing through granulation
• Increased scarring
• Wounds contaminated with debris and bites

Question 7

Tertiary intention healing

Answer 7

• Closure after 3-4 days
• Allows close monitoring
• Increased blood flow to wound to encourage healing
• Immunocomp pts

Question 8

Substate phase of healing

Answer 8

• Coagulation: fibrin, thromoin and compliment attract inflammation cells
• Platelets attract leukocytes
• Interleukins, histamin, serotonin and bradykinin cause constriction then dilation

Question 9

Proliferative phase

Answer 9

• Fibroplasia and matrix deposition
• Collagen and proteoglycans form CT matrix
• Angio genesis in 4 days
• Epitheliazation- keep moist

Question 10

Remodeling phase

Answer 10

• Collagen fiber maturation
• Lysis and contraction
• Fibroblasts and leukocytes

Question 11

Infectious agent

Answer 11

Bacteria creating toxic metabolites leading to tissues destruction

• Skin aerobes- strep and staph
• Clostridium in dead tissue
• Opportunistic pathogens in immunocompromised

Question 12

Susceptible host

Answer 12

• Age- reduced cell fxn
• Immunosuppression- increased susceptibility
• Steroid- suppress inflammation
• Stress, pain
• Smoking- Vasoconstriction

Question 13

Closed, unperfused space

Answer 13

• Perfusion and oxygenation very important
• Lack affects natural ability to fight infection
• Hypercapnia and acidosis increase risk
• Narrow outlets- gall bladder, appendix
• Potential spaces