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2 Types of surgical wounds:
- Incision - cutting in
- Excision - cutting something out
6 Types of traumatic wounds:
- Closed - bruise
- Open - open wound
- Simple - no loss of tissue
- Complicated - tissue lost or destroyed, foreign object inside
- Clean - smooth cut
- Contaminated wound - Object in the wound
What is the infection rate for wound Class I?
- 1 - 5%
- No break in aseptic
- Example: Breast biopsy, thyroidectomy, hip replacement
What is the infection rate for wound Class II?
- 8 - 11%
- GI, GU, Respiratory tract
- Minor or no break in aseptic
- Hysterectomy, Pneunoectomy
What is the infection rate for wound class III?
- 15 - 20%
- Feces, Major break in aseptic
- Gun shot wound to abdomen
What is the infection rate for wound Class IV?
- 27 - 40%
- Bacteria in wound before surgery
- Pus and drainage
- Incision and drainage of excess
What are the phases of wound healing for 1st intention wound?
- Wound closes from the inside out
- 1 Lag/inflammatory phase - Day 1 - 5
- 2 Proliferation - 2 weeks
- 3 Maturation/Differention - Months
What kind of forcep should be used to handle tissue when closing a wound?
- Toothed forcep - Adson
- Don't use smooth forceps- crush tissue due to greater grasping pressure
What is the inflammatory process?
- Pain (dolor)
- Heat (calor)
- Redness (rubor)
- Swelling (tumor)
- Loss of Function (functio laesa)
Factors Influencing Wound Healing:
- Age - Pediatric/Geriatric
- Smoking - Vasoconstrictor
- Immune Deficiency - HIV/Cancer Patients
What is dishiscens?
Wound popping open
What is Evisceration?
What is adhesion?
wound stuck to something else
What is Herniation?
Cuts circulation off to something, popping out
What is a fistula?
Opening that should be there/open on both ends
What is a sinus tract?
Elongated channel in the body that allows fluid to pass through
What are the 2 basic types of sutures?
- Monofilament: Prolene, Nylon, Catgut, PDS, Monocryl
- Multifilament: (braided or twisted) Silk, Vicryl, Braided Polyester
Characteristics of monofilament sutures:
- More difficult to handle
- Require more knots
- Difficult to tie
- Preferred for closing an infected wound
What should you always do when using prolene sutures?
Wet the doctors hands
What is ethibond?
Braided polyester sutures
Characteristics of multifilament sutures:
Reactive and prone to infection
How are knots tied in sutures?
Tied outside the body and pushed into the wound with knot pushers
What determines characteristics of needles?CP
What should a cutting needle point be used for?
- Tough tissue - Skin
- Side - Opthamology
What should a tapered needle point be used for?
- Delicate tissue - Bowel, artery
What should a blunt needle point be used for?
Layer Closure for Abdominal Wounds
What is a skin stapler?
Requires 2 adsons to hold skin together
What is a linear stapler?
- Cuts in a line
- Can be reloaded
What is a chronic wound?
Wound that persists for an extended period of time
What is first intention?
What is Second Intention?
What is Third Intention?
Delayed Primary Closure
What is tensile strength?
How much stress something can endure
What is cicatrix?
Normal scar formation
What is friable?
What is a Kleoid Formation?
Occurs most often in dark skinned patients
What are drains?
Devices that remove unwanted fluids or gases from the body
What factors affect choice of suture?
- Thickness of tissue
- Metabolic factors
What is chromic gut?
- Collagen treated with chromium salts to delay rate of absorbtion
- 90 day absorbtion rate
What is swaged?
Bent or curved
What is ligated?
Put back together with suture
What is a primary suture line?
Sutures placed for first intention healing
What is a secondary suture line?
Sutures to support the primary suture line
What are vessel loops?
Silicone strips that can be placed around veins arteries, etc for retracing and isolating
In what order are items counted in surgery?
SSI - softs, softs, instruments
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