WND581 QUESTION 3 AND VERIFIED SOLUTIONS
Primary incision closure - ✔✔clean wound, approximated with staples, sutures, or skin
glue. maintain post op dressing for 48-72hrs, consider antimicrobial dressing secondary
incision closure - ✔✔at risk for dehiscence and excessive tension, ie bowel perf,
penetrating trauma, compartment syndrome, hx of radiation at site. goal is full wound with
granulation tissue and epithelial resurfacing follow principles of chronic wound
management and wound bed prep tertiary incision closure aka delayed primary - ✔✔heavy
contaminated wounds, left open till bacterial load controlled, then wound is closed at a
later date sterile dressing and technique until closure flap or graft closure - ✔✔large
defects with other tissue from the body Class 1 surgical wound - ✔✔clean, primary closure
Class II - ✔✔clean but in a contaminated location, respiratory, genital, GI, GI, usually
primary closure but with drain in place Class III - ✔✔Contaminated, break in surgical
technique or gut spillage during surgery, procedure is less than 4hrs, delayed primary
closure Class IV - ✔✔Dirty infected, present at the time of surgery, heal by secondary
intention, procedure greater than 4 hours prevent SSI - ✔✔hand washing CHG for pre op
bathing and surgical site prep CHG not for peri care prevent pre and post op hyperglycemia
prophylactic ABX within 1hr of procedure maintain sterile dressing intermittent
claudication - ✔✔pain that occurs with activity and is relieved by rest thin leg with dry skin,
little hair, ABI 0.5 indicates - ✔✔arterial insufficency inelastic compression - ✔✔indicated
for ambulatory patients, used initially in the presence of considerable edema, ABI >0.5
collapse of arch associated with autonomic neuropathy with development of rocker
bottom foot shape - ✔✔Charcot's joint contact casting - ✔✔redistributes the weight of the
diabetic foot, contraindicated if wound has untreated infection how to calculate ABI -
✔✔higher pressure on desired side between dorsal pedis and posterior tibial DIVIDED BY
the higher of the arms (doesn't matter which side) visual characteristics of neuropathic
ulcer - ✔✔location (plantar surface), diabetes, absence of pain..not a location for shear,
venous or arterial indicative of arterial ulcer - ✔✔ABI less than 0.9 venous dermatitis -
✔✔results in erythema, crusting, scaling skin of the leg hemosiderosis - ✔✔reddish brown
hyperpigmentation of the skin in the lower leg, hemosiderin staining, classic sign of LEVD
level of compression when ABI is 0.5-0.8 - ✔✔modified level in the 23-30mmHg When is
compression contraindicated? - ✔✔ABI <0.5 TcPO2 level below 40 - ✔✔demonstrates
skin/tissue hypoxia and is a sign for delayed healing, if eschar is noninflected, dry, and has
a low TcPO2 then leave it alone lipodermatosclerosis - ✔✔fibrosis or hardening of soft
tissue in lower legs, feels firm/woody/hardened, indicative of long-standing venous
disease arterial ulcer characteristics - ✔✔round, punched out appearance, dry, pale
Primary incision closure - ✔✔clean wound, approximated with staples, sutures, or skin
glue. maintain post op dressing for 48-72hrs, consider antimicrobial dressing secondary
incision closure - ✔✔at risk for dehiscence and excessive tension, ie bowel perf,
penetrating trauma, compartment syndrome, hx of radiation at site. goal is full wound with
granulation tissue and epithelial resurfacing follow principles of chronic wound
management and wound bed prep tertiary incision closure aka delayed primary - ✔✔heavy
contaminated wounds, left open till bacterial load controlled, then wound is closed at a
later date sterile dressing and technique until closure flap or graft closure - ✔✔large
defects with other tissue from the body Class 1 surgical wound - ✔✔clean, primary closure
Class II - ✔✔clean but in a contaminated location, respiratory, genital, GI, GI, usually
primary closure but with drain in place Class III - ✔✔Contaminated, break in surgical
technique or gut spillage during surgery, procedure is less than 4hrs, delayed primary
closure Class IV - ✔✔Dirty infected, present at the time of surgery, heal by secondary
intention, procedure greater than 4 hours prevent SSI - ✔✔hand washing CHG for pre op
bathing and surgical site prep CHG not for peri care prevent pre and post op hyperglycemia
prophylactic ABX within 1hr of procedure maintain sterile dressing intermittent
claudication - ✔✔pain that occurs with activity and is relieved by rest thin leg with dry skin,
little hair, ABI 0.5 indicates - ✔✔arterial insufficency inelastic compression - ✔✔indicated
for ambulatory patients, used initially in the presence of considerable edema, ABI >0.5
collapse of arch associated with autonomic neuropathy with development of rocker
bottom foot shape - ✔✔Charcot's joint contact casting - ✔✔redistributes the weight of the
diabetic foot, contraindicated if wound has untreated infection how to calculate ABI -
✔✔higher pressure on desired side between dorsal pedis and posterior tibial DIVIDED BY
the higher of the arms (doesn't matter which side) visual characteristics of neuropathic
ulcer - ✔✔location (plantar surface), diabetes, absence of pain..not a location for shear,
venous or arterial indicative of arterial ulcer - ✔✔ABI less than 0.9 venous dermatitis -
✔✔results in erythema, crusting, scaling skin of the leg hemosiderosis - ✔✔reddish brown
hyperpigmentation of the skin in the lower leg, hemosiderin staining, classic sign of LEVD
level of compression when ABI is 0.5-0.8 - ✔✔modified level in the 23-30mmHg When is
compression contraindicated? - ✔✔ABI <0.5 TcPO2 level below 40 - ✔✔demonstrates
skin/tissue hypoxia and is a sign for delayed healing, if eschar is noninflected, dry, and has
a low TcPO2 then leave it alone lipodermatosclerosis - ✔✔fibrosis or hardening of soft
tissue in lower legs, feels firm/woody/hardened, indicative of long-standing venous
disease arterial ulcer characteristics - ✔✔round, punched out appearance, dry, pale
