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VET 411: Skin > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

four stages of wound healing

A
  1. hemostasis
  2. inflammation
  3. proliferation
  4. remodeling
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1
Q

hemostasis

A

formation of a blood clot to plug bleeding, provide a barrier to infection and fluid loss, and provide an initial substrate for wound healing

  • immediate
  • involves vasoactive substances, platelets, clotting factors, clotting proteins
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2
Q

steps of hemostasis

A
  1. bleeding
  2. release of vasoactive substances
  3. vasoconstriction
  4. vasodilation
  5. blood cells move into wound
  6. clotting cascade
  7. blood clot stabilizes wound
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3
Q

inflammation

A

bacteria and extracellular debris are removed from the wound by WBCs; blood clot stabilizes

  • 1-7 days after injury
  • involves neutrophils, macrophages
  • minimal hemorrhage, less sharp wound edges, scab formation
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4
Q

steps of inflammation

A
  1. WBCs migrate to wound
  2. neutrophils kill bacteria, degrade debris, release cytokines
  3. monocytes proliferate and differentiate
  4. macrophages debride, kill, and strengthen clot
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5
Q

proliferation

A

granulation tissue (collagen and blood vessels) fill the defect to provide a barrier to infection

facilitates wound closure via contraction and epithelialization

  • 3-35 days after injury
  • involves macrophages, fibroblasts, ECM proteins, capillary endothelial cells, new epithelial cells
  • rounded wound edges, granulation tissue forms, resistant to infection
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6
Q

steps of proliferation

A
  1. fibroblasts and endothelial cells migrate to wound
  2. new capillaries form and collagen accumulates
  3. ECM is replaced by red granulation tissue
  4. myofibroblasts contact wound edges
  5. epithelial cells grow inward from edges of wound
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7
Q

remodeling

A

collagen reorganizes to strengthen the closed wound; unneeded cells undergo apoptosis

  • weeks to years
  • involves macrophages, fibroblasts, matrix metalloproteinases, collagen
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8
Q

steps of remodeling

A
  1. wound loses vascularity
  2. type III collagen is replaced with type I collagen
  3. collagen reorganizes along tension lines
  4. wound gains tensile strength
  5. unnecessary cells undergo apoptosis
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9
Q

wound strength during inflammation

A

minimal strength

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10
Q

wound strength during proliferation

A

rapid strength gain

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11
Q

wound strength during remodeling

A

slow strength gain

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12
Q

how strong is the final scar

A

70-80% as strong as original tissue

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13
Q

ways of classifying wounds

A
  1. inciting injury
  2. degree of bacterial contamination
  3. type of closure
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14
Q

contusion

A

bruise

blunt trauma causes an accumulation of blood secondary to ruptured vessels

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15
Q

abrasion

A

partial thickness epithelial injury caused by blunt or shearing forces

minimal hemorrhage
rapidly healed by re-epithelialization

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16
Q

puncture wound

A

penetration of an object into the tissue

small opening with deep tissue contamination and damage

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17
Q

laceration

A

sharply incised skin edges that may extend into deep tissues

minimal peripheral trauma to wound edges

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18
Q

degloving injury

A

extensive loss of skin and underlying tissue

caused by scraping across a hard surface or excessive traction on extremity

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19
Q

thermal burn

A

close proximity of direct application of heat to skin

described by depth (superficial partial, deep partial, full thickness)

high risk of infection

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20
Q

radiation burn

A

secondary to external beam radiation therapy

takes weeks to present

21
Q

decubital ulcer

A

compression of skin and soft tissue between a bony prominence and a hard surface leading to skin loss over bony protuberance

22
Q

classifications by degree of contamination

A
  • clean
  • clean contaminated
  • contaminated
  • dirty
23
Q

clean

A

controlled surgical wound into STERILE tissue compartments

24
Q

clean contaminated

A

controlled surgical wound into GI, UG, or respiratory tracts

25
Q

contaminated

A
  • open, fresh, accidental wounds
  • gross spillage from GI, UG, or respiratory tracts
  • acutely inflamed tissues
26
Q

dirty

A
  • established infection
  • old, traumatic wound
  • devitalized tissues
  • GI, UG, or respiratory perforations
27
Q

when do surgical wound infections occur

A

when bacterial numbers and virulence exceed the host’s immune response

> 10^5 CFUs per gram of tissue

28
Q

what are local or surgical factors that lead to infection

A
  • amount of bacteria
  • necrotic/devitalized tissues
  • ischemia
  • foreign material
  • excessive hematoma or dead space
29
Q

what are local or surgical factors that lead to impaired healing

A
  • excess tension
  • excess motion
  • prior radiation at wound site
30
Q

what are systemic factors that lead to infection or impaired healing

A
  • long surgery/anesthesia
  • hypotension
  • hypothermia
  • concurrent diseases
  • immunosuppressive medications
31
Q

what are steps of basic wound care

A
  1. clip and clean
  2. clean surrounding skin
  3. remove foreign material
  4. debride infected/necrotic tissue
  5. lavage with sterile saline
  6. repair
32
Q

wound repair types

A
  1. open: cover with banadge
  2. closed: suture edges closed +/- drain
33
Q

what are the types of closure

A
  1. first intention
    - primary vs delayed primary
  2. second intention
  3. third intension (secondary closure)
34
Q

first intention healing

A

wound is closed SURGICALLY and BEFORE granulation tissue forms

IDEAL - fast, less new tissue formation

35
Q

first intention - primary closure

A

immediate debridement, lavage, and closure

used on FRESH (<12 hours) and CLEAN wounds (ideally golden period)

36
Q

golden period

A

the first 6 hours after the injury occurs

too soon to allow sufficient replication of microorganisms to cause wound infection

37
Q

first intention - delayed primary closure

A

1-5 days of open wound management with bandaging followed by surgical closure (still before granulation tissue forms)

used on OLDER (>12 hour) and CONTAMINATED wounds with devitalized tissue

38
Q

second intention healing

A

wound is closed NATURALLY via 4 stages of healing (contraction + re-epithelialization)

can used debridement and bandaging to support natural processes

SLOW with lots of new tissue formation

39
Q

when to use second intention healing

A

large areas of tissue loss
dirty/contaminated
infected surgical wounds
financial limitations

40
Q

third intention healing

A

wound is closed SURGICALLY and AFTER granulation tissue forms

open wound management followed by skin flaps/grafts/appositional closure

faster than second intention

41
Q

when to use third intention healing

A
  • severely contaminated, infected, or traumatized wounds
  • large wounds in high motion areas
42
Q

bandaging primary contact layer

A

sterile material applied directly to the wound surface

adherent or non-adherent

43
Q

adherent

A

used for DIRTY/CONTAMINATED effusive wounds during inflammatory phase

provides mechanical debridement when removed

ex. gauze 4x4 sponges

44
Q

non-adherent

A

used on HEALTHY GRANULATION TISSUE or minimally contaminated wounds

ex. Telfa pads or Adaptic gauze

45
Q

bandaging secondary layer

A

holds the primary layer in place over the wound

ex. cotton wrap, cast padding

46
Q

bandaging tertiary layer

A

provides support and protection

ex. vet wrap, elastikon

47
Q

tie over bandages

A

bandage material applied and secured by umbilical tape tied through skin sutures

used when concentric bandages would be difficult to apply or maintain

ex. face, axilla, inguinal area, abdomen, proximal limbs, perineum

48
Q

what are the two greatest indicators that primary closure is appropriate

A
  1. viability of tissues
  2. low contamination
49
Q

what is the number one indicator that a wound will heal well

A

vascularization of the tissues

higher vascularization = greater ability to heal

VET 411: Skin (16 decks)

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