Page 12 of 14
SU5.1-4,SU6.1-2 | Wound Healing and Surgical Infection — Graded Quiz
Click any question card to reveal the correct answer.
During which phase of wound healing do fibroblasts deposit collagen, new capillaries form (angiogenesis), granulation tissue appears and the epithelium migrates across the wound?
Correct. The proliferative phase is defined by fibroblast activity and collagen synthesis, angiogenesis, formation of granulation tissue and re-epithelialisation. Remodelling that follows reorganises collagen and increases tensile strength over months.
Proliferation builds the new tissue (granulation, collagen, vessels, epithelium); remodelling then matures it. A wound only reaches a fraction of normal tensile strength even after months, which is why scars can still fail under load.
Granulation tissue, angiogenesis, collagen deposition and epithelial migration are hallmarks of the proliferative phase. Haemostasis and inflammation precede it, and remodelling follows it.
Click to reveal answer
A contaminated traumatic wound is deliberately left open, observed for several days to ensure it is not infected, and then closed surgically. This approach is called healing by:
Correct. Tertiary or delayed primary intention is used for contaminated wounds: the wound is left open, observed and decontaminated, then closed once it is clean, combining safety against infection with eventual apposition.
Never close a wound you have not satisfied yourself is clean. Tertiary intention is the safe middle path for contaminated wounds — open, observe, decontaminate, then close — avoiding the trapped-bacteria abscess of premature primary closure.
Leaving a contaminated wound open then closing it later is tertiary (delayed primary) intention. Primary intention closes immediately, and secondary intention leaves the wound to granulate to completion.
Click to reveal answer
A doctor in casualty examines and treats a patient with a stab wound that may become the subject of a criminal case. Regarding the medico-legal aspects of wounds, which action is most appropriate?
Correct. The treating doctor's record often decides a legal question, so wounds must be documented accurately and objectively (site, size, shape, edges, depth where ascertainable), contemporaneously and legibly, without speculating about the weapon or assailant.
A wound is, in law, an injury, and the clinician's contemporaneous record is frequently the key evidence. Document objectively (site, size, shape, margins, depth), avoid speculating on weapon or intent, and preserve the record carefully.
Medico-legal documentation must be precise, objective and contemporaneous. Vague notes, speculation about the weapon, or failing to document undermine both patient care and any legal process; the doctor should record facts, not inferences about causation.
Click to reveal answer
Which of the following best describes a lacerated wound, distinguishing it from an incised wound?
Correct. A laceration is caused by blunt force that tears tissue, leaving ragged, irregular margins often with tissue bridges across the wound — in contrast to the clean, sharp, regular edges of an incised wound.
Recognising tissue bridges and ragged edges identifies a laceration (blunt mechanism), which carries different medico-legal and contamination implications from the clean incised wound of a sharp blade.
A lacerated wound is from blunt trauma with ragged edges and tissue bridging. Sharp clean edges describe an incised wound; a graze is an abrasion; a bruise is a contusion; depth>length describes a stab.
Click to reveal answer
A diabetic man's surgical wound is red, tender, warm and discharging pus, but the patient is systemically well and the deeper tissues and organ space are not involved. Which type of surgical infection is this?
Correct. Infection confined to the skin and subcutaneous tissue of the incision, with local signs and pus but no deep or organ-space involvement, is a superficial incisional SSI, generally managed by opening the wound to drain it.
SSI is stratified by depth: superficial incisional (skin/subcutaneous), deep incisional (fascia/muscle), and organ/space. Classifying the depth guides whether simple wound drainage suffices or deeper source control is required.
Pus and local inflammation limited to skin and subcutaneous tissue, with the patient systemically well and no deep involvement, define a superficial incisional SSI — not a deep, organ-space, or necrotizing infection.
Click to reveal answer
Which statement correctly contrasts prophylactic with therapeutic antibiotic use in surgery?
Correct. Prophylaxis aims to prevent SSI and is usually a single dose timed within 60 minutes before incision; therapeutic use is a full, organism-directed course to treat an infection that has already developed.
Sound antibiotic stewardship distinguishes prophylaxis (single, timely, narrow, to prevent) from therapy (full course, directed at culture results, to treat). Prolonged 'prophylaxis' adds toxicity and resistance without benefit.
The two differ in purpose and duration: prophylaxis (prevent SSI, single preoperative dose) versus therapy (treat established infection, full course). They are not interchangeable.
Click to reveal answer
In the management of an established surgical infection such as an abscess, which principle takes absolute priority?
Correct. Source control — physically draining or removing the focus of infection — is the first and paramount pillar; antibiotics are an adjunct. An undrained abscess will not resolve on antibiotics alone.
Source control before antibiotics: pus must be drained and dead tissue debrided. The order of these two pillars must never be reversed, because antibiotics cannot penetrate or sterilise an undrained collection.
The first principle is source control: drain the abscess or remove the focus. Antibiotics, cultures and dressings support but cannot replace physical removal of the infected collection.
Click to reveal answer
When eliciting and documenting the history of a patient presenting with a wound, which element is most important to establish early because it determines tetanus risk and likely contamination?
Correct. The mechanism (sharp vs blunt vs penetrating), the timing (how old the wound is) and the environment (soil, water, animal/human bite) determine contamination, tetanus risk, depth of likely injury and management — and must be elicited and documented early.
A disciplined wound history (SU5.2) captures mechanism, timing, environment, tetanus status and comorbidities. These facts drive decisions on debridement, closure mode, tetanus prophylaxis and antibiotics, and form the medico-legal record.
A wound history centres on mechanism, timing and environment, which together predict contamination, tetanus risk and hidden deep injury. The other options are not the key determinants of management.
Click to reveal answer