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Questions and Answers
What is the duration of the inflammatory phase in wound healing?
What is the duration of the inflammatory phase in wound healing?
What type of wound has a low risk of infection?
What type of wound has a low risk of infection?
What is the purpose of the third intention healing method?
What is the purpose of the third intention healing method?
What type of sutures are absorbed by the body over time?
What type of sutures are absorbed by the body over time?
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What is a risk factor for surgical site infections?
What is a risk factor for surgical site infections?
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What is the term for a wound that exposes subcutaneous tissues?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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.