Wounds and Wound Healing

Question 1

The process of wound closure is classified into what three distinct types based on the timing of replacement of the epithelium over the wound?

Answer 1

Primary
Secondary
Tertiary

Question 2

Wound healing is also divided by physiologic process into what three stages of phases?

Answer 2

Inflammatory or substrate
Proliferative
Maturation or remodeling

Question 3

___ is the basic physiologic process that is common to all wounds.

Answer 3

Inflammation

Question 4

The second and third phases of wound healing are relatively constant, regardless of the type of wound healing. These phases begin only when what has happened?

Answer 4

When the wound is covered by epithelium

Question 5

Main cells involved in the substrate (inflammatory) phase?

Answer 5

PMNs, platelets, macrophages

Question 6

The second phase of wound healing is characterized by what?

Answer 6

The production of collagen in the wound, which appears less edematous and inflamed than before, but the wound scar may be raised, red, and hard

Question 7

Main cell involved in the proliferative phase?

Answer 7

Fibroblast (which produces collagen)

Question 8

The third phase of wound healing is characterized by what?

Answer 8

Maturation of collagen by intermolecular cross-linking

Question 9

What is the most common method to close an acute wound?

Answer 9

Primarily close the wound -> healing by primary intention (closure with sutures, staples, adhesive, any technique by which the surgeon intentionally approximates the epidermal edges of the wound)

Question 10

Advantages and disadvantages of healing by primary intention?

Answer 10

Advantage: easiest for the patient to manage, rapid return of function to the wounded part, final cosmetic result is superior

Disadvantage: risk of wound infection

Question 11

What is involved in healing by secondary intention?

Answer 11

Leaving the full-thickness wound open; classically wounds are treated with “wet-to-dry” dressings wherein a gauze sponge is moistened with saline and used to pack the wound, covered with a dry dressing. The moist sponge dries out and when it is removed and changed once or twice a day, gentle debridement of the wound is achieved. Granulation tissue will form in the base of the wound.

Question 12

Epithelial cells cannot migrate across granulation tissue, so healing in secondary intention occurs primarily by ___.

Answer 12

Wound contraction

Question 13

Advantages and disadvantages of healing by secondary intention?

Answer 13

Adv: wound infection is virtually impossible

Disadv: daily dressing changes are required until the wound is healed, which may take some time, and the final result is a cicatrix that may be unsightly

Question 14

What is healing by tertiary intention?

Answer 14

Delayed primary closure - wound initially managed as a secondary intention wound; after about 5 days, the wound edges are actively approximated

Question 15

Grade 1 Pressure Sore Grade?

Answer 15

Non-blanching erythematous area on intact skin

Question 16

Grade 2 Pressure Sore Grade?

Answer 16

Partial-thickness skin loss with the involvement of the epidermis and/or the dermis; usually superficial and can appear as a blister or abrasion

Question 17

Grade 3 Pressure Sore Grade?

Answer 17

Full-thickness skin loss with necrosis of subcutaneous tissue that can extend to the fascia

Question 18

Grade 4 Pressure Sore Grade?

Answer 18

Full-thickness skin loss with necrosis, destruction can involve muscle, bone, tendons

Question 19

Common sites for pressure ulceration?

Answer 19

Heel, sacrum, ischial tuberosities (bony prominences that bear increased pressure in the bedridden or wheelchair-bound patient)