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