Wound Closure and Healing Flashcards

Which patient factor is the single greatest systemic risk factor for surgical site infection?

Answer: Uncontrolled diabetes mellitus (HbA1c > 8%)

Uncontrolled diabetes mellitus impairs leukocyte function, reduces tissue perfusion, and provides a glucose-rich environment for bacterial growth, making it the strongest systemic SSI risk factor.

Which absorbable suture retains the most tensile strength at 6 weeks postoperatively?

Answer: Polydioxanone (PDS II)

PDS II (polydioxanone) retains approximately 50% tensile strength at 6 weeks and 25% at 6 months, outlasting all other common absorbable sutures.

Dead space in a wound is most dangerous because it:

Answer: Collects serum and blood that serve as a bacterial culture medium, promoting infection and seroma

Dead space allows fluid accumulation, creating a seroma or hematoma that is an ideal medium for bacterial growth and dramatically increases infection and dehiscence risk.

When closing a laparotomy fascial layer, which suture placement technique is recommended to reduce the risk of wound dehiscence?

Answer: Small bites technique — sutures placed 5 mm from edge and 5 mm apart in a continuous fashion

The small bites technique (STITCH trial) using 5 mm bite size and 5 mm spacing in a running fashion significantly reduces incisional hernia and dehiscence compared to large bites.

A patient develops a seroma 10 days after a mastectomy. The CRNFA understands that the most common contributing factor is:

Answer: Lymphatic and small blood vessel disruption during flap creation leading to fluid accumulation

Mastectomy seromas form when lymphatic and small vessels in the dissection planes continue to weep serous fluid into the dead space beneath skin flaps.

Which wound closure device provides the fastest skin closure and lowest rate of tissue strangulation in linear wounds?

Answer: Skin staples

Skin staples provide the fastest mechanical closure with minimal tissue handling and low risk of strangulation because they do not incorporate tissue within a loop under tension.