General Surgery: Wounds and Wound Healing

Comprehensive vocabulary flashcards focusing on definitions, classifications, healing mechanics, and complications of surgical and traumatic wounds.

Wound

A break in the integrity of the skin or tissues often associated with disruption of structure and function, affecting soft tissue, bone, or internal organs.

Ulcer

A disruption or break in the continuity of any lining, such as skin or mucous membrane; a specific subtype of wound.

Tidy wounds

Clean, incised, healthy wounds without tissue loss caused by sharp objects or surgical incisions, typically treated by primary suturing and healing by primary intention.

Untidy wounds

Wounds resulting from crushing, tearing, avulsion, burns, or vascular injury with devitalised tissue; managed by liberal excision and healing by secondary intention.

Clean incised wound

A tidy, simple, clean-cut wound with linear cut edges usually caused by a sharp instrument such as a blade, glass, or knife, managed by primary suturing.

Lacerated wound

A wound characterized by ragged edges and devitalized tissue where depth and viability require assessment, debridement, warm saline wash, and layered closure.

Bruise (Contusion)

A soft tissue injury caused by a blunt blow that crushes capillaries and causes trapped blood seepage under the skin without breaking epidermal continuity.

Haematoma

A localized collection of blood in subcutaneous, intramuscular, subfascial, or intra-articular spaces that clots rapidly and later liquefies, posing risks of infection and pressure effects.

Abrasion

A superficial injury caused by tangential shearing force that rubs off the epidermis, exposing dermal nerves and vessels to produce painful oozing; heals by epithelialisation.

Penetrating wound

A wound where the depth of injury exceeds its surface width, typically caused by a stab that enters natural body cavities or visceral organs.

Degloving injury

An avulsion injury caused by shearing force between tissue planes—typically subcutaneous tissue and deep fascia or muscle and bone—that strips off superficial tissues.

Clean wound (Berard classification)

An elective, primarily closed surgical wound without entrance into normally colonized body cavities and no break in sterile technique, having an infection rate of $< 2\%$.

Clean contaminated wound (Berard classification)

A surgical wound involving controlled opening of a normally colonized cavity with minimal spillage or minor technical breaks, bearing an infection rate up to $30\%$.

Contaminated wound (Berard classification)

A wound showing acute inflammation, gross hollow-organ spillage, open traumatic injury under $4\,\text{hours}$ old, or major sterile breaks; infection rate reaches $60\%$.

Dirty wound (Berard classification)

A wound involving purulent abscesses, bacterial perforation with peritonitis, or penetrating trauma over $4\,\text{hours}$ old, with an infection rate exceeding $60\%$.

Primary healing (First intention)

Healing seen in clean, closely approximated surgical incisions characterized by rapid re-epithelialisation over minimal fibrosis, yielding a thin, linear, supple scar.

Secondary healing (Second intention)

Healing of defects with extensive tissue loss or infection via prolonged granulation, wound contraction by myofibroblasts, and fibrosis, leaving a wide, contracted scar.

Tertiary wound healing (Delayed primary closure)

Surgical approximation or graft coverage of a heavily contaminated or complex wound performed $10\text{--}14\,\text{days}$ following debridement and infection control.

Inflammatory phase

The lag or substrate stage of wound healing lasting from injury to $72\,\text{hours}$, involving platelet thrombus aggregation, vasodilation, vascular permeability, and neutrophil chemotaxis.

Proliferative phase

The healing phase extending from the $3\text{rd}\,\text{day}$ to $3\text{--}6\,\text{weeks}$, dominated by angiogenesis via VEGF, granulation tissue formation, and initial random type III collagen deposition.

Remodelling phase

The maturation phase lasting from $6\,\text{weeks}$ up to $1\text{--}2\,\text{years}$, where collagen fibers cross-link and realign along tension lines, shifting the type I to type III collagen ratio to $4:1$.

Biofilm

A structured community of microorganisms enclosed within a self-produced extracellular polysaccharide matrix (glycocalyx) that adheres to tissue surfaces, resisting host immunity and antibiotics.

TIME acronym

A clinical framework for wound bed preparation representing Tissue assessment/debridement, Infection/inflammation control, Moisture imbalance correction, and advancing Edge monitoring.

Delayed primary suturing

The closure of a contaminated or lacerated wound performed between $48\,\text{hours}$ and $10\,\text{days}$ post-injury once local tissue oedema has subsided.

Secondary suturing

The operative closure of an infected or open wound performed after $10\text{--}14\,\text{days}$ once infection is eradicated and healthy granulation tissue has emerged.

Compartment syndrome

A condition characterized by elevated tissue pressure within an unyielding myofascial compartment ($> 30\,\text{mm Hg}$) causing muscle and nerve ischemia, with severe pain upon passive stretching.

Crush syndrome

A systemic reperfusion and compressive state where necrotic muscle releases myohaemoglobin into circulation, culminating in acute tubular necrosis and renal failure.

Fasciotomy

A surgical decompression procedure involving full-length longitudinal incisions through skin, fat, and deep fascia to relieve elevated intracompartmental pressure above $30\,\text{mm Hg}$.

Keloid

An excessive, progressive scar containing thick type III collagen bundles that extends beyond the original wound boundary into normal skin, possessing a collagen synthesis rate $20$ times normal.

Hypertrophic scar

An elevated scar composed of fine type III collagen that remains strictly within original wound margins, typically peaks within $6\,\text{months}$, and exhibits spontaneous regression.

Wound dehiscence

The acute mechanical failure and separation of closed fascial and skin layers, classically occurring $5\text{--}7\,\text{days}$ after laparotomy with profuse serosanguineous discharge.