wound care basics and surface assessment Flashcards
what is primary intention
clean, straight line, edges well approximated with sutures, rapid healing, best cosmetic outcome
secondary intention
larger wounds with tissue loss, edges not approximated, heals from inside out, grandulation tissue fills in the wound, longer healing time , larger scars
tertiary intention
delay is typically 3-5 days before injury is sutured, used to manage infected or unhealthy wounds, large scar
inflammatory phase
-starts immediately with hemostasis and includes the innate immune system
-exposed collagen activates clotting cascade
-cytokines/chemokines and growth factors released by resident cells and cells that migrate to area of wound
4-6 days
why are neutrophils, monocytes and macrophages essential:
-pathogen control
-pathogen and debris removal
-angiogensiss
-fibroplasia
Proliferative phase
day 4-weeks
-fibroblasts most important cell type: produce collagen to fill wound and provide support
angiogenesis
in proliferative phase
-capillaries bud from nearby vessels and grow into wound
epithelization
in proliferative phase
-epithelial cells from wound margins migrate across wound surface
wound contraction
in proliferative phase
- pulling of edges toward center making wounds smaller
myofibroblast
contractile properties and collagen synthesis
what happens in the proliferative phase
growth of blood vessels, deposition of collagen, formation of granulation tissue, epithelization, wound contraction
epithelialization
-cells migrate across new tissue to form barrier betwen wound and environment
-basal epithlelial cells at wound margin multiply and flatten
-basal cells behind margin undergo vertical growth
Remodeling phase
Collagen type III replaced by Type I
-disorganized fibers rearranged, cross linked, aligned along tension lines (langers lines)
-wound may increase in strength for up to 2 years after injury
21 days-2 years
