CRNFA Wound Closure and Healing 1 — Questions and Answers
Question 1: A wound that is intentionally left open to granulate from the base is healing by which intention?
- Primary intention
- Secondary intention (Correct answer)
- Tertiary intention (delayed primary closure)
- Quaternary intention
Correct answer: Secondary intention
Secondary intention healing occurs when a wound is left open and fills in from the base by granulation tissue formation, contraction, and re-epithelialization.
Question 2: Which suture material is most appropriate for a contaminated abdominal wound requiring fascial closure?
- Silk (braided, non-absorbable)
- Chromic gut (rapidly absorbable)
- Polydioxanone (PDS) — monofilament slowly absorbable (Correct answer)
- Polyester braided suture (Ethibond)
Correct answer: Polydioxanone (PDS) — monofilament slowly absorbable
Monofilament slowly absorbable sutures like PDS are preferred in contaminated wounds because they provide prolonged tensile strength and their monofilament structure harbors fewer bacteria than braided sutures.
Question 3: The greatest tensile strength of a wound scar compared to original tissue is approximately what percentage at full maturation?
- 100% — fully restored
- 80% (Correct answer)
- 50%
- 25%
Correct answer: 80%
A mature scar achieves approximately 80% of the original tissue tensile strength due to reorganization of collagen fibers, but never fully equals normal tissue.
Question 4: Which phase of wound healing is characterized by fibroblast proliferation and collagen deposition?
- Hemostasis phase
- Inflammatory phase
- Proliferative phase (Correct answer)
- Maturation/remodeling phase
Correct answer: Proliferative phase
The proliferative phase (days 4–21) is dominated by fibroblast migration and collagen synthesis, along with angiogenesis and wound contraction.
Question 5: A retention (stay) suture is used in abdominal closure primarily for which purpose?
- Cosmetic skin closure
- To add supplemental strength in high-risk patients prone to dehiscence (Correct answer)
- To approximate subcutaneous fat only
- To secure drains in place
Correct answer: To add supplemental strength in high-risk patients prone to dehiscence
Retention sutures are large, through-and-through sutures placed to provide additional fascial support in obese, malnourished, or immunocompromised patients at high risk for wound dehiscence.
Question 6: The CRNFA notes that the skin edges of a closed wound are inverted (edges pointing inward). This is best corrected by:
- Adding more interrupted sutures
- Everting the skin edges before tying each suture and placing a vertical mattress suture if needed (Correct answer)
- Applying more wound tension by pulling sutures tighter
- Using staples instead of sutures
Correct answer: Everting the skin edges before tying each suture and placing a vertical mattress suture if needed
Skin edge eversion during closure and use of vertical mattress sutures ensures edges are turned outward, promoting apposition of dermis to dermis and optimal scar formation.
CRNFA Wound Closure and Healing 1
A wound that is intentionally left open to granulate from the base is healing by which intention?