Acute Wounds
Avulsion
A wound that occurs when tissue is separated or torn away from the body (degloving)
Retention sutures
Abdominal layers held together without tension. Regular nylon sutures are used and threaded through a short length of plastic or rubber tubing on the outside of the incision. large-gauge, interrupted, non absorbable sutures placed lateral to a primary suture line for wound reinforcement. Used for debilitated patients with malnutrition, old age, immune suffering, cancer, impaired healing, or chronic conditions- obesity, asthma or chronic cough and dehisced incisions. left in place 14 days and removed only by surgeon.
Payne-Martin Classification System- Category 1
Category 1- skin tear without tissue loss (1.A)-Linear skin tear-Full thickness Occurs in wrinkle or furrow of skin. Pulled apart as if an incision was made, exposing tissue below. (1.B)-Flap-skin tear-Partial thickness Wound in which the epidermal flap can be well approximated or approximated so that no more than 1mm of dermis is exposed.
Payne-Martin Classification System- Category 11
Category 11 - skin tear with partial tissue loss (2-A) Scant tissue loss-Partial thickness loss 25% or less of the epidermal flap is lost and at least 75% or more to the dermis is covered by the flap. (2-B) Moderate to large tissue loss- Partial thickness loss. More than 25% of the epidermis flap is lost and more than 25% of the dermis is exposed.
Abrasions
Caused by shearing of the skin by rough surface, superficial AKA road rash
Dirty/infected wounds
Heavily contaminated or clinically infected.
What is the most serious type of bite?
Human- because it causes more serious infection- aerobic and anaerobic bacteria occlusal injury- inflicted by actual biting Clenched- Fist injury-allows tooth to enter the joint space serious injury
Payne-Martin Classification System- Category 111
Skin tears with complete tissue loss Partial thickness wound in which the epidermal flap is absent.
Acute wound
Without an underlying defect and usually occur secondary to surgery or trauma. heal by themselves uneventful, heal quickly. time frame 4-6 weeks.
How many days for epithelial resurfacing in acute wounds?
2-3 days after surgery with sutures or steri strips
Post op incisions closed by primary intention are covered with a sterile dressing for?
24-48 hours
What is a healing ridge?
A deposit of collagen palpated as an induration beneath the skin under the suture line. Extending 1 cm on each side of the incision. Evident between 5-9 days Chance of infection and dehiscence is high with no ridge.
Post-op care for skin flaps
Air fluidized bed Pressure relief is most important Closed drain system unit removal when drainage is minimal 5-7 days Assess suture line for infection and approximation. Spasticity must be controlled (diazepam or baclofen). check color of flap pale arterial blood supply blocked, cyanotic vascular supply effected. HBO, Leeches for venous congestion. Mobility can start in (3 WEEKS) based on skin and suture line.
Pin care
Avoid crusting- care is every 8 hours in the presence of drainage and daily with no drainage.
Clean-contaminated wounds
Contaminated wound have usual normal flora without usual contamination. (such as pus or foreign bodies.) Exp: vaginal operations, appy.
Gun shot wounds
Degree of injury depends upon caliber of bullet May produce enormous damage by cavitation. Cavity along the projectile path, localized area of blunt trauma High risk for infection: wound left open and irrigated with normal saline
With incisions epithelial resurfacing?
Due to smaller area required for epithelial cells to travel resurfacing of primary intention wounds generally occurs within 24-48 hours.
Contaminated wound
Fresh traumatic injury -soft tissue laceration, open Fx and penetrating wound. Operative procedure in which gross spillage from GI occurs.
Grade system for external wounds.
Grade-1 normal. Grade-2 Inflamed with some exudate. Grade-3 Breaking down with purulent drainage.
Dog bite appearance
Infected bite cellulitis (gray malodorous discharge. Intense inflammatory reaction in 24 hours
Primary nutrient required for wound healing is?
Oxygen
How many days for collagen deposition in acute wounds?
Post-op days 4-21
Cat Scratch
Presents 3-10 days following injury Erythematous , papule and fever. Self limiting resolves in about 2 months Tx Tetracycline
What it treatment for radiation?
Protect the skin- cleanliness, avoid irritants, using razors, avoid sunlight and extreme heat and cold apply appropriate emolients, use mild soaps wear loose clothing Relieve discomfort- Use cornstarch or powders not talcum in dry areas apply topical corticosteroids sparingly to reduce itching Treat open areas_ Saline compresses, sits bath, semi occlusive dressings for nerve endings. Use non adherent dressings secure with mesh and stockinet. Culture wounds and treat bacterial or fungal infections. Use appropriate dressing for the amount and type of exudate to prevent skin damage or irritation of periwound.
Suture removal
Should removed before the epithelium has migrate into deeper parts of the dermis, to prevent widening of the scar.
Skin grafts- host site
Simple measure of wound closure. Failure occurs when graft is not immobilized/ and or infection. Can be: autograft, allograft, Heterograft or Xenograft.
Sterile technique for post op dressing changes are done?
The first 48 hours.
Post op sterile technique is used?
The first 48 hours. (2) days
Tissue flap
Tissue moved from one area to another that keeps its own blood supply Transfer of skin, SUBCUTANEOUS , FASCIA, MUSCLE PROVIDES- PADDING Used for pressure ulcer Considerations: pressure relief monitor closely Check color & hematoma Pale= obstruction of arterial blood supply Cyanotic= failure of vascular. Spasticity must be controlled may need HBO Leeches used for venous congestion for 30-60 minutes
Time frame for suture removal
Varies -depends on rate of healing and the nature of the wound Face-3-5 days Trunk, arms, legs and scalp-7 days Hands, feet, over joints back- 10-14 days.
Evisceration
Wound separation with protrusion of organs (usually bowel.) Can lead to peritonitis and septic shock.
Primary intention wound healing
Wounds with minimal tissue loss and well approximated edges. Resurfacing occurs in 24-48 hours Surgical incisions.
Allergic reactions
a condition caused by an overreaction of the body's immune system Sensitivation phase: Transpires in 7-10 days exposure to substance- develops ability to recognize antigen Elicitation phase: Re exposure to substance Acute inflammatory allergic reaction is observed. 48-72 hours
donor site
a site where healthy skin is taken and used as a graft. TRANSFER OF EPIDERMIS AND MEASURED PORTION OF THE DERMIS, SHALLOW WELL VASCULARIZED- HEALS BY RE EPITHELIALIZATION. Protect- Keep moist, minimize dressing change. Tx- transparent films, Xeroform , fine mesh gauze
Types of grafts
autograft= your own tissue allograft=tissue from another human Heterograft=tissue from a non human Xenograft=tissue from a non human including bone
Tertiary intention wound healing
delayed primary, wounds that are left open for several days to allow edema or infection to resolve or exudate to drain, and then are closed
compartment syndrome
involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles or from cast or dressings.
Laceration
jagged wound tear, tends to be caused by blunt trauma (blow, fall or collision)
Crush injury
mechanism of injury in which tissue is locally compressed by high pressure forces. can cause compartmental syndrome
Clean wound
no organ is entered no breaks in sterile technique exp: hernia repair.
Radiation staging
stage 1 Slight edema and inflammation with erythema that may result in burning, itching and discomfort, caused by dilation and increased permeability of capillaries. stage 2 Dry itching scaly skin with partial sloughing of epidermis, caused by inability of basal epidermal cells to adequately replace surface cells and decreased functioning of skin glands. stage 3 Moist blistering of the skin with loss of epidermal tissue, serous drainage and increase pain with exposure of nerves cause by continued deterioration of skin. stage 4 Loss of body hair and sweat glands suppression resulting in permanent hair loss, atrophy, pigmentation changes and ulcerations, cause by accumulation of radiation in the tissues.
Dehiscence
total or partial disruption in wound edges. Outer layer of the joined incision. Caused by pressure, shear, improper lifting, vascular compromise, infection or skin weakness.
Skin tears
traumatic wounds in which the epidermis separates from the dermis partial thickness wound or separate the epidermis and dermis from the underlying structures (full thickness.) Mostly occurs in older adults as the result of friction and shear.
Secondary intention healing
wound in which the tissue surfaces are not approximated and there is extensive tissue loss; formation of granulation tissue and scarring. Wound remains open, heal from bottom up to edges to center. Contaminated wounds.