General Surgery Wounds Practice Quiz (23 questions)

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A wound is a discontinuity in the skin, mucous membrane, or underlying tissue resulting from physical, chemical, or biological injury. The tissue-restoring process describes wound healing rather than the wound itself.

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Wound healing is the body’s coordinated process for restoring tissue continuity, structure, and function. A wound, by contrast, represents disrupted tissue integrity rather than its restoration.

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Blunt injury can damage deeper tissues without producing an obvious break in the skin. Penetrating injury differs because it creates an entry through the tissue.

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Tidy wounds are generally sharp, clean-cut, and have little or no devitalized tissue, while untidy wounds commonly result from crushing, tearing, avulsion, vascular injury, or burns. The alternatives reverse or misapply these characteristic features.

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Chronic wounds fail to heal within the expected time and may recur, with the stated duration ranging from more than four weeks to three months. Acute wounds generally heal within the expected time.

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The four surgical contamination classes are clean, clean-contaminated, contaminated, and dirty or infected. The other sequences describe depth, healing behavior, or different wound distinctions rather than contamination classes.

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A full-thickness wound involves the entire epidermis and dermis and may extend into fat or deeper structures. A partial-thickness wound involves the epidermis and only part of the dermis.

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Wound healing progresses through inflammatory, proliferative, and maturation and remodeling phases that overlap. They are not completely separate stages with one phase waiting for the entire previous phase to end.

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Neutrophils initially remove bacteria and debris, while macrophages become predominant later and release cytokines and growth factors. Fibroblasts and epithelial cells have important roles in later repair rather than this early inflammatory sequence.

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The proliferative phase replaces lost tissue through angiogenesis, fibroplasia, granulation tissue formation, epithelialization, and wound contraction. Hemostasis and inflammatory-cell recruitment belong mainly to the inflammatory phase, while collagen reorganization characterizes maturation and remodeling.

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Maturation and remodeling may last a year or longer as collagen is reorganized and the scar gradually gains strength. However, the repaired tissue does not necessarily regain the full strength of uninjured tissue.

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Primary intention closes a clean wound with minimal tissue damage by bringing its edges together, which limits tissue loss and scarring. Leaving a wound open for granulation describes secondary intention, while delayed closure describes tertiary intention.

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Secondary intention is used when tissue loss or extensive trauma prevents approximation of the wound edges, so healing proceeds through granulation, epithelialization, and contraction. Primary intention requires direct closure, whereas tertiary intention involves delayed closure after initial wound management.

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Tertiary intention involves initially leaving a heavily contaminated wound open and closing it later, often after three to five days. Primary intention closes a clean wound promptly, while secondary intention allows an open wound to heal without planned delayed closure.

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Tissue ischemia is a local factor that limits oxygen and nutrient delivery needed for repair. Adequate perfusion supports healing, while nutrition and systemic inflammation represent broader patient-related considerations.

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Diabetes mellitus is a systemic factor because it reflects the patient’s general condition and can interfere with repair. Hematoma, surgical technique, and foreign bodies are local factors arising at or near the wound.

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Dehiscence is the separation or breakdown of a wound that had previously been closed. Protrusion of abdominal contents is evisceration, while extension beyond the wound margins describes a keloid.

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Evisceration is the protrusion of abdominal contents through a disrupted abdominal wound and is a surgical emergency. Dehiscence describes wound separation without necessarily exposing abdominal contents, while a keloid is an abnormal scar extending beyond the original wound.

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A hypertrophic scar remains confined to the original wound boundaries, while a keloid grows beyond those margins. Wound separation and abdominal-content protrusion are different complications, and infection or ischemia do not define this scar distinction.

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Wound management progresses from patient assessment and stabilization through wound examination, cleaning, indicated debridement, closure or reconstruction, and follow-up. Closing before assessing and preparing the wound reverses important clinical priorities.

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Debridement is directed at removing clearly devitalized tissue, while irrigation is used to remove visible contamination. Irrigation therefore does not perform the same function as debridement.

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A complete 15-mark wound answer should cover the definition, causes, classification, healing phases and types, relevant factors, complications, and management principles. A clinical procedure list does not provide the full examination structure expected for the answer.

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The recommended diagrams cover biological healing phases, the distinction between primary and secondary intention, and the clinical management sequence. A healing timeline explains biology, whereas a management flowchart organizes clinical actions.