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

approximated

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

Chronic wounds

Medical name for a scar

cicatrix

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

dead space

What is the removal of devitalized tissue and contaminants

debridement

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

Dehiscence

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

Evisceration

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

first intention

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

French-eyed needle

What is defined as easily torn or crumbled

friable

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

herniation

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

immunosuppressed patient

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

inflammation

What is a cut or tear

laceration

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)

ligated

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

monofilament

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

packing

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

primary suture line

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

Polytetrafluoroethylene (PTFE)

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

second intention

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

swaged

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

tensile strength

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

third intention

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

vessel loops

What is and accidental wound called

traumatic

What is a surgical wound called

intentional

What does ideal wound healing involve

restoration of continuity, strength, function, and appearance

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

The word wound

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)

CLASS I-CLEAN-INFECTION RATE 1-5%

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

(Examples - Appendectomy, cholecystectomy, tonsillectomy)

CLASS II-CLEAN CONTAMINATED-INFECTION RATE 8-11%

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)

CLASS III-CONTAMINATED-INFECTION RATE 15-20%

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)

CLASS IV-DIRTY/INFECTED-INFECTION RATE 27-40%

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

At the end of the procedure

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

Traumatic wounds

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

Closed wound

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

Open wound
(higher infection rate)

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.

Simple wound

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

Complicated wound
(open wound , same as simple wound, but with foreign body))

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

Clean wound

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).

Contaminated wound

Define abrasion:
mechanism of injury

Scrape

Define contusion:
mechanism of injury

Bruise

Define Laceration:
mechanism of injury

Cut or tear

Define Puncture:
mechanism of injury

Penetration

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

1. pain (dolar)
2. heat (calor)
3. redness (rubor)
4. swelling (tumor)
5. loss of function (function laesa)

Define Thermal:
mechanism of injury

Heat or cold (can be chemical)

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.

An inflammatory reaction

First intention
Types of Wound Healing

Primary union

Second intention
Types of Wound Healing

Granulation

Third intention
Types of Wound Healing

Delayed primary closure

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.

First intention healing
3 distinct phases

What are the 3 distinct phases of first intention healing

(A) Phase 1, inflammatory response and debridement process
(B) Phase 2, collagen formation (scar tissue)
(C) Phase 3, sufficient collagen laid down

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.

Phase 1: Lag Phase or Inflammatory Response 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.

Phase 2: Proliferation Phase

• 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.

Phase 3: Maturation or Differentiation 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.

Second Intention (Granulation)
(No suture involved)

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

“proud flesh,”
(flakes)

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

Herniation

• 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.

Third Intention (Delayed Primary Closure)

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.

First consideration is the physical condition of the patient
Factors Influencing Wound 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

First consideration is the physical condition of the patient
Factors Influencing Wound Healing

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

Second consideration is intraoperative tissue handling
Factors Influencing Wound Healing

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.

Third consideration is the application of the principles of asepsis through the use of sterile technique
Factors Influencing Wound Healing

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"

Dehiscence
(Wound opening)

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

Evisceration

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.

Hemorrhage

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

Infection

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.

adhesion

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.

Herniation

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.

Fistula

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.

Sinus tract

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.

Suture complications

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.

Keloid scar

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.

Dead space

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.

Postoperative wound care

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

With a contaminated wound

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

Natural - Absorbable

Which suture is hydrolyzed by the body

Synthetic - Absorbable

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

Absorbable suture
Suture Material

What resists enzymatic digestion or absorption by tissue

Nonabsorbable suture
Suture Material

What is made of a single thread-like structure

Monofilament suture
Suture Material

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

Should not be use in the presence of infection

Multifilament suture
Suture Material

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

Monofilament suture
Suture Material

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

Multifilament suture
Suture Material

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

Natural absorbable sutures

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

Synthetic absorbable sutures

What is referred to as the suture diameter

gauge of the suture

Who specifies diameter range for suture materials

The United States Pharmacopeia (USP)

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

Brown and Sharpe (B and S)

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

Suture sizes

What are the most commonly used suture sizes

USP suture sizes #1 through 4-0

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

Suture sizes #1 and #0

What sutures are typically used for aortic anastomosis

Suture sizes 4-0 and 5-0

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

Suture sizes 6-0 through 7-0

What sutures are used for microvascular and eye procedures

Suture sizes 8-0 through 11-0

What sutures are used to close dural incisions

Suture sizes 4-0 sutures

What sutures are used for most sub-cuticular skin closures

Suture sizes 3-0 and 4-0

What are the suture lengths ranges available

Suture lengths 5 in. to 59 in

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

Nonabsorbable sutures

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

Absorbable sutures

What important factor determines suture choice

Knot tensile strength.

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

Knot tensile strength

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

General Factors Affecting Choice of Suture

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

General Factors Affecting Choice of Suture

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

Conditions for suture choice ST needs to be aware of that plain gut and other sutures can not be used on:

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

Suture materials

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

Suture size
Material
Type and size of needle

What information does the suture packet identify

Product code
Number
Material
Size (USP and metric)
Needle type and number

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

Rapid release needles

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

Ligatures or ties

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 )

Free tie

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

Suture ligature
Stick tie

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

Ligature reel

What are used to occlude deep bleeding vessels

Instrument Tie (Tie-on-a-Pass)

What are best practices for suture use

Only open what is needed
Arrange in order of use
Leave packs unopened on sterile field until needed

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

Mayo stand

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

Mayo stand

(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.

Loading the suture: