Surgery Wounds USMLE 2

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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)

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Number of cards 31