NBSTSA Wound Management & Surgical Complications 5 — Questions and Answers
Question 1: A surgeon requests retention sutures for closure of a high-risk abdominal wound. The purpose of retention sutures is to:
- Approximate skin edges without tension
- Provide additional support to prevent dehiscence of fascial layers (Correct answer)
- Control bleeding along the incision line
- Secure the drain in place postoperatively
Correct answer: Provide additional support to prevent dehiscence of fascial layers
Retention sutures (e.g., through-and-through sutures with bolsters) provide supplemental support to the fascial closure and reduce the risk of wound dehiscence in high-risk patients.
Question 2: Which complication is MOST associated with the use of electrosurgery near a wound that has been prepped with alcohol-based antiseptic that has not fully dried?
- Surgical site infection
- Surgical fire (Correct answer)
- Electrosurgical burn to intact skin
- Interference with cardiac monitoring
Correct answer: Surgical fire
Pooled alcohol-based prep solution that has not fully evaporated can be ignited by an electrosurgical spark, causing a surgical fire.
Question 3: Keloid formation differs from hypertrophic scarring in that keloids:
- Regress spontaneously over time
- Remain confined within the original wound boundaries
- Extend beyond the original wound margins into surrounding tissue (Correct answer)
- Occur only in patients with diabetes mellitus
Correct answer: Extend beyond the original wound margins into surrounding tissue
Keloids are characterized by excessive collagen deposition that extends beyond the original wound boundaries, unlike hypertrophic scars which remain within the wound margins.
Question 4: When performing sharp wound debridement intraoperatively, the scrub technologist should:
- Pass soiled instruments back to the sterile Mayo stand after use
- Remove debrided tissue from the sterile field immediately and discard instruments used on necrotic tissue (Correct answer)
- Irrigate the wound with saline before each pass of the instrument
- Keep all instruments within the sterile field until the procedure is complete
Correct answer: Remove debrided tissue from the sterile field immediately and discard instruments used on necrotic tissue
Instruments contaminated with necrotic or infected tissue should be removed from the sterile field promptly to prevent cross-contamination of clean instruments.
Question 5: A patient experiences evisceration of abdominal contents through the wound on postoperative day 6. The IMMEDIATE nursing/surgical technologist action is to:
- Attempt to reduce the eviscerated contents manually
- Cover the evisceration with sterile saline-moistened dressings and notify the surgeon (Correct answer)
- Apply an abdominal binder tightly over the wound
- Administer oral fluids and place patient in Trendelenburg position
Correct answer: Cover the evisceration with sterile saline-moistened dressings and notify the surgeon
Sterile saline-moistened dressings protect the eviscerated organs from drying and further injury while the surgical team prepares for emergent return to the OR.
Question 6: Biofilm formation in a chronic wound is clinically significant because biofilms:
- Accelerate granulation tissue formation
- Protect bacteria from antibiotics and the host immune response (Correct answer)
- Indicate wound healing is progressing normally
- Are only found in wounds infected with gram-negative organisms
Correct answer: Protect bacteria from antibiotics and the host immune response
Bacterial biofilms are structured communities encased in a polysaccharide matrix that renders them highly resistant to antibiotics and phagocytosis, perpetuating chronic wound states.
Question 7: Which suture material is MOST appropriate for closing a contaminated wound where the suture must maintain tensile strength during the period of infection?
- Plain gut
- Chromic gut
- Poliglecaprone 25 (Monocryl)
- Polypropylene (Prolene) (Correct answer)
Correct answer: Polypropylene (Prolene)
Polypropylene is a non-absorbable, monofilament suture that maintains its tensile strength indefinitely and resists bacterial harboring, making it suitable for contaminated wound closures.
NBSTSA Wound Management & Surgical Complications 5
A surgeon requests retention sutures for closure of a high-risk abdominal wound.
The purpose of retention sutures is to: