NBSTSA Wound Management & Surgical Complications 1 — Questions and Answers
Question 1: A wound that is left open initially and then closed several days later after infection risk decreases is classified as:
- Primary intention healing
- Secondary intention healing
- Tertiary intention (delayed primary closure) (Correct answer)
- Granulation healing
Correct answer: Tertiary intention (delayed primary closure)
Tertiary intention (delayed primary closure) involves intentionally leaving a wound open to reduce infection risk and closing it surgically 3–5 days later.
Question 2: Which complication is characterized by a loop of bowel protruding through an abdominal incision after surgery?
- Hematoma
- Seroma
- Evisceration (Correct answer)
- Dehiscence
Correct answer: Evisceration
Evisceration is the protrusion of abdominal viscera (bowel) through a disrupted surgical incision, a surgical emergency requiring immediate intervention.
Question 3: When a surgical site infection (SSI) occurs within the skin and subcutaneous tissue only, it is classified as:
- Deep incisional SSI
- Organ/space SSI
- Superficial incisional SSI (Correct answer)
- Remote SSI
Correct answer: Superficial incisional SSI
The CDC classifies SSIs as superficial incisional (skin/subcutaneous), deep incisional (fascia/muscle), or organ/space (body cavity), based on the depth of involvement.
Question 4: Which suture technique provides the strongest abdominal fascial closure?
- Simple interrupted
- Continuous (running) closure
- Subcuticular closure
- Figure-of-eight suture (Correct answer)
Correct answer: Figure-of-eight suture
The figure-of-eight suture provides a mass closure with double-strand reinforcement at each bite, making it particularly strong for high-tension fascial closures.
Question 5: A patient's wound shows redness, warmth, swelling, and purulent drainage on postoperative day 4. The MOST likely diagnosis is:
- Normal inflammatory response
- Wound dehiscence
- Surgical site infection (Correct answer)
- Seroma formation
Correct answer: Surgical site infection
Classic signs of surgical site infection (SSI) include the cardinal signs of inflammation plus purulent drainage, typically appearing 4–8 days postoperatively.
Question 6: Which factor is the MOST significant risk for developing a postoperative surgical site infection?
- Patient age over 50
- Preoperative diabetes mellitus with poor glycemic control (Correct answer)
- Use of absorbable sutures
- Female gender
Correct answer: Preoperative diabetes mellitus with poor glycemic control
Poorly controlled diabetes mellitus is one of the strongest independent risk factors for SSI due to impaired neutrophil function, decreased tissue perfusion, and delayed healing.
NBSTSA Wound Management & Surgical Complications 1
A wound that is left open initially and then closed several days later after infection risk decreases is classified as: