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Fiser's ABSITE Ryan > Chapter 14 - Wound Healing > Flashcards

Chapter 14 - Wound Healing Flashcards

1
Q

This is the first stage of Wound Healing. Days? Cells?

A

Inflammation; Days 1-10; PMNs, Macrophages; Epithelialization at 1-2mm/day

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2
Q

This is the second stage of wound healing. Days? cells?

A

Proliferation; 5 days-3 weeks;
Fibroblasts
-neovascularization,
-production of collagen and granulation tissue

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3
Q

This is the third stage of wound healing. Days? what happens?

A

Remodeling; 3 weeks to 1 year

  • Type III collagen replaced with type I
  • Net amount of collagen does not change
  • Collagen cross linking occurs
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4
Q

At what pace do peripheral nerves regenerate?

A

1mm/day

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5
Q

The order of cell arrival in a wound:

A
  1. Platelets
  2. PMNs
  3. Macrophages
  4. Fibroblasts
  5. Lymphocytes
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6
Q

What do macrophages do in wound healing?

A

essential for wound healing

-release growth factors, cytokines, etc.

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7
Q

What do fibroblasts do in wound healing?

A

replace fibronectin-fibrin with collagen

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8
Q

What does fibronectin do in wound healing?

A

Chemotactic for macrophages; anchors fibroblasts.

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9
Q

What does Thrombin and Fibrin do in wound healing?

A

act as growh factors for endothelial cells and fibroblasts.

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10
Q

These are the primary cells in days 0-2

A

PMN’s

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11
Q

These are the primary cells in days 3-4

A

Macrophages

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12
Q

These are the primary cells in days 5 and on

A

Fibroblasts

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13
Q

What makes up the platelet plug?

A

Platelets and Fibrin

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14
Q

What makes up the provisional Matrix?

A

platelets, Fibrin, Fibronectin

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15
Q

What is meant by accelerated wound healing?

A

Reopening of a wound results in quicker healing the 2nd time, as cells are already present

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16
Q

Platelet Alpha granules contain what?

A
  • Platelet Factor 4- aggregation
  • Beta Thrombomodulin- binds thrombin
  • PDGF - chemoattractant
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17
Q

Dense Granules of platelets contain what?

A
  • Adenosine
  • Serotonin
  • Calcium
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18
Q

Platelet Aggregation factors include what?

A
  • TXA2
  • Thrombin
  • Platelet factor 4
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19
Q

Where is platelet activating factor released from?

A

Platelets

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20
Q

Where is transforming growth factor-alpha released from?

A

platelets

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21
Q

Where is fibroblast growth factor released from?

A

Platelets

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22
Q

Where is Beta Lysin released from and what does it do?

A

Platelets; antimicrobial

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23
Q

Where is PGE2 and PGI2 released from and what do they do?

A

Platelets; Vasodilator

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24
Q

Where is PGF2 released from? what does it do?

A

Platelets; Vasoconstriction

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25
Q

What is the most important fact in healing open wounds (secondary intention)?

A

Epithelial integrity; migration from wound edges, sweat glands, hair follicles
-dependent on granulation tissue

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26
Q

Unepithelialized wounds leak what and promote what?

A

Leak serum and protein, promote bacteria

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27
Q

The most importan factor in healing closed incisions (primary intention) is what?

A

Tensile strength

28
Q

Tensile strength depends on what?

A

collagen deposition and cross linking of collagen

29
Q

What is the strength layer of bowel?

A

Submucosa

30
Q

When is the weakest time point for small bowel anastamosis?

A

Days 3-5

31
Q

Which has better wound healing, Perineum or leg?

A

Taint, Nacho, Grundel, Gooch, Banus, et al

32
Q

Type I collagen?

A

Most common type

  • skin, bone, tendons
  • Primary collagen in healed wound
33
Q

Type II Collagen?

A

Cartilage

34
Q

Type III Collagen?

A

Healing wound, also in blood vessels and skin

35
Q

Type IV collagen?

A

Basement Membranes

36
Q

Type V collagen?

A

Widespread, particularly in the cornea

37
Q

These substances are required for the hydroxylation of proline and crosslinking of proline residues:

A
  • Alpha-ketoglutarate
  • Vitamin C
  • Oxygen
  • Iron
38
Q

Collegen has ________every 3rd amino acid and abundant___________

A

Proline; Lysine

39
Q

The tensile strength of a sound is only ever what percentage of the prewound strength?

A

80%

40
Q

The predominant Collagen produced for days 1-2 is?

A

Type III

41
Q

Predominant Collagen synthesized by days 3-4

A

Type I

42
Q

At 6 weeks a wound is ____% of final strength and ____% of original

A

80; 60

43
Q

At what point does a wound reach its maximal tensile strength?

A

8 weeks

44
Q

When does a wound have maximum collagen accumulation?

A

2-3 weeks. After than amount stays same but cross linking improves strength

45
Q

What does d-Penacillamine do to collagen?

A

Inhibits cross-linking

46
Q

What do you want transcutaneous oxygen measurement to be in a healing wound?

A

25 mmhg

47
Q

What is essential to wound healing?

A

moist, O2 delivery, no edema, necrotic tissue must be removed

48
Q

What level of Bacteria inhibits wound healing and why?

A

> 10^5

  • Decreases O2 content
  • collagen lysis
  • Prolonged inflammation
49
Q

What is the effect of devitalized tissue and foreign bodies on wound healing?

A

retards granulation tissue formation

50
Q

How does diabetes contribute to poor wound healing?

A

impedes early phase response

51
Q

What level of albumin can be a factor in poor wound healing?

A

<3.0

52
Q

How do steroids inhibit wound healing?

A

inhibit macrophages, PMNs, Collagen synthesis by fibroblasts, decrease tensile strength

53
Q

What can be given to counteract steroid effect on wound healing?

A

Vitamin A

54
Q

Osteogenesis Imperfecta is a defect in what?

A

Type I collagen

55
Q

Ehlers-Danlos syndrome is what?

A

Collagen disorder; 10 types identified

56
Q

Marfan’s syndrome is a defect in what?

A

Fibrillin (Collagen)

57
Q

What is Epidermolysis Bullosa, and how is it treated?

A

Excessive fibroblasts; phenytoin

58
Q

What is Charcot’s joint?

A

2nd MTP- diabetic foot ulcer 2* to neuropathy

59
Q

How long do you wait before doing a scar revision?

A

1 year

60
Q

Does cartilage contain blood vessels?

A

No

61
Q

Does Denervation have an effect on wound healing?

A

No

62
Q

Chemo can be given how many days after surgery and have no effect on wound healing?

A

14

63
Q

What inheritance is Keloiding?

A

Autosomal Dominant

64
Q

In Keloids, How far does collagen extend, and what is Tx?

A

Beyond the original scar; XRT, steroids, silicone, pressure garments

65
Q

Where are hypertrophic scars usually found?

A

flexor surfaces of upper torso

66
Q

In hypertrophic scars, how far does collagen extend?

A

Stays within confines of scar, treat with steroids, silicone, pressure garments

Fiser's ABSITE Ryan (50 decks)

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