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Questions and Answers
What is the duration of the inflammatory phase in wound healing?
What type of wound has a low risk of infection?
What is the purpose of the third intention healing method?
What type of sutures are absorbed by the body over time?
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What is a risk factor for surgical site infections?
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What is the term for a wound that exposes subcutaneous tissues?
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What is the term for a burn that affects the full thickness of the skin?
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What is the term for a wound that is caused by a sharp object?
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What is the primary concern in the initial management of burns?
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What is the percentage of body surface area affected by a burn on the front of the torso?
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What is the purpose of xenografts in burn treatment?
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What is the formula used to calculate the amount of fluid needed for rehydration?
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What is the primary mechanism of auto-grafting?
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What is the complication of burns that occurs when the body loses too much blood or fluid?
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What is the treatment for hypovolemic shock?
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What is the purpose of making incisions to relieve pressure in a deep burn?
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Study Notes
Cirugía Plástica
• Banco de cirugía plástica: pequeño y sencillo
Cicatrización de la Herida
• Fase inflamatoria (hemostasia, inflamación): 1-3 días • Fase proliferativa (granulación, proliferación de fibroblastos): 4-14 días • Fase de maduración (reorganización del colágeno, contracción de la cicatriz): 2-12 años • Fibroblastos especializados en la fase de contracción de maduración
Clasificación de Heridas
• Herida limpia contaminada: tiene una baja posibilidad de infección (ej., apendicitis aguda) • Herida sucia contaminada: tiene una alta posibilidad de infección (ej., perforación del colon)
Manejo de Heridas
• Cierre inmediato: sutura o afrontamiento • Cierre por segunda intención: cicatrización espontánea • Cierre por tercera intención: cierre tardío
Procesos de Cicatrización
• Limpia contaminada: apendicitis, cirugía gastrointestinal • Sucia contaminada: perforación del colon, heridas traumáticas
Sutura de Anastomosis
• Bordes invertidos y puntos separados • No se recomiendan puntos continuos • Técnicas de sutura: Lambert, Lembert, et al.
Materiales de Sutura
• Reabsorbibles: PGA, PLA, Poliglicólico, Polioxanona (180 días) • No reabsorbibles: Nylon, Polipropileno, Lino, Seda, Acero
Factores de Riesgo de Infección Quirúrgica
• Mala preparación de la piel • Contaminación de la herida • Falta de profilaxis • Cirugía prolongada
Heridas por Avulsión y Desgarro
• Herida abusiva: exposición de tejidos celulares subcutáneos • Herida por avulsión: desgarro de tejidos • Herida por abrasión: rasguño de la piel • Herida cortante o laceración: corte por objetos filosos### Burns and Wound Care
- A burn is classified as superficial (1st degree), partial thickness (2nd degree), or full thickness (3rd degree) based on the depth of tissue damage.
- 2nd-degree burns are further classified as superficial or deep, depending on the extent of dermal damage.
- 3rd-degree burns involve the hypodermis and may lead to compartment syndrome.
- 4th-degree burns involve muscle, bone, or other deeper tissues.
Classification of Burns
- Rule of Nines: a method for estimating the percentage of body surface area affected by a burn.
- Each arm is 9% of the body surface area, each leg is 18%, the front and back of the torso are 18% each, and the head and neck are 9%.
- For the face, 1/3 is 3% of the body surface area.
Quemadura por Agua Hervida (Burn from Boiling Water)
- A 60-year-old man suffers burns from boiling water on his arm.
- The burn is deep and circular, with a high risk of compartment syndrome.
- To avoid compartment syndrome, the pressure must be released, not by removing the crust, but by making incisions to relieve the pressure.
Rehidratación (Rehydration)
- The Parkland Formula is used to calculate the amount of fluid needed for rehydration.
- The formula is: 4 mL/kg/% of burned body surface area.
Regla de los Nueve (Rule of Nines)
- Used to estimate the percentage of body surface area affected by a burn.
- Each arm is 9% of the body surface area, each leg is 18%, the front and back of the torso are 18% each, and the head and neck are 9%.
Injertos (Grafts)
- There are two types of grafts: xenografts (from another species, such as pig skin) and autografts (from the same person).
- Xenografts are used as a temporary measure to protect the wound and promote healing.
- Autografts are the definitive treatment and involve transplanting the person's own skin to the affected area.
Mecanismo Fundamental (Fundamental Mechanism)
- The fundamental mechanism of auto-grafting is the formation of vascular connections to ensure the graft's survival.
Initial Management of Burns
- The initial priority is to secure the airway, as burns can cause respiratory distress.
- Fluid resuscitation is crucial to prevent hypovolemic shock.
- Hidratación (hydration) is achieved through crystalloid solutions, such as saline.
- Colloids may be used later, but crystalloids are the first line of treatment.
Shock Hipovolémico (Hypovolemic Shock)
- A life-threatening condition that occurs when the body loses too much blood or fluid.
- It is a common complication of burns.
- Treatment involves aggressive fluid resuscitation with crystalloid solutions.
Plastic Surgery
- A small and simple bank of plastic surgery is available.
Wound Healing
- The wound healing process consists of three phases:
- Inflammatory phase (hemostasis, inflammation): 1-3 days
- Proliferative phase (granulation, proliferation of fibroblasts): 4-14 days
- Maturation phase (reorganization of collagen, contraction of the scar): 2-12 years
- Specialized fibroblasts are involved in the contraction phase of maturation.
Wound Classification
- Clean-contaminated wounds have a low risk of infection (e.g., acute appendicitis)
- Dirty-contaminated wounds have a high risk of infection (e.g., colon perforation)
Wound Management
- Immediate closure: suturing or apposition
- Delayed closure by secondary intention: spontaneous healing
- Delayed closure by tertiary intention: late closure
Wound Healing Processes
- Clean-contaminated wounds: appendicitis, gastrointestinal surgery
- Dirty-contaminated wounds: colon perforation, traumatic wounds
Anastomosis Suture
- Inverted edges and separate points are recommended
- Continuous points are not recommended
- Techniques include Lambert, Lembert, and others.
Suture Materials
- Reabsorbable materials: PGA, PLA, Poliglicolic, Polioxanona (180 days)
- Non-reabsorbable materials: Nylon, Polypropylene, Linen, Silk, Steel
Risk Factors for Surgical Infection
- Poor skin preparation
- Wound contamination
- Lack of prophylaxis
- Prolonged surgery
Avulsion and Laceration Wounds
- Avulsion wounds: exposure of subcutaneous cellular tissues
- Avulsion wounds: tearing of tissues
- Abrasion wounds: skin scraping
- Cutting wounds or lacerations: cuts from sharp objects
Burns and Wound Care
- Burns are classified as superficial (1st degree), partial thickness (2nd degree), or full thickness (3rd degree) based on tissue damage depth.
- 2nd-degree burns are further classified as superficial or deep based on dermal damage extent.
- 3rd-degree burns involve the hypodermis and may lead to compartment syndrome.
- 4th-degree burns involve muscle, bone, or other deeper tissues.
Classification of Burns
- Rule of Nines: a method for estimating the percentage of body surface area affected by a burn.
- Each arm is 9% of the body surface area, each leg is 18%, the front and back of the torso are 18% each, and the head and neck are 9%.
- For the face, 1/3 is 3% of the body surface area.
Burns from Boiling Water
- A 60-year-old man suffers deep and circular burns from boiling water on his arm.
- The burn has a high risk of compartment syndrome.
- To avoid compartment syndrome, the pressure must be released, not by removing the crust, but by making incisions to relieve the pressure.
Rehydration
- The Parkland Formula is used to calculate the amount of fluid needed for rehydration.
- The formula is: 4 mL/kg/% of burned body surface area.
Rule of Nines
- Used to estimate the percentage of body surface area affected by a burn.
- Each arm is 9% of the body surface area, each leg is 18%, the front and back of the torso are 18% each, and the head and neck are 9%.
Grafts
- There are two types of grafts: xenografts (from another species, such as pig skin) and autografts (from the same person).
- Xenografts are used as a temporary measure to protect the wound and promote healing.
- Autografts are the definitive treatment and involve transplanting the person's own skin to the affected area.
Fundamental Mechanism
- The fundamental mechanism of auto-grafting is the formation of vascular connections to ensure the graft's survival.
Initial Management of Burns
- The initial priority is to secure the airway, as burns can cause respiratory distress.
- Fluid resuscitation is crucial to prevent hypovolemic shock.
- Hydration is achieved through crystalloid solutions, such as saline.
- Colloids may be used later, but crystalloids are the first line of treatment.
Hypovolemic Shock
- A life-threatening condition that occurs when the body loses too much blood or fluid.
- It is a common complication of burns.
- Treatment involves aggressive fluid resuscitation with crystalloid solutions.
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Description
Explore the wound healing process and classification of wounds in plastic surgery. Learn about the different stages of wound healing and types of wounds.
