Wound Healing Flashcards Preview

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Flashcards in Wound Healing Deck (31):
1

Why do we need to know about wound healing?

Common problems
Failure to treat will lead to morbidity, increased costs
Concepts relatively simple & can lead to good results

2

How to Understand Wounds

Phases of wound healing
Important factors in each phase
Understand factors that influence wound healing

3

4 Stages of Wound Healing

Hemostasis/Coagulation
Inflammation
Migration/Proliferation
Remodeling

4

Coagulation

Platelet aggregation
Degranulation of platelets
Fibrin clot formation

5

Inflammation

Attraction/activation of infiltrating cells
Neutrophils
Macrophages

6

Neutrophils in the Inflammation Process

Phagocytosis of bacteria & matrix

7

Macrophages in the Inflammation Process

Debridement/matrix turnover
Major source of stimulatory signals
Important for would healing

8

Define Angiogenesis

Formation of blood vessels

9

How does angiogenesis occur?

Begin as endothelial cell buds
Progress toward wound space (follows oxygen gradient)
Immature vessels differentiate into capillaries, arterioles, & venues
Macrophages & keratinocytes provide angiogenic stimuli

10

Describe Epithelization

Epidermal covering reconstituted from wound margin & hair follicle remnants

11

How does epithelization occur?

Keratinocytes migrate across wound
During & after migration, differentiation & stratification of neodermis occurs
Epithelization aided by moist environment

12

What happens to the fibroblasts in fibroplasia?

Migrate into wound site & replicate
Dominant cell type at wound edge
Synthesize & deposit collagen & proteoglycans

13

What is matrix deposition dependent on?

Oxygen & substrate availability
Growth factors

14

Define Remodeling

Changes in matrix composition over time

15

What is healing retarded by?

Ischemia
Dry wound environment
Infection
Foreign bodies
Anti-inflammatory therapy
Nutritional deficiency

16

Local Factors Affecting Wound Healing

Mechanical injury
Infection
Edema
Ischemia/necrotic tissue
Topical agents
Ionizing radiation
Low oxygen tension
Foreign bodies

17

Things to Know About Your Patient that will Affect Wound Healing

Age
Nutritional status
Circulation
DM
Smoking
Steroids
Support system

18

Essential Nutrients for Wound Healing

Calories
Carbs
Protein
Fats
Vitamin A
Vitamin C
Zinc
Water

19

Halsted's Principles of Wound Care

Gentle handling of tissues
Careful hemostasis
Aseptic technique
Avoidance of tension
Sharp dissection
Obliteration of dead space

20

3 Types of Wound Healing

Primary intention
Secondary intention
Third intention

21

Primary Intention of Wound Healing

Wound closed with stitches or staples
Cover with sterile dressing
Keep protected from getting wet
Monitor for erythema, swelling, warmth, & drainage

22

Secondary Intention of Wound Healing

Epidermis & dermis not closed
Usually due to contamination, an infected wound, or peritonitis
Packed daily with saline moistened gauze or sponges
Covered with sterile dressing

23

Third Intention of Wound Healing

I&D
Observed 3-4 days
Closed

24

Types of Wound Closure

Staples
Sutures
Wound Vac

25

Purpose of the Wound Vac

Decreases edema
Enhances granulation & vascularity
Lower bacterial counts
Excellent results

26

Define Surgical Site Infection

Infection at the incision site
May extend to adjacent deeper tissues

27

Most Common Nosocomial Infection Among Surgical Patients

Surgical site infection

28

Patient Risk Factors for Surgical Site Infection

DM
Obesity
Cigarette smoking
Systemic corticosteroids or other immunosuppressive drugs
Malnutrition
Pre-op nasal carriage or colonization with S. aureus
Presence of remote focus of infection
Duration of preoperative hospitalization
Preoperative severity of illness

29

Most Important Factors for Prevention of Surgical Site Infections

General health of patient
Meticulous operative techniques
Timely administration of pre-op antibiotics

30

IV Antibiotic Prophylaxis Regimen for Colorectal Surgery

Cefoxitin or cefotetan
Cefazolin + metronidazole

31

Hair Removal and Surgical Site Infections

Due immediately prior to surgical incision