Flashcards in Chap 83 Wound Care Deck (26):
List causes of non-healing wounds and name one method of investigation for each.
Arterial insufficiency--NIVs (macro), tcPO2/biopsy (micro)
Bacterial colonization--wound culture or biopsy
Lymphatic obstruction--clinical, lymphangiography
Collagen vascular disorders--serum markers
Excessive pressure---vibratory sensation (>25mV)
What are the stage of normal wound healing.
epithelialization and remodelling
Describe the inflammatory phase.
Mediated by Mast cells, neutrophils, macrophages
Release cytokines that recruit fibroblast and epithelial cells
Describe the proliferative phase.
Macs---growth factors that begin angiogenesis
Finroblast and cytokines synthesize collagen and proteoglycans---granulation tissue
Describe the Epithelialization and remodelling phase
Epithelial cells migrate into the wounds, secret MMP to degrade nonviable tissue
Remodeling long-term procee where type III collagen replaces type I
List mechanisms of abnormal wound healing
Inflam cause up regulation of cytokins and MMP which has a detrimental effect because they are present persistently
Upregulation of THN-alpha, IL-1, IL-6
Cells have diminished response to agonist-induced proliferation
What is the National Pressure Ulcer Advisory Panel Staging of ulcers?
Stage I Non-blacheable erythema
Stage II partial thickness (partial dermis)
Stage III Full thickness skin loss
Stage IV full thickness tissue loss (bone, tendon, muscle)
Unstageable--until eschar comes off)
List forms of non-vaible tissue.
List methods of debridement and examples.
When to treat bacterial colonization?
when counts are > 10 5th power counts per cubic millimeter
Give an example, advantages/disadvantage and e.g. of when to use gauze.
may dehydrate wound
damage granulation tissue
Give an example, advantages/disadvantage and e.g. of when to use film.
visualization of wound
can't use on infected wounds
may tear skin
Give an example, advantages/disadvantage and e.g. of when to use hydrogel.
extends time b/w dressing changes
fills dead spar
may be difficult to secure secondary dressing
may macerate skin
diabetic foot ulcers
minimally exudative wounds
Give an example, advantages/disadvantage and e.g. of when to use hydrocolloid.
impremeable to bacteria
facilitates autolytic debridement
not for infected or exudative wounds
may cause skin tears
low-exudative pressure ulcers
Give an example, advantages/disadvantage and e.g. of when to use foam.
not effective for dry wounds
highly exudative wounds
Give an example, advantages/disadvantage and e.g. of when to use alginate.
forms moist gel in wound
controls heavy exudate
can dehydrate wound
heavily exudative wounds
what are diabetic wounds best treated with?
donate moisture like hydrogels
What are draining wounds best treated with
what is the evidence for silver impregnated dressing for colonized wounds?
does not heal better then without
What is the evidence for compression and pentoxifylline for leg ulcer?
combo results in faster healing
What is the evidence for vein stripping in leg ulcers?
RCT showed at 4 years, stripping + compression 31% had recurrence, vs 56% with compression alone
Venous stripping reasonable when superficial venous reflux is a prominent compoenet (30-50%)
What is the evidence for skin grafting?
there is non to show better
can get recurrence
What is evidence for VAC therapy?
RCT--accelerates wound healing
Hoe does VAC therapy work?
Removal of exudate, stimulation of senescent cells, mobilization of macrophages, stimulation of angiogenesis
How does hyperbaric O2 therapy work?
100% oxygen at elevated atmospheric pressure
increase partial pressure of oxygen in tissues
improve oxygen supply, reduction of inflammation and edema, inhibition of infection, stimulate angiogenesis, enhance fibroblast function
one treatment daily for total of 20-40 treatments