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Types of Wound

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Presentation

Risk Factors

DIDN’T → Patient Factor

• DM,
• Infection,
• Drug (Steroid, Anti-metabolite)
• Nutrition (Protein, calories, A, C, zinc)
• Tissue necrosis

HEAL →Technical Factor

• Hypoxia

• Excessive tension on wound edge

• Another wound

• Low temp

• Past Note </aside>

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Treatment

Prevention → Pre-op Tasks

• Surgery Pre-op Risk Assessment and Optimization (Address RF)
  • High Protein Diet (1.5 g per kg)
  • Smoking cessation Therapy
  • Optimize Blood Sugar
• Pre-op Abx and DVT Prophylaxis
  • Abx within 1hr prior to incision, in OR
    • Cefazolin (1 gen IV) (Skin flora)
    • Metronidazole (GI coverage)
  • Normothermia***
  • Skin prep: Chlorhexidine / Betadine
  • Hair clipping instead of removal
  • Proper Gowning Technique Scrubbing

Management

• Open incision
• Debridement
• Wound care
• Systemic → Abx, get culture </aside>