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Criado por Elizabeth Then
aproximadamente 6 anos atrás
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Questão | Responda |
refresher-anatomy | integumentary system 3 layers -epidermis, dermis, hypodermis (subcutaneous layer) |
types of wounds | surgical -caused by excision, incision traumatic- mechanial, thermal, chemical, destruction chronic - pressure ulcers implications to practice- determines wound closure |
three types of wound closure | primary - first intention secondary - intention, granulation tertiatry - intention, delayed primary closure |
primary intention | health edges incised wound minimal infection - strict aseptic technique minimal trauma to wound no tissue loss no dead space minimal drainage |
secondary intention | occurs when wound edges cannot be joined together wound left open to heal from inside to outside typically for infection large scar, skin contractions, prolonged healing |
tertiary intention | delated primary closure typically seen - inflamed, contaminated, traumatic, haemodynamically unstable closure delyaed |
3 phases of wound healhting | inflammatory (reactive), proliferative (regenerative), remodelling (maturation) |
inflammatory phase | inflammatory response, migration of exudate, increased blood supply, vascular response, cellular response to fight infection, formation of scab, lasts 1-4 days |
proliferative phase | allows new epithelial to cover wound occurs within hours of injury cells migrate and proliferate to close defect collagen synthesis, wound contraction occurs formation of granulation tissue surgical implications - may need skin graft |
remodeling phase | late process - begins 2-4 weeks after injury can last up to 1 year scar tissue formed during fibroplasia break down and regeneration of collagen scare ages, fibre bundles closelyy packed best tensile strength 80% approx |
factors influencing wound healing | patient factors - nutrition, oxygenation, age, disease state Perioperative factors - maintanence of body temp, consequences of hypothermia |
causes of delayed wound healing | patient factors age, stress, immunological status, smoking perioperative factors SSI, aseptic technique, antibiotic prophylaxis criteria for SSI superficial, deep, organ/space |
Intraoperative tissue handling | length, direction, dissection technique (blunt/sharp) amount of tissue handling, retraction technique, achievement of haemstasis, precise tissue approximation, elimination of dead space, secure wound closure |
wound classification | CDC classification system class 1 - clean wounds class 2 - clean contaminated wounds class 3 - contaminated wounds class 4 - infected wounds |
clean - class 1 wounds | uninfected wound no inflammation |
clean contaminated wounds - class 2 | operative wounds, nil unusual contamination, controlled conditions |
contaminated wounds - class 3 | open, fresh, accidental wounds, major breaks in sterile techniques, nonpurulent inflammation is encountered |
dirty/infected wounds - class 4 | includes old traumatic wounds, retained tissue, involve existing clinical infection or perforated viscera |
complications of wound healthing | dehiscence, eviceratoin, haemorrhage, infection, fistula |
factors preventing dehiscence | long paramedian incision adequacy of closure intraabdominal pressure deficient wound healing infection |
factors preventing infeciton | degree of contamination adequacy of local blood supply virulence of organism presence of dead space |
wound management alternatives | debridement, hyperbaric oxygenation, negative pressure wound therapy, vacuum assisted closure, skin substitutes, growth factors |
debridement | removal of patients dead tissue, reveal health tissue surgery, mechanical means forceful irrigtion |
hyperbaric oxygenation or HBO | definition - use of oxygen at a higher level than atmospheric pressure technique - 100% oxygen, under pressure in chamber, increase oxygen dissolved in plasma (increase oxygen tension) |
negative pressure or VAC | definition - continous suction in a sealed environment to aid wound healing principle use for: acute, traumatic wounds, subacute wounds, dehisced incisions, pressure ulcers, flaps contraindications: fistulas, necrotic tissue, osteomyelitis, malignancy |
hydrotherapy | water used to perform debridement pulsative lavage hazardous - aerosol/droplets - good use of PPE |
Skin substitutes | group of substances, that aid in temporary permanent closure of wound for coverage used on thermal injuries |
growth factors | naturally occuring substance capable of stimulating cellular growth, proliferation, cellular differentiation types - platelet derived growth factors, epidermal growth factors |
haemostatics | chemical, external, thermal |
chemical | absorbed gelatin, collagen, oxytocin, thrombin |
external | antiembolic stockings, torniquets, bp cuff, pressure dressings, packing, suction |
thermal | cold/hot methods, diathermy, electrosurgery, laser |
tissue replacement materials | biologic wound cover, biologic materials |
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