Second intention healing Flashcards Preview

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Flashcards in Second intention healing Deck (55):
1

What are the key components of second intention healing?

1. granulation
2. contraction
3. epithelialization

2

How does the phases of wound healing in second intention differ from first intention (sutured wounds)

The phases are identical but the magnitude and duration of the CELLULAR phase is longer

3

How does contraction occur?

myfibroblasts (actin, fibronectin)

4

What are the two contraction theories?

1. picture frame theory
2. pull theory

5

What are the limits to contraction? (3)

1. contact inhibition
2. opposing tension
3. myofibroblasts disappear (large old wounds)

6

What is usually the greatest limit to contraction on limbs?

opposing tension

7

What can be done to old, large wounds to stimulate contraction?

scrape the granulation tissue/wound to cause upregulation of myofibroblasts

8

What is the rate of contraction on the body?

1mm/day (each side)

9

What is the rate of contraction on the limbs?

0.2mm/day

10

why is contraction slower on the limb?

1. inelasticity of skin
2. vascular insufficiency
3. fewer myofibroblasts
4. cytokines

11

What is the rate of epithelialization on the body?

0.2mm/day

12

What is the rate of epithelialization on the limb?

0.09mm/day

13

Why is epithelialization slower on the limb?

unknown

14

Why don't you see epithelialization until contraction has pretty well stopped?

because contraction occurs faster than epithelialization so it is just like the trickle in front of a wave and don't see significant epithelialization until contraction pretty well stops

15

How do you prevent exuberant granulation tissue?

1. debridement
2. sterile dressing
3. pressure bandages

16

Why is prevention better than treatment with exuberant granulation tissue?

because once a wound becomes exuberant, it tends to keep being exuberant

17

What is the bandage philosophy in second intention healing?

1. pressure bandage early to minimize swelling and reduce wound size--less retraction

18

What is the bandage philosophy in second intention healing?

1. pressure bandage early to minimize swelling and reduce wound size--less retraction b.c less swelling
2. after inflammatory phase it's a catch 22-may stimulate more granulation tissue and slow healing but also provides mechanical protection--abandon bandage when can!

19

Which of the following healed best 1) no treatment 2) cryosurgery 3) bandage 4) cast

1) no treatment

20

What can be a problem with wound medications?

t get a medication passed for wound healing, just have to show that causes no harm

21

When is immobilization indicated?

1. wounds in high motion areas

22

What requires critical observation?

equine sarcoids--horses are prone to develop equine sarcoids in areas of wounding. NOT granulation tissue--if trimmed will become more aggressive

23

How could you distinguish equine sarcoids and exuberant granulation tissue?

exuberant granulation tissue will eventually become exuberant over the whole wound

24

What are two ways that exuberant granulation tissue can be managed?

1. sharp debridement
2. topical medicaments

25

What are 2 advantages of surgical debridement? How is hemostasis acheived?

1. predictable result
2. can repeat as needed

achieve hemostasis by pressure bandage. (minimize by doing a fast debridement)

26

In what direction do you go when performing wound debridement?

start from bottom and work way up

27

What are two advantages of topical medications for the management of exuberant granulation tissue?

1. owner friendly
2. control granulation tissue

28

What is a disadvantage of topical medications for the treatment of exuberant granulation tissue?

1. impede healing (slow contraction, slow epithelialization)

29

Does sharp debridement of exuberant granulation tissue slow healing?

no

30

What does topical corticosteroids do?

inhibit granulation tissue
(also slows epithelialization)

(judicious use)

31

What are common preparations of topical corticosteroids?

1. panalog--$
2. green wound cream--penicillin + corticosteroid--sensitization?
3. 0.1% dexamethasone :)

32

What is white wound lotion?

lead acetate and zinc sulfate

33

Why is white wound lotion not good to use on wounds?

1. metabolic toxins (lead acetate, zinc sulphate)
2. kill fibroblasts
3. slow epithelialization
4. lead poisoning--not bandaged--lick--poisoned

34

What is the cheapest topical medication

copper sulfate (10% concentration mix with corn starch)

35

What is a negative effect of copper sulfate?

it is astringent/caustic and kills fibroblasts

36

What is a negative effect of copper sulfate?

it is astringent/caustic and kills fibroblasts

37

Which is preferred, topical corticosteroids or copper sulfate to manage exuberant granulation tissue? (if must be topical?)

corticosteroids

38

Is Furacin (nitrofurazon) a good choice for topical application on open wounds?

no,
1. it causes granulation tissue. not a good choice on open wounds
2. inhibits epithelialization
3. harbors pseudomonas

39

What is preparation H?

it is yeast extract

40

What can preparation H (yeast extract) be used for?

to stimulate the production of granulation tissue early on (n long effects)

41

What is a negative consequence of preparation H?

slows contraction and epithelialization

42

What is a negative consequence of preparation H?

slows contraction and epithelialization

43

What is the effect of amnion as a topical medication?

as a wound dressing
1. inhibits granulation tissue
2. promotes epithelialization
3. speeds healing

44

What is a problem with amnion:

not available commercially

45

What is the effect of honey as a topical medication?

1. osmotic effect on bacteria--antibacterial
2. unpasteurized my have enzymes to activate hydrogen peroxide

good to use in early wound management

46

What is the current data on collagen preparations as topical medications?

1. no negative effects demonstrated
2. so far no benefits
3. expensive

47

What is biosyst?

procine small intestinal submucosa

48

What does biosyst have?

1. collagen
2. protepglycans
3. cytokines

49

What is biosyst promoted as doing? Is there evidence of this?

1. scaffold
2. healing modifier

no good research to support

50

What are two benefits of using split thickness skin grafts?

1. inhibit granulation tissue
2. promote wound contraction

51

What are three types of skin grafts?

1. zenographs (pig)
2. allografts
3. autograft

52

Give an example where the medical preparation had an effect on wound healing

1. gentamicin cream vs solution
trial revealed that the cream affected contraction and inhibited epithelialization. The solution caused faster healing

53

What is a good saying for what to put on a wound?

If you wouldn't put it in your eye, don't put it on a wound

54

What are examples of topical medications?

1. corticosteroids
2. white wound lotion
3. copper sulfate
4. furacin
5. preparation H
6. amnion
7. honey
8. collagen preparation
9. biosyst
10. split thickness skin grafts

55

If you see exuberant granulation tissue, what should you do?

look for a reason!