11-Wound Care

Question 1

What are the stages of wound healing?

Answer 1

• inflammatory phase
• proliferative (repair) phase
• remodeling (maturation) phase

Question 2

in what stage of healing do chronic wounds stop progressing?

Answer 2

proliferative (repair) phase

Question 3

what occurs during inflammatory phase?

time scale

Answer 3

• (days 1-4)
• initial vasoconstriction followed by vasodilation
• neutrophils and macrophages are recruited

Question 4

what occurs during proliferative (repair) phase? time scale?

Answer 4

• (days 3-21)
• collagen synthesis provides tensile strength of wound at 14 days
• tensile strength of wound equals that of suture

Question 5

what is the time scale for remodeling (maturation) phase?

Answer 5

days 21 up to one year

Question 6

What is Santyl?

Answer 6

collagenase- enzymatic debrider that digests collagen in necrotic tissue

Question 7

what is Regranex?

Answer 7

PDGF-1 (platelet derived growth factor)

Question 8

What is a normal value for serum albumin?

Answer 8

3.4-5.0 g/dL

Question 9

what is low serum album (<3.5 g/dL) associated with?

Answer 9

• decreased wound healing
• edema
• impaired cellular immunity
• decreased collagen synthesis
• decreased fibroblast proliferation

Question 10

what minimum ABI is necessary for wound healing?

Answer 10

• non-diabetic: 0.35
• diabetic: 0.45

Question 11

Using transcutaneous oximetry (TcO2), what min. pressure is necessary for wound healing?

Answer 11

• non-diabetic: 30 mmgHg
• diabetic: 40 mmHg

Question 12

how does negative pressure wound therapy (NPWT) (e.g. wound VAC) assist wound closure?

Answer 12

• NPWT applies mechanical shear stress to the wound site.
• This is believed to promote granulation by decreasing bacterial bioburden, reducing edema, and inducing capillary budding.

Question 13

how does hyperbaric oxygen therapy assist wound closure?

Answer 13

• increases partial pressure of O2 in arterial circulation, which increases diffusion of O2 at the wound site.
• this is believed to increase growth factors promoting angiogenesis and collagen synthesis.

Question 14

What is Integra?

Answer 14

bilayer graft composed of bovine (Cow) tendon collagen with chondroitin-6-sulfate and a silicone layer to control moisture loss

Question 15

what is Oasis?

Answer 15

extracellular graft matrix derived from porcine, small intenstinal submucosa

Question 16

what is Apligraf?

Answer 16

bilayer graft derived from nenonatal foreskin with dermal and epidermal layers

Question 17

what is graft jacket?

Answer 17

extracellular graft matrix derived from human tissue with intact vascular channels

Question 18

what is tissue mend?

Answer 18

acellular collagen matrix derived from fetal bovine dermis

(STRYKER)

Question 19

where is Regranex made?

Answer 19

puerto rico

Question 20

what is Theraskin

Answer 20

Real human skin allograft containing growth factors, cytokines and collagens

(MISONIX)

Question 21

what is Epifix?

Answer 21

Dehydrated Human Amnion/Chorion Membrane (dHACM) Allograft is a placental-based tissue product that acts as a semi-permeable protective barrier that supports the healing cascade

(MIMEDX)

Question 22

what is Revita?

Answer 22

Dehydrated full-thickness placental membrane allograft intended for use as a wound covering and barrier membrane

Question 23

what is Dermagraft?

Answer 23

FDA-approved, bioengineered human fibroblast-derived dermal substitute for the healing of diabetic foot ulcers; polyester-based;

*constructed by growing human neonatal foreskin fibroblasts to confluence on a mesh of polyglactin-910 (Vicryl)

Question 24

what is Kerecis Omega3?

Answer 24

Intact fish skin sheets containing fat, protein, elastin, glycans and other natural skin elements

Question 25

what is Affinity?

Answer 25

The only fresh amniotic membrane wound covering, retaining viable cells, growth factors and cytokines in a native ECM structure. Aseptically processed and hypothermically preserved using the proprietary AlloFresh® method

(Organogenesis)

Question 26

what is NuShield?

Answer 26

Sterile and shelf-stable dehydrated placental allograft wound covering that retains all the layers of the placental membrane due to the novel LayerLoc™ preservation method

(Organogenesis)

Question 27

what is PuraPly?

Answer 27

Unique combination of native, cross-linked extra-cellular matrix (ECM) + broad-spectrum polyhexamethylene biguanide (PHMB)

(organogenesis)

Question 28

what is Stravix?

Answer 28

Lyopreserved Umbilical Tissue for wound management and surgical applications is composed of the umbilical amnion and Wharton’s jelly and retains native living cells, growth factors and extracellular matrix

(SMITH & NEPHEW)

Question 29

what is Grafix?

Answer 29

lyopreserved placental membrane for wound management is composed of native living cells, growth factors and an intact extracellular matrix

(Osiris Therapeutics)

Question 30

difference between Grafix and Stravix?

Answer 30

Grafix is intended to replace skin after being directly applied to deep acute and chronic wounds;

Stravix is used as a surgical wrap to support soft tissue repairs in a range of procedures; can be used to cover or wrap acute and chronic wounds encompassing both upper and lower extremity

Question 31

what is the most common type of skin graft use?

Answer 31

xenograft

(harvested from animals for use as temporary graft in humans)

• PORCINE (pig) is most commonly used in burn care
• Earliest xenograft application was in 1500 BC with frog skin

Question 32

4 types of skin grafts

Answer 32

• Autograft or autologous graft: skin obtained from the patient’s own donor site.
• Allograft or heterologous graft: skin obtained from another person.
• Xenograft or heterograft: skin from other species, such as pigs.
• Synthetic skin substitutes: manufactured products that work as skin equivalents