Surgical Technology for the Surgical Technologist: A Positive Care Approach: Wound Healing & Sutures, Chapter 11 (Nicola) Flashcards

What is a abnormal attachment of two surfaces or structures that are normally separate

What is the surgical removal of a foreign body or of tissue (cut out)

What is surgical cut made in skin or flesh (cut in)

What is a pathological, surgical, or traumatic formation of an opening between two normally separate organs or spaces

What is defined as returned to proximity; brought together sides or edges

Classification for a wound that persists for an extended period of time

Medical name for a scar

What is a space that remains in the tissues as a result of failure of proper closure of a surgical wound

What is the removal of devitalized tissue and contaminants

What is a partial or total separation of a layer or layers of tissue after closure of the wound

What is an interruption of a closed wound or traumatic injury that exposes the viscera

What is a type of healing that occurs with primary union that is typical of an incision opened under ideal conditions; healing occurs from side to side, dead space has been eliminated, and the wound edges are accurately approximated

What is a type of needle in which the suture must be threaded by pulling the strand into a V-shaped area just above the eye

What is defined as easily torn or crumbled

What is an abnormal protrusion of an organ or other body structure through an opening in a covering membrane or muscle

A patient whose immune system has decreased due to disease, or intentionally decreased with immunosuppressive drugs for organ transplant patients to prevent organ rejection

What is the body’s protective response to injury or tissue destruction

What is a cut or tear

What is the placement of a suture tie around a vessel or other anatomical structure for the purpose of constriction (i.e., to control hemorrhage from a blood vessel)

What is a suture that is manufactured from one strand of natural or synthetic material

What is sterile fine-mesh gauze that is loosely placed in a chronic wound or one that has been left open to heal by second intention

What is a main suture that approximates the wound edges for first intention healing to occur

What is a versatile polymer used in a broad range of medical, industrial, and high technology applications

Which healing occurs when a wound fails to heal by primary union, or the wound is left open and allowed to heal from the inside to the outside by filling with granulation tissue

What is a strand of suture material with an eyeless needle attached by the manufacturer; the needle is continuous with the suture strand

What is the amount of pull or tension that a suture strand will withstand before breaking; expressed in pounds

Which healing occurs when two granulated surfaces are approximated; also referred to as delayed primary closure

What are thin strips made of silicone that can be placed around a vessel, nerve, or duct for the purposes of retracting or isolating; the loops are colored for easy identification of the retracted structures

What is and accidental wound called

What is a surgical wound called

What does ideal wound healing involve

What word is described as any tissue that has been damaged by surgical or traumatic means.

Incision made under ideal surgical conditions; No break in sterile technique during procedure; Primary closure; No wound drain; No entry to aero digestive or genitourinary tract

(Examples - Coronary artery bypass graft, total hip, breast biopsy, craniotomy)

Uninfected operative wound; respiratory, alimentary, genital, or urinary tract is entered under controlled circumstances without unusual contamination

(Examples - Appendectomy, cholecystectomy, tonsillectomy)

Open traumatic wound (less than 4 hours old); Major break in sterile technique occurred; Acute inflammation present; Entry to aero digestive (includes billary tract) or genitourinary tract with spillage

(Example - Open fracture, colon resection with gross spillage of GI contents, penetrating trauma)

Open traumatic wound (more than 4 hours old); Microbial contamination prior to procedure; Perforated viscus, traumatic wounds with retained necrotic tissue

(Examples - Resection of ruptured appendix)

When is the final wound classification assigned and is included in the intraoperative documentation

What are classified in several different ways according to severity. A single wound may fall into more that one category.

What is the name of the wound then the skin remains intact, but underlying tissues suffer damage

What is the name of the wound when integrity of the skin is damaged.

What is the name of the wound when integrity of the skin is compromised. There is no loss or destruction of tissue and there is no foreign body in the wound.

What is the name of the wound when tissue is lost or destroyed, or a foreign body remains in the wound.

What is the name of the wound when wound edges can be approximated and secured, and is expected to heal by first intention

What is the name of the wound when a dirty object damages the integrity of the skin, infected within a short period of time. Debridement of infected and/or necrosed tissue may be necessary, followed by thorough irrigation of the wound to further clean and wash out the contaminants, a procedure commonly referred to as an irrigation and debridement (I and D).

Define abrasion:
mechanism of injury

Define contusion:
mechanism of injury

Define Laceration:
mechanism of injury

Define Puncture:
mechanism of injury

What are the classic signs of an inflammatory process = body’s protective response to injury or tissue destruction

Define Thermal:
mechanism of injury

What occurs when injured tissues release histamine from the damaged cells. The histamine causes the small blood vessels in the area to dilate, increasing the blood flow to the area, resulting in heat, redness, and swelling.

First intention
Types of Wound Healing

Second intention
Types of Wound Healing

Third intention
Types of Wound Healing

Which healing occurs with an incision that was opened under ideal conditions. Healing occurs from side to side in a sterile wound in which dead space has been eliminated and the wound edges have been accurately approximated. Wound tensile strength at third month 78-80% after suturing.

What are the 3 distinct phases of first intention healing

What are the 3 distinct phases of first intention healing

• This stage begins within minutes of injury and lasts approximately 3–5 days.
• This stage controls bleeding
• A scab forms to seal the wound
• Leukocytes move in to fight infection
• Basal cells migrate across the skin edges, closing the surface of the wound.
• Fibroblasts in the deeper tissue begin the reconstruction of the nonepithelial tissue.
• The wound does not gain tensile strength during this phase.

• This stage begins around the 3rd postoperative day for up to 20 days.
• The fibroblasts secrete collagen that forms into fibers that give the wound approximately 25–30% of its original tensile strength.
• New networks are formed by the 5th to 8th day, and lymphatic networks are reformed by the l0th day, many of which diminish during the final phase of wound healing.

• This stage begins on the l4th postoperative day, until the wound is completely healed (up to l2 months).
• myofibroblasts is completed in approximately 2l days.
• Collagen formation causes scar tissue to pale.
• A small, white, mature surface scar, called a cicatrix, appears during the maturation phase.

Heals from the outside in. Packaging material used following the removal of necrotic tissue or after a wide debridement. The wound is left open and the tissue starts to "granulate" this contains myofibroblasts forms in the wound, causing closure by contraction.

Excessive granulation tissue, sometimes referred to as ............ may protrude above the defect margins and block re-epithelialization.

What will occur if a weak union and a wide, irregular scar is left at the wound site

• This stage occurs when two granulated surfaces are approximated.
surgical wound is debrided, left open to heal by second intention (granulation) for 4 to 6 days.
• The infection-free wound is closed and allowed to finish the healing process through first intention (primary closure).
• The result is a wound that heals by contraction, granulation, and connective tissue repair with intermediate tensile strength and scarring.
• This method of repair works well for contaminated or dirty wounds.

What is one of the factors influencing wound healing that include:
• Age: Pediatric and geriatric patients may have decreased vascularity or poor muscle tone.
• Nutritional status: Dietary deficiencies can alter the healing process.
• Obesity: The weight and pressure of adipose tissue may make it difficult to achieve a secure wound closure and contribute to incisional hernia. Adipose tissue also has a poor blood supply contributing to slow healing.

What is one of the factors influencing wound healing that include:
• Disease (chronic or acute): Metabolic disease, cardiovascular or respiratory insufficiency, malignancy, and infection all negatively impact wound healing.
• Smoking: Smoking causes vasoconstriction, diminishes oxygenation, and causes coughing that can put stress on a healing wound.
• Radiation exposure: Patients undergoing radiation treatment in large doses may experience a decrease in blood supply to the irradiated tissue.
• Immunocompromised or immunosuppressed patients
as the patient’s immune system may be deficient due to congenital or acquired conditions

What is one of the factors influencing wound healing that include:
•Length and direction of the incision
•Dissection technique (sharp or blunt)
•Duration of surgery
•Amount of tissue handling (tissue should be handled as little and as gently as possible)
•Achievement of hemostasis
•Precise tissue approximation
•Elimination of dead space
•Secure wound closure

What is one of the factors influencing wound healing that include:
• Any microbial contamination of the wound could lead to an infection, causing an increase in morbidity or mortality.

What frequently occurs between the 5th and 10th postoperative day and is seen most often in debilitated patients with friable (easily torn) tissue. "Popping sensation"

What is a rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision

What may be concealed or evident and occurs most frequently in the first few postoperative hours. and can result in postoperative shock. Surgery is frequently required to achieve hemostasis.

What occurs in the wound when microbial contamination overrides the resistance of the host. It results in increased morbidity and mortality. In addition to antibiotic therapy, additional surgery may be required as part of the treatment regimen

What is an abnormal attachment of two surfaces or structures that are normally separate. Fibrous tissue can develop within the peritoneal cavity because of previous surgery, infection, improper tissue handling, or the presence of a foreign body The fibrous tissue that develops can cause abnormal attachments of the abdominal viscera that may cause pain and/or bowel obstruction.

What is a result of wound dehiscence and occurs most often in lower abdominal incisions, and is discovered 2–3 months postoperatively and could result in bowel incarceration. Surgery may be required to correct this condition.

What is an abnormal tract between two epithelium-lined surfaces that is open at BOTH ends. It occurs most often after bladder, bowel, and pelvic procedures. Abnormal drainage is a prevalent sign. Surgery is required for correction.

What is an abnormal tract between two epithelium-lined surfaces that is open at ONE END only. Its occurrence is highest in bladder, bowel, and pelvic procedures. Abnormal drainage is a common sign. Surgery is often required to correct this condition.

What can occur because of either a failure to properly absorb the material or an irritation caused by the material that results in inflammation. It occurs most frequently with silk and is characterized by an evisceration (referred to as “spitting”) of the material from the wound or sinus tract formation.

What formation is a hypertrophic scar formation and occurs most frequently in dark-skinned individuals. Corticoid injections and use of pressure dressings can help reduce the size of the scar, but plastic surgery may be required for correction.

What is the separation of wound layers that have not been closely approximated or air that has become trapped between tissue layers. The space may allow for serum or blood to collect and provide a medium for microbial growth, resulting in a wound infection. It is eliminated by use of proper suturing techniques, wound drains, and/or pressure dressings.

What is the prevention of infection and other complications, it may include the use of drains and protection of the wound with different types of dressings.

When are the skin and subcutaneous tissues generally left open and packed loosely with fine mesh gauze, such as Iodoform. Packaging is removed after 4–5 days and, if no infection is present, the wound may be closed at that time

Which suture is digested by the body enzymes that attack the suture strand, eventually destroying it

Which suture is hydrolyzed by the body

What is capable of being absorbed by tissue within a given period of time,

What resists enzymatic digestion or absorption by tissue

What is made of a single thread-like structure

What consists of multiple thread-like structures braided or twisted into a single strand.

Should not be use in the presence of infection

What are relatively inert and do not readily harbor bacteria, and glide through tissues more easily resulting in minimal tissue damage because they encounter little resistance within the tissue.
CONS: Do not hold knots as well and are difficult to handle

What exhibit a characteristic called capillarity "to harbor bacteria, retain tissue fluids that can be communicated along the length of the strand". Great tensile, pliability, knots securely.
CON: Should not be used in the presence of infection

What are digested by body enzymes that attack the suture strand, eventually destroying it.

What are hydrolyzed by the body. Water within the tissue penetrates the strand and breaks down the their fiber’s polymer chain, resulting in minimal tissue reaction

What is referred to as the suture diameter

Who specifies diameter range for suture materials

The diameter of stainless steel sutures is identified by the ................commercial wire gauge numbers

Modern sutures range from #5 heavy braided suture for orthopedics to #11-0 fine monofilament suture for ophthalmics. As the number of 0’s increase, the smaller the diameter

What are the most commonly used suture sizes

What sutures are used frequently for closure of orthopedic wounds and abdominal fascia

What sutures are typically used for aortic anastomosis

What suture are used for smaller vessel anastomoses, such as those on the coronary or carotid arteries

What sutures are used for microvascular and eye procedures

What sutures are used to close dural incisions

What sutures are used for most sub-cuticular skin closures

What are the suture lengths ranges available

Which sutures are used where continued strength is necessary, for instance, to close abnormal openings in the heart, typically used to close dura over the brain, used to close fascia and skin closure, silk commonly used for ligating vessels

Which sutures are often the 1st choice for tissue that does not need continued support. Often used for subcutaneous tissue and the mucosal layer of the intestine

What important factor determines suture choice

What is measured by the force in pounds that the suture strand can withstand before it breaks

What could be a factor when choosing a suture: Fascia and skin are strong but heal slowly, Gastrointestinal tissue is relatively weak but heals quickly

What could be a factor when choosing a suture:
•Age of the patient
•Metabolic factors
•Dehydration
•Vascularization
•Thickness of tissue at a given time
•Radiation therapy

What are some individual disease processes affecting suture choice that ST should be aware of:
•Diabetes mellitus
•Immune system diseases
•Pituitary gland dysfunction
•Localized infection
•Systemic infection

What has these characteristics: configuration, capillarity, ability to absorb fluid, size (diameter), tensile strength, knot strength, elasticity, and memory.

What is the most important information that the surgical technologist should learn to look for on a suture box

What information does the suture packet identify

What also referred to as controlled release (CR), are designed to “pop off” the suture strand after a single suture has been placed.

What are used to occlude vessels for hemorrhage control or for organ or extremity removal

What is removed as single strands from the package and placed into the open hand of the surgeon
(not on a reel, SA cuts monofilament suture )

What are used to occlude large vessels to prevent slippage. The suture is placed through the center of a large vessel after a hemostat is placed

What are used to occlude superficial bleeders, typically chromic, plain, or polyglactin 910 sutures

What are used to occlude deep bleeding vessels

What are best practices for suture use

Ligature reels should be removed from their packets and placed onto the .......with the strand end extended slightly.

Free-ties should be opened at the end of the packet and placed on the ........ with the suture strands protruding for easy access.

(A) Needle holder is clamped onto the needle approximately one-third the distance from the swage.
(B) Suture is removed from the package without placing tension on the swage.
(C) Needle is correctly armed on needle holder (close-up).
(D) The armed needle holder is placed in the surgeon’s hand.