When does epithelialization of surgical wounds closed primarily complete?
24-48 hours
When does a wound closed by primary intention reach max strength?
3 months (70-80% that of normal skin)
What are the 6 steps of wound healing
- Coagulation
- Inflammation
- Collagen synthesis
- Angiogenesis
- Epithelialization
- Contraction
What cells perform collagen synthesis
fibroblasts
Early surgical site infections in the first 24 hours are typically from which 2 organisms?
- Streptococcus
- Clostridium
(because they grow really fast and excrete enzymes that digest local tissue and impair host defenses)
What is the magic number for dose of contaminating microorganisms required to result in an increased risk of wound infection?
100,000 (10^5)
What are the 5 W’s of post operative fever?
- Wind (atelectasis, not moving enough air)
- Water (UTI from prolonged foley catheter)
- Walking (DVT)
- Wound
- Wonder about drugs
What is the most common cause of post operative fever in the first 24 hours?
atelectasis
What are the classic signs of infection (4)
- Redness
- Swelling
- Heat
- Pain
What is the proper work up for febrile patient? (4)
- CBC
- blood and urine cultures
- Urinalysis
- Chest Xray
Best prophylactic antibiotic for anaerobes
- Metronidazole (Flagyl)
2. Clindamycin
Best prophylactic antibiotic for gram-negative rods
- Third gen cephalosporin
2. Aminoglycosides
Best prophylactic antibiotic for gram-positive cocci
- First or second gen cephalosporin
