AST Chapter 11 - Wound Healing.

Ligation.

to tie off.

If Rh positive blood is given to an Rh negative person, what will occur?

hemolysis. destruction of red blood cells.

Herniation -

result of wound dehiscence. Weakened tissue. weak facia wall.

Cicatrix -

scar formation.

Pharmacological

Absorbable gelatin. Collagen. Oxidized cellulose. Silver nitrate. Epinephrine. Thrombin. Bone wax.

Dehiscence -

tissue separation. Postoperativly the suture doesn't hold wound opens back up.

Fistula -

Tract between 2 surfaces.

Sinus tract -

A narrow, elongated channel in the body that allows the escape of fluid.

Epinephrine

AKA Adrenaline constricts the vessels and reduced the blood flow to help form clot.

Influencing Wound Healing

Age Nutrition Disease Smoking Radiation Immune deficiency

If an hemolytic transfusion occurs what are some of the signs?

Awake patient: lack of energy, rapid pulse, shortness of breath may become januced. asleep patient: low oxygen levels, due to the red blood cells not flowing. treatment: stop transfusion immediately,start fluids.

Chronic Wounds

Bed sores. Pressure sores. Decubitus Ulcer. Non healing wounds.

Intentional wounds

Chemical Occlusion banding Surgical site incision Incision Excision

Open Contaminated -

May be infected, and be left open and packed. May need a debridement.

Class I : Clean

Incision made under ideal conditions. No break in technique. Closed primarily. No drains needed. No entry into the GI tract or GU tract.

Harmonic scalpel

Electrocautery Ultrasonic scalpel. Single-use titanium blade. Electrical energy.

Thermal

Electrocautery AKA Bovie. Must have a grounding pad. Most common. Uses heat to coagulate. Laser Intense, concentrated beam of light.

Types of Wound Healing

First Intention AKA primary closure. Second Intention AKA Granulation. Third Intention AKA Delayed primary closure.

Pledgets

For bleeding through needle holes in vessel anastomosis Small squares of Teflon Sewn over the hole

Blood Types and Groups

Four main blood types: A, B, O, AB.

Postoperative wound care

Goal is to prevent infection Drains - remove fluids Dressings create a barrier Sterile technique should be used Promotes wound healing

Hemolytic Transfusion Reactions

If blood is not properly matched hemolytic anemia may develop. Rh incompatibility Mismatched Can be fatal

Vasoconstriction

Increase blood pressure to the injured vessel to constrict the vessels to create pressure and slow down the blood flow. pale skin. The bodies reaction to blood loss.Slows the flow by narrowing the vessels walls.

Class IV : Dirty/ Infected

Infection rate is 27%-40% higher for these patients. Open traumatic wound More than 4hrs old. Microbial contamination occurred before the procedure. Perforated viscus.

What is the most common reason for blood loss?

Injury to a vessel.

Blood Loss

Injury to vessel: Body reacts to stop hemorrhage. Vasoconstriction. Coagulation. Blood clot (thrombus). Platelets and clotting factors.

Mechanical Hemostasis

Instruments Ligatures Clips Sponges

Intraoperative wound care

Involves local and systemic care Sterile technique Tissue perfusion Antibiotics Care should be taken to prevent "Dead Space" Dead space - separation of wound where it should be approximated

Blood type B.

Naturally produce anti-A

Blood type A.

Naturally produce anti-B

Blood type O

Naturally produces both A and B Agglutinins. Universal donor.

Open Simple -

No loss or destruction of tissue.

Serotonin

Once the platelets bind to a clot the body releases serotonin. serotonin is a vasoconstrictor. also helps with growth factors and healing of wounds.

Class III : Contaminated

Open traumatic wound less than 4hrs old. Major break in technique. Acute inflammation present. Entry into the GI or GU tract with spillage.

Inflammatory Process

Pain. Heat. Redness. Swelling. Loss of function. Inflammatory reaction occurs when damaged tissue releases a histamine that causes the small blood vessel to dilate and increase blood flow to that area.

Layer Closure for Abdominal Wounds

Peritoneum Fascia Muscle Subcutaneous Subcuticular Skin

After vasoconstriction

Platelets clump together forming a plug. Your body Release chemicals Epinephrine Serotonin Adenosine diphosphate (ADP)

Class II : Clean Contaminated

Primary closure. Wound may be drained. Minor break in technique occurred. Controlled entry into the GI or GU tract. any time you are in the GI tract it is classified as clean contaminated.

Blood type AB

Produce neither antibody. Universal recipients.

Stapling Devices

Skin Stapler. Linear Stapler. Automated Ligating Clip Applier. Linear Cutter. Endoscopic Linear Cutter. Open Intraluminal Stapler. Closed Intraluminal Stapler.

Open wounds

Skin integrity has been compromised.

Closed Wounds

Skin remains intact, but there's underlying tissue damage.

Stages of healing by first intention.

Stage 1 Lag phase. From injury to 3-5 days. Stage 2 proliferation phase. fibers start bringing tissue together. 3 days to 21 days. Stage 3 Differentiation phase. materation stage Day 14 until completely healed.

Adenosine diphosphate (ADP)

Stimulates other platelets to activate and bind together to form a membrane around thrombus.

Hemostasis

The process of controlling and stopping bleeding. To stop hemorrhaging. Clot formation. Surgical pressure. Ligation. Hemostatic agents. Electrocautery.(thermal)

Open Clean -

Wound edges can safely be approximated.

Second Intention AKA Granulation.

Wound fails to heal by primary closure. Some sort of breakdown or infection caused breakdown of suture and wound Left open and heals from inside out forming granulation tissue. Results in weak and wider scar.

A blood clot is also called?

Thrombus.

Open Complicated -

Tissue is destroyed, or a foreign body is present.

First Intention AKA primary closure

Under ideal circumstances. Wound heals side to side. No separation. Minimal scarring.

Rh Factor

Used for blood matching Antigenic substance Individuals with the factor are Rh positive Individuals without are Rh negative Same as mixing incompatible ABO blood types

Suction

Used to aspirate Clear the surgical site Connected to disposable tubing Must always be available

Third Intention AKA Delayed primary closure.

Usually a traumatic wound that needs to be debrided and left open to heal by second intention for 4-6 days. Treated with antibiotics and closed to heal by first intention. Used for contaminated or dirty wounds.

Tensile strength -

ability to resist tearing or rupture and hold a certin amount of pressure.

Adhesion -

abnormal attachment of scar tissue. adhesion occurs after multiple surgery. can cause bowel obstruction

Evisceration -

exposure of viscera. abdominal wounds organs exposed. viscera- organs.

Dead Space

separation of wound layers that have not been closely approximated or air that has become trapped between tissue layers.

Keloid -

thickened scar

Heprin

used for anti coagulation. used tp prevent thrombus.