Exam (elaborations)
8. Principles Of Wound Management – Q’s And A’s (A+)
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8. Principles Of Wound Management – Q’s And A’s (A+)
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8. Principles Of Wound Management – Q’s And A’s (A+)What are ways wounds can be managed? Right Ans - 1. being surgically
close
2. Delayed surgical closure
3. Left open to heal by secondary intention
How do we decide to close or not to close a wound? Right Ans - 1. degree of
contamination
2. Amount of tissue trauma
3. Patients general heath
4. Extent of free skin in adjacent areass
What are the 4 classifications of contamination of a wound? Right Ans - 1.
Clean
2. Clean-contaminated
3. Contaminated
4. Dirty
What is a 'clean' wound? Right Ans - minimally traumatic, no inflammation,
no entry into lumen of viscera
What is a 'clean-contaminated' wound? Right Ans - Entry into lumen of
viscera without infection but no gross spillage, minor break in sterile
technique
What is a 'contaminated' wound Right Ans - Traumatic wound <6-8hrs old
Spillage of GIT
Bacteria present but they have not had time to sterilise
What is a dirty wound? Right Ans - Infection present
Incision into inflamed tissue/pus encountered
What type of wound is more likely to be managed as open wound? Right
Ans - a contaminated or traumatic wound
How is an >8hr old wound managed? Right Ans - Consider leaving open as
bacterial proliferation may have occurred
, If not too traumatic close and consider a drain
How does amount of tissue trauma effect the decision to close a wound?
Right Ans - Effects
- status of blood supply
- amount of necrotic tissue
more traumatic = less likely to perform primary closure
How does the patients general health effect the decision to close a wound?
Right Ans - Can they cope with anaesthetic
Are they in shock
Are the immunocompromised
According to the Gustilo and Anderson grading system, what is a type 1 open
fracture? Right Ans - Open fracture with wound <1cm and clean
According to the Gustilo and Anderson grading system, what is a type 2 open
fracture? Right Ans - Open fracture with laceration >1cm with extensive
soft tissue damage, flaps or avulsions
According to the Gustilo and Anderson grading system, what is a type 3 open
fracture? Right Ans - Open fracture with extensive soft tissue damage, or
traumatic amputation
According to the Gustilo and Anderson grading system, what is a type 3a open
fracture? Right Ans - open fracture with adequate soft tissue coverage of
bone despite extensive soft tissue laceration/flaps/high energy trauma
regardless of size of wound
According to the Gustilo and Anderson grading system, what is a type 3b open
fracture? Right Ans - open fractures with extensive soft tissue injury loss
with periosteal stripping and bone exposure - massive contaminatio
According to the Gustilo and Anderson grading system, what is a type 3c open
fracture? Right Ans - open fractures associated with arterial injury
requiring repair
What are the 3 basic considerations of wound care? Right Ans - 1. cleaning
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