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Wound Healing Sutures Needles Stapling Devices
Surg class for acc
Wound? Any tissue that has been damaged by either intentional/accidental means. Incision? Intentional cut of tissue for exposing/excising underlying structures. Excision? Removal of tissue. Closed wound? Skin is intact, but underlying tissue suffers damage. Class I? Clean; I.R: 1-5%; Uninfected; Primary union. Class II? Clean Contaminated; I.R: 8-11%; Under controlled circumstances; Primary union. Class III? Contaminated; I.R 15-20%; Open traumatic wound >4 hrs old; Major break in sterile technique; Acute inflammation. Class IV? Dirty/Infected; I.R 27-40%; Clinically infected wound/perforated viscera; Open traumatic wound <4hrs. Simple wound? Skin is destroyed, no loss/destruction of tissue & noforeign body in wound. Complicated wound? Tissue is lost/destroyed/a foreign body remains. Clean wound? Edges can be approximated & may heal by 1st intention. Contaminated wound? When dirty object damages the integrity of the skin, can become infected. Debridement? Excision of infected &/ necrosed tissue. Signs of inflammation? Pain, heat, redness, swelling, loss of function. Name the types of wound healing and the a.k.a's: (1) 1stintention (Primary Union) (2) 2nd intention (Granulation) (3) 3rd intention (Delayed Primary Closure). Name & describe the phases of 1st intention: 1. Lag/ Inflammatory response phase; Begins within minutes. 2. Proliferation phase; Fibroblasts secrete collagen that forms into fibers. 3.Maturation/Differentiation Phase; undergoes slow sustained increase in tissue tensile strength. Describe 2nd intention; Wound fails to heal by primary union, wound is left open to heal from inner layer to the outside, wound cannot be approximated, may result in herniation. Keloid? Raised, thickened scar due to excessive collage. “
” Excessive granulation. Described 3rd intention; heals by 2nd & 1st intention, typically classIII/IV surgical wounds. Dehiscene? Partial/total separation of layer/s of tissue after closure. Adhesion? Abnormal attachment of 2 surfaces/structures that are normally separated. Fistula? Tract between 2 epithelium-lined surfaces that is open at both ends. Sinus tract? Tract between 2 epithelium-lined surfaces that is open at oneend only. One-Layer Dressing? Used to cover a small incision from which drainage is expected to be minimal. Other types of one-layer dressings? Aerosol adhesive sprays, foams, gels, hydrocolloids, and skin closure takes. Nonocclusive? Allow passage of air & fluid. Intermediate layer? Absorbs any drainage/secretions. Gauge? Suture diameter. Size #5: Largest available suture. Size #1 & 0: Closure of ortho & abdominal fascia Size #4-0 & 5-0: Aortic Anastomosis Size #6-0 & 7-0: Smaller anastomosis Size #8-0 through 11-0: Micro vascular & eye procedures Size #4-0: Dural incisions Size #3-0 & 4-0: Subcuticular skin closure. Plain gut, Chromic Gut, Maxon, PDS II, Monocryl are what kind of sutures? Monofilament absorbable Sutures. Prolene, Pronova, Nylon, Stainless Steel, and novafil are what kind of sutures? Monofilament nonabsorbable sutures. Vicryl and Dexon are what kind of sutures? Multifilament Absorbable Sutures Rapid released needles are a.k.a? Controlled released (CR). Free-tie? Single strands placed into the opened hand of the surgeon. Tie-on-a-passer? Ties loaded onto a curved clamp. Suture ligature/stick tie? A sutures with a swaged atraumatic needle loadedonto a needle holder. What are the characteristics of a needle? Eye, point, body, and shape. Conventional cutting needles? Has 3 cutting edges in the inner curve of the needle. Reverse cutting needles? Has a triangular configuration used for the skin Side cutting needle? For ophthalmic procedures (will not penetrate deeper). Tapered point needles? Has round shaft without cutting edge, will penetrate tissue without cutting it, used for delicate tissue. Blunt points? Round shaft ends with a blunt tip, primary for kidney/liver. What determines shape of body? Point. BP Blunt Point C Cardiovascular CFS Conventional for Skin CP Cutting Point CPX Cutting Point Extra Large CT Circle Taper CTX Circle Taper Extra Large CV Cardiovascular FS For Skin FSL For Skin Large MO Mayo OS Orthopaedic Surgery P Plastic RB Renal (artery) Bypass S Spatula TF Tetralogy of Fallot UR Urology Peritoneum? Fast healing lining the abdominal cavity. Subcuticular? Beneath skin, above subcutaneous layer. Continuous/running suture? A single strand of suture placed as a series of stitches. Traction sutures? Used to retract a structures. Retention? Large-gauge interrupted, nonabsorbable sutures placed lateral to a primary suture like for wound reinforcement. Bolsters? Pieces of plastic/rubber tubing threaded over the retention suture ends before the ends are tied. Bridges? Plastic devices that “bridge” the closed incision. Umbilical Tape? Used as a retraction & isolation device for bowel, nerves,vessels, or ducts. Vessel Loops? Used as a retraction & isolation device for vessels, nerves, ducts or delicate tissues. Linear Staplers? Inserts 2 straight evenly spaced parallel rows of staples into tissue. Linear Cutters? Staples & transects the tissue. Ligating Clips? Occlude single small structures such as a blood vessel or aduct. Intraluminal Staplers? Anastasia tubular structures within the gastrointestinal tract. Polypropylene mesh? Can be used in the presence of infection. Polyglactin 910 mesh? Absorbable, provides temp support during healing.
Not absorable, should not be used in the presence ofinfection. Stainless Steel Mesh? Causes discomfort, most inert, can be used in the presence of infection/during 2nd intention healing. Polyester Fiber Mesh? Least inert, must not be used in presence of infection (multifilament)