Mod 2 Week 2 Healing wounds

Stages of wound healing 4
1. Haemostasis 2. Inflammation 3. Proliferation and migration (of fibroblasts) 4. Remodelling.
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How long does it take a scar to reach its steady state?
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Drugs that delay wound healing
Oral steroids, anticoagulants, retinoids, immunosuppressants
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What is healing by primary intention
Edges brought together by sutures etc.
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What is healing by secondary intention
Wound left to heal without closure
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Rfs for keloids
1. Age 10-30 2. Fhx (50% have +ve fh) 3. African American (15-20x more prone)
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Common sites for keloids?
Sites of tension - back, chest, shoulder. Earlobes. Suprapubic. Most are above ****** line.
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Where is pain/itch?
Pain in the centre, itchy at the edge.
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Rx keloid - gold standard
Surgery and post-operative DXT (removes keloid and replaces with fine scar)
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Other Rx for keloid, SEs
Steroid injection (SE skin thinning, white plaques, visible vessels, hypo/hyper pig - hypo more common). Steroid tape. Massage.
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Treatment for ear keloid (developed after piercing)
Shave cautery, il steroid to base, compression with clip-on earring.
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Features of venous hypertension
Lipodermatosclerosis (woody brown hardening), oedema, atrophie blanche (white scarring), venous flare (dilated small veins over foot)
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Where do venous ulcers occur?
Malleoli and lower 3rd leg. Foot ulcers very rare
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What to consider if very painful infected ulcer that is proving hard to heal? Ix
Osteomyelitis. MRI
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Treatment of venous leg ulcers?
Graduated compression
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What to do with aspirin pre-op? Warfarin?
Continue aspirin. Stop warfarin 3d before, check INR on day of op, needs to be <1.5.
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Risks with electrical hyfrecator?
Can interfere with PPM/ICD.
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What LA to use? How to minimise pain of injection?
Lidocaine 2% with adrenaline 1:80,000 via dental syringe. Warm the liquid, inject slowly, relaxed pt, ice at injection site, lower % lidocaine
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Max lidocaine 1% for 70kg adult. Earliest sign of toxicity. What site to avoid adrenaline?
20ml. Perioral tingling. Digital ring block.
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How to do cryo
Hold upright with tip 2cm from lesion, freeze commenced until ice ball created with area 1-2mm around lesion also being frozen. Once ice ball created give small pulses to maintain freeze for 5-10sec. Allow to thaw then repeat (max 2 freezes).
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Risks of cryo
Nerve damage (freeze area overlying tendon/nerve). Ulcer esp on lower leg (poor healing in this area). Hypo/hyperpigmentation, especially in pigmented skin. Pain, erythema, blistering.
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What to advise post-op for cryo?
Apply Vaseling daily, tell patients it will look worse ebfore it looks better.
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What sutures to use at mucosal sites?
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What size suture for facial site
5-6 gauge
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When to use subcuticular sutures? Suitable suture material?
In areas where there is tension on the wound. Prolene
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Do surgical sounds heal better if dry or moist?
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Currettage of lesion can lead to a depressed scar? T/F
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When to remove sutures on face?
1 week
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How long does it take a scar to reach its steady state?



Card 3


Drugs that delay wound healing


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Card 4


What is healing by primary intention


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Card 5


What is healing by secondary intention


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