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Wound Healing Flashcards

(92 cards)

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1
Q

First 3 step in the inflammatory phase ?

A

Hemostasis with a fibrin-platelet clot

Platelets release platelet-derived growth factor (PDGF)

Provisional matrix develops in first 24 hours

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2
Q

What are PMN role in the inflammatory phase in wound healing ?

A

They arrive through leaky capillaries, attracted by the PDGF growth factor releases by the platelets

Enhance cell migration

Phagocytose the clot

Kill bacteria

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3
Q

Inflammatory phase Last step: By __-__ hours, macrophages release growth factor

A

48-72

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4
Q

Proliferative Phase ?

A

72 hours after the wound started, fibroblasts provide structure to the wound in the form of collagen

Intramolecular cross-linking occurs, giving strength

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5
Q

What cell is mostly involved in the Proliferative Phase ?

A

fibroblasts

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6
Q

Remodeling / Maturation phase ?

A

By 2-3 weeks after the wound, the density of inflammatory cells and new capillaries start to resolve by apoptosis

Simultaneous collagen increase and breakdown

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7
Q

Remodeling phase can last months to ______ as collagen fibrils get more organized and cross-linked

A

2 years

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8
Q

Remodeling phase: Visible scars that remain are due to ?

A

residual disorganized collagen

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9
Q

If the inflammatory process lasts too long, persistent ___ and __________ activity cause increased collagen synthesis, leading to ?

A

PMN and macrophage

Hypertrophic scars

Keloids

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10
Q

Last 2 steps in the remodeling phase ?

A

Wound contraction occurs

Fibroblasts attach to the collagen matrix and contract the network

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11
Q

In surgical wounds, contraction can _____ or ___________ – undesirable look

A

shorten or depress scars

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12
Q

In circular incisions (anastomosis) contraction can cause ?

A

stenosis

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13
Q

Contraction occurs less over tighter skin (eg. shoulder) than over _______ (eg. groin)

A

loose skin

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14
Q

Epithelialization specific to ?

A

skin and gut tissue

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15
Q

Epithelialization occurs in what phase ?

A

Inflammatory

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16
Q

In a well-approximated wound, epithelialization is nearly complete at __-__ hours

A

24-48

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17
Q

In an open wound, this would take days to months

A

Epithelialization

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18
Q

Epithelialization benefits/facts ?

A

Provides a barrier on the skin to water, bacteria and other items in the environment

Multilayered by a few days

Sterile dressing in OR – do not remove for 3-4 days unless it gets wet

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19
Q

In a_____________ wound, minimal dermis is lost so wound heals by epithelialization

A

partial-thickness

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20
Q

Partial-thickness wound heals from ?

A

Wound heals from edges and from epidermal islands

1-2 mm/day

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21
Q

In open, ____________ wounds, epithelial cells can migrate only from the edges of the wound

A

full-thickness

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22
Q

full-thickness healing time ?

A

Takes longer, 1-2 cm/month

A 3-4 cm lower leg ulcer will take optimally 2-4 mos to close

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23
Q

Partial-thickness Wounds facts ?

A

If a wound is allowed to dry out, upper cell layers die and depth of injury extends

so

Keep wound occluded with a cream or polyurethane film – maintains moisture without eschar formation

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24
Q

______ is inelastic, putting shearing forces on underlying tissue during motion – painful

A

Eschar

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25
Full-thickness Wounds facts ?
Historically – “leave it open to air” But epithelial cells migrate significantly faster in moist environment Dressings, creams
26
What can slow down cell migration during wound healing ?
Eschar necrotic tissue excess exudate dry material
27
Epithelialization: Epithelium has no _______ , so it is sensitive to ______ and will ?
strength Sensitive to shearing forces Will blister or break down with trauma
28
Epithelialization: As it matures over months, it anchors to the dermis by______
fibers
29
Epithelialization: May appear different from surrounding skin due to ?
altered collagen and any absence of hair or glands
30
Well-approximated wounds have epithelial cover by __ hours so okay to bathe.....unless ?
24 prosthesis or foreign material in wound Early washing helps to rid exudate, blood and bacteria
31
An open wound continuously releases exudate which is_______ to tissue so it can Get colonized and becomes a ____________
adherent culture medium
32
Colonization and culturing of bacteria is improved with ?
Frequent dressing changes Irrigation Mechanical removal of debris - debridement Detergents Sterile saline Tap water better than a dirty wound
33
With cutaneous sutures, epithelium starts to migrate down suture track ________
immediately
34
If sutures are too tight or if there is swelling, suture will cut through the dermis – causing ?
“railroad tracks”
35
Remove cutaneous sutures within ______
1 week
36
So remove cutaneous sutures within 1 week | .... BUT tensile strength at 1 week is __ of normal
3%
37
Tensile strength at 3 weeks, it is ___ of normal
10%
38
Tensile strength at 6 weeks, it is ___-___ of normal
35-50%
39
Wound Strength: ______________- sutures help (last 3 weeks)
Subcuticular
40
Wound Strength: Wounds of abdominal fascia or tendons need to be protected for ______ (at 35-50% of normal by then)
6 weeks
41
Wounds over high tension areas need support for several weeks to allow ?
collagen remodeling and cross-linking
42
High tension wounds need support like ?
Steristrips Wound immobilizers Semiocclusive dressing Silicone gel sheeting Goal is to keep wound moist and absorb exudate
43
Wound Complications ?
Hematoma Seroma Dehiscence
44
Hematoma, patho, RF, and tx. ?
Collection of blood and clot Higher risk in pts on ASA or low-dose heparin, coughing, HTN Tx – evacuate the clot under sterile conditions, ligate, reclose
45
Seroma, patho, RF, and tx. ?
Fluid other than pus or blood Mainly when lymphatics are cut Compression dressing, vacuum device
46
Dehiscence definition ?
Partial or total disruption of any or all layers
47
___________ – all layers of abdominal wall with extrusion of abdominal organs
Evisceration
48
Wound dehiscence RF ?
*Inadequate closure - #1 reason Increased intraabdominal pressure Deficient wound healing
49
What is the #1 reason for wound dehiscence ?
Inadequate closure
50
Wound dehiscence tx. ?
Reclose using heavy gauge suture/wire If due to infection – tx infection and delay
51
Options for Optimizing Healing ?
Regranex - GF (PDGF) Apligraf - Artificial Skin Equivalents Hyperbaric oxygen - Seems effective though no clinical trials Electrical stimulation - By physical therapists
52
Growth factors – PDGF (Regranex) usually for ?
For diabetic foot ulcers
53
Artificial Skin Equivalents – Apligraf - usually for ?
Engineered skin for chronic wounds, venous ulcers
54
Factors that Impair Healing ?
Diabetes Aging Ischemia Malnutrition or catabolic state Edema Radiation Steroids or chemotherapy Collagen vascular disease
55
________ is a common cause of fever after 3rd postop day
Phlebitis
56
A post-op fever is more likely infectious if ?
Preoperative trauma Onset after the second post op day WBC above 10,000 BUN above 15 Surgery class above a 2 Temp above 38.6
57
5 Ws of post op fever ?
``` Wind Wound Water Walk Wonder drugs ```
58
________ is the most common pulmonary postop complication
Atelectasis
59
Fever ______ in the immediate postoperative period (1st 48 hours) is usually due to atelectasis
<102
60
atelectasis PE ?
Decreased breath sounds, esp bases in a patient taking shallow breaths. CXR can confirm
61
atelectasis prevention anf tx. ?
deep breath, cough, ambulation
62
What decrease the tidal volume ?
Pain, anesthesia, analgesia
63
Pneumonia fever level and sxs. ?
102 fever, confusion, hallucination, tachypnea, hypoxia, elevated WBC, purulent sputum **<102 in first 48 hours is usually atelectasis**
64
Chemical pneumonitis patho ?
Aspiration of gastric contents
65
Chemical pneumonitis | RF ?
Elderly, chronically ill, pts with GERD, food in stomach, pregnant at higher risk
66
Chemical pneumonitis | tx. ?
supportive Antibiotics only if the pneumonitis becomes a bacterial pneumonia (purulent sputum)
67
Most common nosocomial infection ?
UTI indwelling foleys
68
If UTI develops, give empiric antibiotics until culture results are back, which organisms are you wanting to cover ?
E. coli Klebsiella Pseudomonas
69
Early fever, 1st 48 hours ?
Atelectasis No work up needed, if patient is otherwise okay
70
Fever days __-__ could be infectious or not
2-5
71
Fever lasting after 5th day, what is much more likely ?
Wound infection
72
Signs and Symptoms of Infection, other ?
Fever, chills Malaise, fatigue, loss of appetite ~N/V Tachycardia, tachypnea Hypovolemia
73
Sxs. of hypovolemia ?
Dry mucous membranes Hypotension Oliguria, concentrated urine, anuria
74
____________ – most appear during surgery or in first 3 postop days
Dysrhythmias
75
Postop MI - ____ of all patients
0.4%
76
Postop cardiac failure – ____ of pts over 40 yo, usually due to fluid overload
4%
77
Postoperative Parotitis ?
rare staph infxn of parotid gland
78
Postop fecal impaction due to ?
colonic ileus opioids
79
Postop fecal impaction | Dx, ?
rectal exam
80
Postop fecal impaction | tx. ?
manual disimpaction then enema
81
Bowel obstruction due ?
paralytic ileus mechanical obstruction
82
Bowel obstruction what to look for ?
Look for air-fluid levels in loops of small bowel
83
Fat embolism ?
Common but usually asymptomatic Resp and neuro symptoms when severe
84
Hemoperitoneum ?
Rapid and life-threatening
85
Clostridium difficile colitis ?
Common nosocomial infection Asymptomatic to severe IV metronidazole or oral vancomycin
86
Postop pancreatitis ?
Usually after surgery near the pancreas Often necrotizing type
87
Postop urinary retention ?
Inability to void, common, often due to over distention Risk of UTI
88
Postop cholecystitis ?
After any surgery, but esp GI Usually no stones and more common in men Often becomes necrotic
89
CNS complications ?
Postop CVA Seizures – esp patients with Crohn or UC
90
Postop CVA ?
Usually due to poor perfusion Elderly with atherosclerosis, hypotensive
91
Psychiatric complications ?
“Postop psychosis”
92
“Postop psychosis” ?
On 3rd postop day, confusion, fear, disorientation Rule out metabolic derangement, infection

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