wound healing and would care

Question 1

Inflammatory phase

Answer 1

bodys initial response to injury
stop bleeding–> fibrin platelet clots attract RBC’s into matrix clots
48 hrs after wound–> monocytes invade wound; release growth factor to continue wound healing

Question 2

what phase of healing begins 72 hours after injury

Answer 2

prloliferative phase

Question 3

proliferative phase

Answer 3

fibroblasts provude structure to wound via collagen

wound will be impervous to water

Question 4

what phase begins at 2-3 weeks after wound

Answer 4

remodeling phase

Question 5

how long does remodeling phase take

Answer 5

up to 2 years

Question 6

what occurs during remodeling phase

Answer 6

high levels of collagen, wound is 70% of normal skin strength

Question 7

what can happen if the inflammatory phase of wound healing is too long

Answer 7

a keloid scar

Question 8

what is wound contraction and when does it occur

Answer 8

the natural process of the body pulling normal skin over the wound, it aids in closure
its faster in areas where skin is loose
it occurs druing the first week of healing (remodeling phase)

Question 9

when does epithelialization occur

Answer 9

during the inflammatory phase

Question 10

what is epithelialization

Answer 10

dermal soft tissue repair
keratinized epithelium forms a barrier to water
-wound can now be exposed to water
with injury to the dermis, would will heal this way

Question 11

primary healing

Answer 11

healing by first intention
early debridment & suturing-->optimal healing
-wound edges are directly approximated
-lower layers closed
-needs to be closed in under 24 hrs

Question 12

secondary healing

Answer 12

healing by secondary intention
wound left open, heals spontaneously from edges towards center of the wound
usually packed with iodine packing–> closes from bottom up–> prevents bacteria from growing at the bottom

not as satisfying of a cosmetic result

Question 13

Tertiary healing

Answer 13

healing by third intention

closed after a delay of days-weeks

Question 14

factors related to the wound that affect healing

Answer 14

nature of the wound, laceration/crush
treatment within golden period
presence of hemotoma and level of contaminination
blood supply to area

Question 15

why is a hematoma bad for wound healing

Answer 15

it acts as a medium for infections to grow on

Question 16

factors related to the pt that affect wound healing

Answer 16

over 60
DM, collagen or vascular dz, anti clotting meds
immunosupressed
nutritional status
use of steroids/chemo
edema
immunizations up to date (tetanus)

Question 17

abrasions

Answer 17

loss of superifical epitheloum
dermis is intact
need to clean carefully

Question 18

contusion

Answer 18

soft tissue swelling/hemorrhage
skin intact
rarely requires aspiration

Question 19

Laceration

Answer 19

cut
needs to be debrided (remove devitalized tissue
often suture closed

Question 20

avulsion

Answer 20

loss of tissue, under minign flap
debride, suture of blood supply is ok
t

Question 21

Puncture wounds

Answer 21

what happends underneath is often worse than what you see superficially, need to make sure there isnt a foreign body isndie

Question 22

crush injury

Answer 22

extensive injury to underlying structures
need to debride skin flaps
IV fluorescein can be helpful to check the interstitial capillaries

Question 23

what can epi be used for

Answer 23

stopping the bleeding

Question 24

where cant it be used

Answer 24

fingers
toes
noes
penis

Question 25

what is usually used as a local anesthetic

Answer 25

xylocaine .5% or 1%

Question 26

what do you use to irrigate the wound

Answer 26

NS 20'cc from large bore needle

Question 27

what does debridment do

Answer 27

removes debris, clots, and necrotic tissue

Question 28

what can be used to stop the bleeding (hemostasis)

Answer 28

cautery or ligate bleeders

Question 29

which sutures are the most reactive with tissue and cause the most inflamation

Answer 29

biologic (cat/sheep gut)

Question 30

what is a new and better option for biologic/absorbable

Answer 30

vivryl or dexon

Question 31

what is most often used in surgery to close incisions

Answer 31

staples | metal is inert, very low reactivity

Question 32

what would get you the rail road tract appearance

Answer 32

if the sutures are too tight | causes ischemia, the ischemia causes inflammation which causes the rail road track appearance

Question 33

what 3 things should dressings be able to do

Answer 33

provide compression absorb secretions protect form inadvertent injury

Question 34

what is the strength of a wound after 1 week?

Answer 34

3% of normal skin strength

Question 35

what happens if sutures are left in for over 1 week?

Answer 35

get poorer cosmesis

Question 36

what makes for less risk of infection

Answer 36

good debridement & lavage | closed by primary intention

Question 37

what classifies a wound as significantly contaminated

Answer 37

contaminated with bacteria at 100k col/gm of tissue

Question 38

what is the most important element to reduce bacteria colony count?

Answer 38

debridement

Question 39

how frequently should dressings be changed

Answer 39

TID every day

Question 40

what agents can be used to reduce colony counts in contaminated wounds

Answer 40

topical silver sulfadiazine

Question 41

what classifies a wound as infected

Answer 41

>100k colonies per gm of tissue | often colonized by staph

Question 42

how would you tx an infected wound

Answer 42

deligent debridement/frequent dressing changed and topical silver silfadiazine

Question 43

what are 3 causes of chronic wounds

Answer 43

venous insufficiency (venous stasis) diabetic foot ulcers (poor neurovascularization) pressure sores

Question 44

how long will epithelialization take if the wound is well approximated

Answer 44

24 hrs

Question 45

why are scars visible

Answer 45

residual disorganized collagen

Question 46

what must exist for wound contraction to occur

Answer 46

fibrinonectin and collagen matrix framework must exist

Question 47

how does a partial thickness wound heal

Answer 47

by epithelialization

Question 48

how fast does epithelialization occur in partial thickness wound?

Answer 48

1-2mm/day

Question 49

how fast does epithelialization occur in an open, full thickness wound?

Answer 49

1-2 cm/month

Question 50

why is new epithelium so sensitive?

Answer 50

because it takes a very long time for it to form its anchoring (hemidesmosome attachments) to the basement membranes, which is how epithelial cells get their strength

Question 51

how can you avoid suture marks (rail road tracks) and also not disrupt the wound/reopen the incision which only has 3% of the normal skin tensile strenght at 1 week?

Answer 51

use subcutaneous stitches which will dissolve and not have to be taken out

Question 52

what is the wound strength at 3 weeks?

Answer 52

10%

Question 53

what will happen if a small amount of blood/eschar is left on the surface of the wound/incision

Answer 53

bacteria will adhere, grow, and delay epithelialization

Question 54

how much strength do wounds have at 6 weeks?

Answer 54

35-50% of prewounding strength

Question 55

how is debridment accomplished?

Answer 55

surgery

Question 56

what vitamin is necessary for collagen synthesis

Answer 56

vitamin c

Question 57

in pts taking steroids, what vitamin can help speed up wound healing?

Answer 57

vitamin a

Question 58

what kind of abx propholaxis do you use in class 2 wounds

Answer 58

first gen cephalosporins

Question 59

what kind or abx prophopaxis do you use in class III wounds

Answer 59

second generation cephalosporins, or ampicillin/gentamycin/flagyl

Question 60

when abx do you use in pcn allergic pts or in pts with MRSA

Answer 60

vancomysin

Question 61

necrotizing fasciatis

Answer 61

life threatening involves different fascial layers of the body caused by streep or staph occurs in contaminated soft tissue injuries, esp in pts with DM or peripheral vascular dz