A U E R S & T > Chapter 5 - Wound healing > Flashcards

Chapter 5 - Wound healing Flashcards

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1
Q

What is the major function of interferon IFN?

A

Proinflammatory; relase of other cytokines inhibit fibrosis

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2
Q

How are wounds traditionally classified?

A) By size and depth

B) By cause and location

C) As open or closed, and further as clean or contaminated

D) By duration and severity

A

C) As open or closed, and further as clean or contaminated

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3
Q

What characterizes closed wounds?

A

crushing or contusion injuries without skin loss

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4
Q

What type of wounds are considered clean?

A

Surgical wounds under aseptic conditions - electives

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5
Q

What bacterial count differentiates contaminated from infected wounds?

A) Less than 1 × 10^5 bacteria/g of tissue for contaminated

B) More than 1 × 10^5 bacteria/g of tissue for infected

C) Less than 1 × 10^4 bacteria/g of tissue for contaminated

D) More than 1 × 10^6 bacteria/g of tissue for infected

A

B) More than 1 × 10^5 bacteria/g of tissue for infected

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6
Q

What are the three phases of wound healing?

A) Inflammatory, proliferative, and remodeling

B) Hemostasis, infection control, and tissue regeneration

C) Infection, granulation, and epithelialization

D) Blood clotting, cell migration, and scar formation

A

A) Inflammatory, proliferative, and remodeling

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7
Q

What initiates the inflammatory phase of wound healing?

A

Hemostasis and acute inflammation
Reflex vasoconstriction by smooth muscle contraction and relase of endothelin and thromboxane A2 from injured bessels
Thrombin is the pricipal factor in clot formation

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8
Q

In the inflammatory phase after hemostasis by compresison of vessels by soft tissue swelling and clot formatio by thrombin wha is the going to be cleaved by thombin?

A

Thrombin will cleave fibrinogen into fibrin monomers that with polymerization into fibrin fibers interact with plasma fibronectin and stabilize the hemostatic plug called: provisional wound matrix

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9
Q

what is a clean contaminated wound?

A

Clean-contaminated wounds are surgical wounds in which
the respiratory, alimentary, or urogenital tract is entered under
controlled conditions without unusual contamination

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10
Q

what is a contaminated wound?

A

contaminated wounds are open, acute, accidental, or surgical wounds in which there has been a major break in aseptic
technique.

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11
Q

what is a dirt or infected wound?

A

Dirty or infected wounds are those that are old, have
devitalized tissue, or have gross contamination with foreign
debris

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12
Q

choice of wound closure primarily depends on 2 things which are

A

the type of wound (puncture vs laceration)
degree of contamination

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13
Q
A
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14
Q
A
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15
Q

What is the role of platelets in the early wound healing process?

A

Stopping blood loss and releasing wound-repair mediators

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16
Q

Which cells are the first to enter the wound during the inflammatory phase?

A

Polymorphonuclear cells (PMNs)

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17
Q

What characterizes the tissue formation phase?

A

Active by the THIRD day following injury characterized by: angiogenesis, fibrous and granulation tissue formation

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18
Q

When is fibroplasia and granulation tissue formation start? Regulated by who?

A

Recruitment from adjacent tissue, local proliferation, and
transformation of undifferentiated local and systemic mesenchymal stem cells (MSCs) into fibroblasts all contribute to the
peak in fibroblast numbers at 7 to 14 days after injury
Fibroblast migration into the wound and their subsequent
proliferation is largely regulated by PDGF, TGF-β, and bFGF

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19
Q

What triggers angiogenesis during wound healing?

A

Decreased oxygen tension and high lactate levels

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20
Q

In fibroplasia and granulation phase the collagen production happens when?

A

Collagen production begins slowly on the second or third
day after wounding and reaches peak production within 1 to 3
week

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21
Q

Which type of collagen is most common in wound?

A

type III collagen produced by blood vessls contaning type III as the wound heals and vascularity is reduced it shift to type I

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22
Q

What triggers the start of the epitheliazation?

A

starts immediately after wounding as a result
of local hypoxia, caused by vessel clotting, and basal keratinocyte
release of heat shock protein 90α (hsp90α)

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23
Q

During wound healing, when do neutrophils peak in number? Day 1, day 2, day 3

A

Around day 2

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24
Q

What is the role of platelets in the early inflammatory phase?

A

To release growth factors

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25
What is the primary function of macrophages in wound healing?
To remove necrotic tissue and bacteria
26
What characterizes the proliferative phase of wound healing?
Angiogenesis and tissue formation
27
What is the major function of the tumor necrosis factor?
Proinflammatory enhances angiogenesis, epithelialization and remodeling
28
When do fibroblasts predominantly appear in the wound?
During the proliferative phase
29
In remodeling and maturation phase (final phase of wound healing) goes from second week of repair and ends with formation of scartissue 1 to 2 years later. How weaker is this scar tissue?
20% weaker
30
When do fibroblasts start to appear in the wound?
Fibroblasts start to appear in the wound during the **proliferative phase of wound healing**. This phase typically begins about **3 days after the injury and peak 7-14 days**
31
What unique characteristic distinguishes wound healing in horses compared to other animals?
Greater propensity for developing exuberant granulation tissue
32
How does the healing rate of ponies compare to that of horses?
Faster than horses thanks to **leukocytes** that produce greater levels of **reactive oxygen species, interleukin (IL)-1, tumor necrosis factor, chemoattractants, and TGF-β1**, likely explaining why ponies’ wounds are more resistant to infection and why wound contraction is greater than in horses
33
what do keratinocytes synthetize and release i epithelialization phase?
collagenases MMPs Plasminogen activator
34
What type of response is quicker and more intense in ponies compared to horses?
Inflammatory response
35
What happens in the remodeling and maturation phase?
Replacement of the hyaluronan content within the provisional matrix by proteoglycans in the ECM. This gr**adually stops fibroblast** proliferation and migration. The cellular content within the ECM slowly decreases as **cytokine and growth factor signals declin**e and the **collagen content increases**.
36
In contraction phase: when does it start? Fibroblasts differentiate in what?
Contraction begins on **week 2** Reduces area of original wound 40-80% Differentiation of fibroblasts into **myofibroblasts** induced by **TGF-β1** (macrophages and keratinocytes)
37
What are the mediators of macrophage?
Cytokines :TNFalfa IL-1β, IL-6 Growth factors for vessels: PDGF VEGF bFGF Cytokines : TGF-α TGF-β Enzymes: tPA uPA Lack of natural selection for efficient healing
38
What are the mediators of PMN?
ROS Eicosanoids Proteases Cationic peptides TNFα IL-1β, IL-6 VEGF IL-8
39
In horses, what type of wounds typically heal slower than those on the upper body?
Limb wounds
40
What factors adversely affect the rate of epithelialization and contraction in limb wounds?
Excessive motion, infection, development of exuberant granulation tissue
41
What process is delayed in horses' wounds if bone is exposed?
Granulation tissue development
42
What type of wounds in horses are more at risk of infection?
Limb wounds Crushing or contusion
43
What common development occurs in wounds involving the limbs of horses managed by second-intention healing?
Development of exuberant granulation tissue
44
45
name the 3 phases of wound healing
three phases: (1) the inflammatory or lag phase, which involves hemostasis and acute inflammation; (2) the proliferative phase, during which tissue formation occurs; and (3) the remodeling phase, during which the healing tissue regains strength.
46
47
48
Acute wounds do expand in the _______ weeks
A cute wounds in horses, regardless of their location, typically expand in size in the first **1 to 2 weeks** because of the tensional forces of the adjacent tissues
49
what exuberant tissue granulation in distal limbs?
The inefficient inflammatory response (in horses), an imbalance in collagen homeostasis, a shift toward a profibrotic environment, tissue hypoxia, and inappropriate cell apoptosis have all been reported to influence its development
50
2.5-cm × 2.5-cm full-thickness limb wounds, wound areas expanded___ to ____times the original size during the first 2 weeks.
**2.5-cm × 2.5-cm** full-thickness limb wounds, wound areas expanded **1.4 to 1.8 times** the original size during the first 2 weeks.
51
what is the reepithelialization in mm/day in experimental distal leg wounds?
0.09 mm/day
52
How many mm/day do wound in the body contract versus in legs?
body 0.8 to 1 mm/day leg 0.2mm/day (high motion, high tension, low vascularization)
53
soil components in contaminated traumatic wounds reduce a number of important cells which one?
white blood cells effectiveness, decrease humoral defenses and neutralize antibodies
54
what are the 2 most common organisms in polymicrobial wounds?
*Pseudomonas aeruginos*a and *Staphylococcus spp*. being the most common isolates.
55
What is a characteristic feature of exuberant granulation tissue or "proud flesh"?
Abundance of capillaries surrounded by collagen
56
What is hypothesized to contribute to a profibrotic state leading to the formation of exuberant granulation tissue in horses?
The imbalance of mediators released by PMNs
57
Which factor is NOT associated with the development of exuberant granulation tissue? A) Chronic inflammation B) High levels of TGF-β1 C) Efficient inflammatory response D) Downregulation of MMPs
C) Efficient inflammatory response
58
What effect does microvascular occlusion in granulation tissue have on wound healing? A) Accelerates healing B) Has no effect C) Delays healing due to local hypoxia D) Increases infection risk
C) Delays healing due to local hypoxia
59
What is the recommended management for controlling exuberant granulation tissue?
Excision of protruding tissue and minimizing inflammation
60
What is the effect of equine amnion as a wound dressing?
Decreases development of granulation tissue and accelerates epithelialization
61
What is a potential benefit of using extracorporeal shock wave therapy on limb wounds?
Reducing TGF-β1 and preventing exuberant granulation tissue
62
How does advancing age affect wound healing in horses?
Slows it down
63
What condition in older horses may delay wound healing due to high cortisol levels?
Cushing disease
64
How does malnutrition at the time of injury affect wound healing?
Delays healing
65
What type of injury is most prone to infection and slow healing in horses?
Contusion and crush injuries
66
What role do vitamins and micronutrients play in wound healing?
Significant in the healing process
67
What is essential for wound healing in terms of tissue perfusion?
Adequate arterial circulation
68
How can anemia impact wound healing?
No impact if blood flow is maintained
69
What is the effect of hyperbaric oxygen therapy (HBOT) on local wound oxygen?
Increases it
70
How do seromas and hematomas affect wound healing?
Impede healing
71
What impact do chemotherapeutic drugs have on wound healing
Impair healing chapter 5 and no effect on healong according to chapter 28
72
Mast cell mediators are 3 name them
Histamine Chymase Tryptase
73
How does gabapentin, a common analgesic, affect wound healing?
Delays it
74
What is the effect of local anesthetics on wound healing?
Can detrimentally affect healing
75
What is the primary function of PMNs?
Phagocytosis of microbes Macrophage activation Amplify inflammatory response Stimulate repair process
76
What is the Mast Cell function?
Control vascular permeability Control influx of PMN Regulate tissue remodeling
77
How do PMNs contribute to the body's defense mechanisms?
Through amplifying the inflammatory response
78
Connective tissue growth factor CTGF is produced by who? what is the major function?
Produced by: Fibroblasts Function: mediator of TGF-β (cell proliferation)
79
Epidermal growth factor EGF is produced by who? what is the purpose?
Platelet and saliva Epitheliazation chemotactic and mitogenic to fibroblast protein and MMP synthesis angiogensis
80
Eicosanoids, produced by PMNs, play a role in which process?
Activate macrophages
81
Insulin-like growth factor IGF is produced where? what is the function?
Liver and platelets Function: chemotactic and mitogenic to epithelial cell; migration of epithelial cell; fibroblast proliferation protein and GAG synthesis
82
VEGF, vascular endothelial growth factor is produced by who? and what is the function?
Produced by: macrophage - fibroblatst - endothelial cell - epithelial cell Function: Angiogenesis
83
which type of lesion is prone to infection? cutting or crush injury?
Of the seven types, those with the least risk of developing infection are caused by sharp objects (e.g., an incision, a laceration caused by a nail). Contusion and crush injuries, which often include vessel thrombosis, are most prone to infection.
84
Suture tension that increases the interstitial pressure within the center of incision above tha capillary pressure of ____ mmHg can lead to tissue necrosis
above 30 to 40 mmHg
85
what is the ideal fluid for wound cleaning?
fresh wound can be safely cleaned with tap water, but isotonic fluids should be used once a granulation tissue bed has developed to avoid cellular swelling and destruction
86
what are chlorhexidine dilution values for cleaning of wound?
Dilute chlorhexidine solution (0.05%) can be made by adding 25 mL of a 2% chlorhexidine stock solution to 975 mL of sterile saline. Higher concentrations are cytotoxic to both tissue and bacteria
87
what are povidone-iodine dilution values for cleaning of wound?
If povidone-iodine is used, it should be diluted to a concentration of 0.1% to 0.2% (10 to 20 mL of a 10% stock solution added to sterile saline to a total volume of 1 L l). Concentrations greater than this have been shown to be toxic to canine fibroblasts, lymphocytes, and monocytes and to inhibit neutrophil migration
88
Lastly, hydrogen peroxide is cytotoxic to
fibroblasts in aqueous 3% solution, but bery fast healing if 1%
89
what are the spectrums of acitivity for triple antibiotic ointment and silver sulfadizine?
Triple-antibiotic ointment (bacitracin, polymyxin B, and neomycin) and silver sulfadiazine (SSD) have broad spectrums of activity,
90
Silver sulfadiazine is good for a type of bacteria, which one?
Pseudomonas spp. and fungi.
91
what are the disadvantages of nitrofurazone?
decrease epithelialization and to delay wound contraction. It also possesses carcinogenic properties.
92
Platelets are rich in (name the factors)
TGF-β, PDGF, epidermal growth factor (EGF), transforming growth factor-α (TGF-α), VEGF, serotonin, and histamine
93
what is the dosage for tx with cisplatin?
1 mg/cm3 during the perioperative period did not reveal any adverse effect on wound healing
94
which 2 type of neoplasia can be similar to granulation tissue?
SCC and sarcoids
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