STUVIA 2024/2025
Clin Med IV: Wounds
Wound edges are brought together w/ sutures - ✔✔Primary intention of wounds.
- Acute inflammatory response in wound
- By 3rd day, granulation tissue bridges dermal defect
- Epithelium proliferates & restores epidermis
- Fibroblasts invade granulation tissue, laying collagen
- Scar is still red, but blood vessels gradually regress
- Becomes pale linear scar within a few months - ✔✔Primary intention characteristics.
- New
- Clean wound
- No FB
- No necrotic tissue - ✔✔Indications for primary intention of wounds.
- Decreased healing time
- Decreased bleeding
- Decreased discomfort seen in open wounds - ✔✔Advantages to primary intention of wounds.
%
Wound allowed to heal on its own - ✔✔Secondary intention of wounds.
- Tissue loss prevents wound edges from coming together
- Healing must bridge defect -> initially filled with clot -> then vascular granulation tissue
- Inflammatory exudate solidifies forming scab
- Fibroblasts invade and lay collagen - ✔✔Characteristics of secondary intention.
- Highly contaminated or infected wounds
- Pts at high risk for infection - ✔✔Secondary intention of wounds are good for what?
- Relatively slow and uncomfortable
- Leaves larger scar than first degree closure - ✔✔Disadvantages of secondary intention of wounds.
Healing by secondary intention followed by primary closure - ✔✔Delayed primary closure (tertiary)
intention of wounds.
- Wound cleaned, packed w/ moist sterile gauze, and covered w/ sterile dressing
- Dressing left undisturbed unless signs of infection
- After 4-5d, dressing removed, wound can be closed if no infection - ✔✔Characteristics of tertiary
intention.
stuvia
, STUVIA 2024/2025
- Grossly contaminated wounds
- Animal bites - ✔✔Tertiary wounds are good for what?
- Fever
- Purulent exudate
- Spreading cellulitis - ✔✔Signs of wound infection that would prevent closing off a tertiary intention
wound.
- Infection
- Poor perfusion
- Contamination
- FB
- Necrotic tissue
- Unsuitable dressing
- Patient interference - ✔✔Etiology of impaired wound healing due to local factors.
- Arterial or venous insufficiency
- Radiation tx - ✔✔Etiology of impaired wound healing due to regional factors.
%
- Malnutrition
- Anemia
- Immunosuppression
- CCS
- Alcoholism
- IVDA
- Renal failure
- Hepatic failure
- Diabetes (especially uncontrolled) - ✔✔Etiology of impaired wound healing due to systemic factors.
Hematoma - ✔✔Results from unrecognized, inadequate hemostasis in wounds.
- Pain
- Pressure
- Swelling within the wound
- May be febrile and have sanguineous or serous drainage - ✔✔Hematoma s/s.
- Remove a few sutures to allow drainage
- Obtain culture - ✔✔Tx for a wound with a hematoma.
stuvia
Clin Med IV: Wounds
Wound edges are brought together w/ sutures - ✔✔Primary intention of wounds.
- Acute inflammatory response in wound
- By 3rd day, granulation tissue bridges dermal defect
- Epithelium proliferates & restores epidermis
- Fibroblasts invade granulation tissue, laying collagen
- Scar is still red, but blood vessels gradually regress
- Becomes pale linear scar within a few months - ✔✔Primary intention characteristics.
- New
- Clean wound
- No FB
- No necrotic tissue - ✔✔Indications for primary intention of wounds.
- Decreased healing time
- Decreased bleeding
- Decreased discomfort seen in open wounds - ✔✔Advantages to primary intention of wounds.
%
Wound allowed to heal on its own - ✔✔Secondary intention of wounds.
- Tissue loss prevents wound edges from coming together
- Healing must bridge defect -> initially filled with clot -> then vascular granulation tissue
- Inflammatory exudate solidifies forming scab
- Fibroblasts invade and lay collagen - ✔✔Characteristics of secondary intention.
- Highly contaminated or infected wounds
- Pts at high risk for infection - ✔✔Secondary intention of wounds are good for what?
- Relatively slow and uncomfortable
- Leaves larger scar than first degree closure - ✔✔Disadvantages of secondary intention of wounds.
Healing by secondary intention followed by primary closure - ✔✔Delayed primary closure (tertiary)
intention of wounds.
- Wound cleaned, packed w/ moist sterile gauze, and covered w/ sterile dressing
- Dressing left undisturbed unless signs of infection
- After 4-5d, dressing removed, wound can be closed if no infection - ✔✔Characteristics of tertiary
intention.
stuvia
, STUVIA 2024/2025
- Grossly contaminated wounds
- Animal bites - ✔✔Tertiary wounds are good for what?
- Fever
- Purulent exudate
- Spreading cellulitis - ✔✔Signs of wound infection that would prevent closing off a tertiary intention
wound.
- Infection
- Poor perfusion
- Contamination
- FB
- Necrotic tissue
- Unsuitable dressing
- Patient interference - ✔✔Etiology of impaired wound healing due to local factors.
- Arterial or venous insufficiency
- Radiation tx - ✔✔Etiology of impaired wound healing due to regional factors.
%
- Malnutrition
- Anemia
- Immunosuppression
- CCS
- Alcoholism
- IVDA
- Renal failure
- Hepatic failure
- Diabetes (especially uncontrolled) - ✔✔Etiology of impaired wound healing due to systemic factors.
Hematoma - ✔✔Results from unrecognized, inadequate hemostasis in wounds.
- Pain
- Pressure
- Swelling within the wound
- May be febrile and have sanguineous or serous drainage - ✔✔Hematoma s/s.
- Remove a few sutures to allow drainage
- Obtain culture - ✔✔Tx for a wound with a hematoma.
stuvia
