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2 Types of surgical wounds:
- Incision - cutting in
- Excision - cutting something out
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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
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What is the infection rate for wound Class I?
- 1 - 5%
- No break in aseptic
- Elective
- Example: Breast biopsy, thyroidectomy, hip replacement
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What is the infection rate for wound Class II?
- 8 - 11%
- GI, GU, Respiratory tract
- Minor or no break in aseptic
- Hysterectomy, Pneunoectomy
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What is the infection rate for wound class III?
- 15 - 20%
- Feces, Major break in aseptic
- Gun shot wound to abdomen
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What is the infection rate for wound Class IV?
- 27 - 40%
- Bacteria in wound before surgery
- Pus and drainage
- Incision and drainage of excess
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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
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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
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What is the inflammatory process?
- Pain (dolor)
- Heat (calor)
- Redness (rubor)
- Swelling (tumor)
- Loss of Function (functio laesa)
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Factors Influencing Wound Healing:
- Age - Pediatric/Geriatric
- Nutrition
- Disease
- Smoking - Vasoconstrictor
- Radiation
- Immune Deficiency - HIV/Cancer Patients
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What is dishiscens?
Wound popping open
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What is Evisceration?
hanging out
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What is adhesion?
wound stuck to something else
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What is Herniation?
Cuts circulation off to something, popping out
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What is a fistula?
Opening that should be there/open on both ends
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What is a sinus tract?
Elongated channel in the body that allows fluid to pass through
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What are the 2 basic types of sutures?
- Monofilament: Prolene, Nylon, Catgut, PDS, Monocryl
- Multifilament: (braided or twisted) Silk, Vicryl, Braided Polyester
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Characteristics of monofilament sutures:
- More difficult to handle
- Require more knots
- Difficult to tie
- Preferred for closing an infected wound
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What should you always do when using prolene sutures?
Wet the doctors hands
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What is ethibond?
Braided polyester sutures
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Characteristics of multifilament sutures:
Reactive and prone to infection
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How are knots tied in sutures?
Tied outside the body and pushed into the wound with knot pushers
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What determines characteristics of needles?CP
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What should a cutting needle point be used for?
- Tough tissue - Skin
- Reverse
- Side - Opthamology
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What should a tapered needle point be used for?
- Delicate tissue - Bowel, artery
- Tapercut
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What should a blunt needle point be used for?
Kidney, Liver
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Layer Closure for Abdominal Wounds
- Peritoneum
- Fascia
- Muscle
- Subcutaneous
- Subuticular
- Skin
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What is a skin stapler?
Requires 2 adsons to hold skin together
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What is a linear stapler?
- Cuts in a line
- Can be reloaded
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What is a chronic wound?
Wound that persists for an extended period of time
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What is first intention?
Primary Union
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What is Second Intention?
Granulation
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What is Third Intention?
Delayed Primary Closure
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What is tensile strength?
How much stress something can endure
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What is cicatrix?
Normal scar formation
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What is friable?
Easily torn
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What is a Kleoid Formation?
Occurs most often in dark skinned patients
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What are drains?
Devices that remove unwanted fluids or gases from the body
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What factors affect choice of suture?
- Age
- Weight
- Thickness of tissue
- Edema
- Metabolic factors
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What is chromic gut?
- Collagen treated with chromium salts to delay rate of absorbtion
- 90 day absorbtion rate
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What is swaged?
Bent or curved
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What is ligated?
Put back together with suture
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What is a primary suture line?
Sutures placed for first intention healing
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What is a secondary suture line?
Sutures to support the primary suture line
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What are vessel loops?
Silicone strips that can be placed around veins arteries, etc for retracing and isolating
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In what order are items counted in surgery?
SSI - softs, softs, instruments
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