Surgery Wounds USMLE 2
Terms
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- what are the (6)* steps of wound healing?
-
Can I Care And Eliminate Cuts:
Coagulation;
Inflammation;
Collagen synthesis;
Angiogenesis;
Epithelialization;
Contraction -
Another name for angiogenesis?
what growth factor is responsible for it? -
Granulation
VEGF: Vascular Endothelial GF - how long after closure of primary surgical wound does epithelialization occur?
- 24 - 48 hours
- what cells are responsible for wound contraction?
- Myofibroblasts
- what type of surgical wound classification is: Gross spillage from the GI tract?
- Contaminated
- what is considered a "Clean-Contaminated" surgical wound?
- the respiratory, GI or GU tract was entered w/o spillage of contents
-
with Primary (First) Intention wounds, how long after surgery does wound strength reach its maximum?
what is the percentage of maximum strength compared to uninjured skin? -
3 months
70 - 80% of normal skin -
what is a Second Intention wound?
How is it dressed? -
closure of wound not approximated by sutures
Dressed w/ packing of moist gauze and covered w/ sterile dressing -
what is a Third Intention wound?
give example -
a "Delayed Primary" where there is gross contamination of incision site, but closed w/ sutures
Example: Ruptured appendix -
skin and sub-q is not closed for 3 - 5 days after bacterial contamination is decreased -
If surgical site infection occurs w/i 24 hours, what are the (2) MC bugs?
when is an infection apparent w/ other bugs? -
Streptococcus
or
Clostridium
other bugs: 4 - 5 days post-op - what (3) operative sites are usually contaminated by Staphylococcus?
-
"A man's STAPH is his HEAD, HEART and BONE"
HEAD: Neurological or ophthalmic surgery
HEART: CV/thoracic surgery
BONE: Orthopaedic surgery - what bug type is usually the cause of post-op contamination for surgery on: GI, GU, OB/GYN cases?
-
Gram-Negative Bacilli
(and anaerobes) - what bug type is usually the cause of post-op contamination for surgery on head and neck procedures of oral mucosa?
- Streptococcus
- MCC of post-op fever w/i first 24 hours
- Atelectasis
-
what are the (5) "W's" of post-op fever?
(in order) -
Wind (Atelectasis);
Water (UTI);
Wound Infection;
Walking (DVT);
Wonder drugs -
Antibotic Prophylaxis:
in general - Cefazolin
-
Antibotic Prophylaxis:
GI surgery / appendectomy - Cefoxitin
-
Antibotic Prophylaxis:
Urological procedure - Ciprofloxacin
-
Antibotic Prophylaxis:
Head and Neck
(2) -
Cefazolin or Clindamycin
and
Gentamicin -
Antibotic Prophylaxis:
Gram-positive cocci - First and Second generation Cephalosporins
-
Antibotic Prophylaxis:
Gram-negative rods
(2 possible) -
Third generation Cephalosporins
or
Aminoglycosides -
Antibotic Prophylaxis:
Anaerobes
(2 possible) -
Metronidazole
or
Clindamycin -
Antibotic Prophylaxis:
MRSA - Vancomycin
- Name and define the (4) classic signs of infection
-
Calor - Heat, warmth
Dolor - pain
Rubor - redness
Tumor - swelling - what in a wound stimulates angiogenesis?
- the Clot
-
What cells does Thrombin stimulate?
(4) -
Endothelial cells;
Fibroblasts;
Monocytes;
Platelets -
what is characteristic of the second phase of wound healing?
when does this occur? -
Fibroblastic response to form collagen
(occurs on day 3) -
what occurs in the Third phase of wound healing?
when does this occur? -
Remodeling of tissue
(occurs 3 weeks after wound onset) - if person has vocal cord injury why is a Teflon injection used?
- to cause a Chronic Granulomatous reaction which will stimulate fibrous tissue formation (approximating vocal cords)
- where does epithelialization occur from?
-
Hair follicles
(and sebaceous glands) -
in calculating burn surface areas, what amount is given to the:
1. Upper extremity
2. Lower extremity
3. Trunk and Abdomen -
Rule of 9:
each UE = 9%
each LE = 18%
Trunk = 36% (divided into 4 quadrants of 9 each)