Wound Healing and Wound Management Flashcards
(282 cards)
1
Q
First to differentiate diseased and infected wounds from non-infected wounds
A
Egyptians
2
Q
Relates use of mixtures containing homey, lint and grease for treating wounds
A
Ebers’s Papyrus
3
Q
Describes at least 48 types of wounds
A
Edwin Smith Surgical Papyrus
4
Q
Successful surgical case
A
Patient survives
Pathology is removed and/or corrected
Patient’s wound heals
5
Q
Employed 2 types of treatment (spiritual and physical method)
A
Sumerians
6
Q
Dispelled the theory of spontaneous generation of germs
A
Louis Pasteur
7
Q
Started soaking surgical instruments in phenol and spraying operating room
A
Joseph Lister
8
Q
Classified wounds into acute or chronic
A
Greeks
10
Q
Doctor of Roman gladiators
A
Galen of Pergamum
10
Q
Emphasized the need of moist environment to ensure adequate healing
A
Galen of Pergamum
11
Q
Production of antiseptic dressing - cotton gauze impregnated with iodoform
A
Robert Wood Johnson
12
Q
Normal wound healing pattern
A
- Hemostasis and inflammation
- Proliferation
- Maturation and remodelling
13
Q
Phase which begins immediately and ends within a few days
A
Inflammatory phase
14
Q
Hungarian obstetrician who noted the incidence of puerperal fever was much lower if medical students washed their hands following cadaver dissection and prior to attending childbirth
A
Ignaz Phillipp Semmelweis
15
Q
Capillary regression leads to a less vascularized wound
A
Remodeling phase
16
Q
Precedes inflammation and initiates inflammation with the ensuing release of chemotactic factors from the wound site
A
Hemostasis
17
Q
Wounding leads to (3)
A
- Division of blood vessel and direct exposure of ECM to platelets
- Direct exposure of subendothelial collagen to platelets
- Release of wound active sibstances through platelet alpha granules
18
Q
Complex cellular and biochemical cascade that leads to restitution of integrity and function
A
Wound healing
20
Q
Direct exposure of subendothelial collagen to platelets results to
A
Platelet aggregation, coagulation and activation of coagulation cascade
21
Q
Deposition of the fibrin-fibrinogen matrix and collagen, resulting in formation of the wound matrix and an increase in wound strength
A
Proliferation phase
22
Q
Serves as scaffolding for the migration into the wound of inflammatory cells
A
Fibrin clot
23
Q
Peaks at 24 to 48 hiurs but most do not survive in >1 day
A
Polymorphonuclear neutrophils
24
Q
Functions of inflammatory cells (2)
A
- Sterilize the ound
2. Secrete growth factors
25
Q
Primary role of PMNs
A
Phagocytosis of bacteria and tissue debris
26
Disruption of tissue integrity
Wounding
27
Wound active substances include (4)
```
PDGF
TGF-beta
Platelet-activating factor
Fibronectin
Serotonin
```
28
Achieve significant numbers in the wound by 48-96 hours post-injury
Macrophages
29
First to infiltrate wound site
Polymorphonuclear neutrophils
30
PMNs are stimulated by (7)
```
Inc. vascular permeability
Release of local prostaglandins
Complement factors
IL-1
TNF-alpha
TFG, platelet factor 4
Bacterial products
```
30
Release proteases that participate in matrix and ground substance degradation in the early phase of wound healing
PMNs
32
Macrophages contribute to microbial stasis through (3)
Oxygen radical synthesis
Nitric oxide synthesis
Regulation of cell proliferation, matrix matrix synthesis and angiogenesis
33
Most pivotal function of macrophages
Activation and recruitment of other cells
34
Major source of cytokines early during inflammation which may have a significant influence on subsequent angiogenesis and collagen synthesis
PMNs
35
Less numerous than macrophages
T-lymphocytes
36
Do not appear to play a role in collagen deposition or acquisition of mechanical wound strength
PMNs
37
Remain present until wound healing is complete
Macrophages
38
Macrophages regulate cell proliferation, matrix synthesis and angiogenesis by releasing (5)
```
TGF
VEGF
Insulin-like GF
Epithelial GF
Lactate
```
39
Depletion of most wound T lymphocytes lead to (2)
Decreased wound strength
| Decreased collagen content
40
Exert a down-regulating effect on fibroblast collagen synthesis
T lymphocytes
41
T lymphocytes exert a down-regulating effect on fibroblast collagen synthesis by
Cell-associated interferon, TNF-alpha and IL-1
42
Macrophages activate and recruit other cells via (2)
Mediators such as cytokines and GFs
| Directly by cell-cell interaction and ICAM
43
Peaks at 1 week post-injury
T-lymphocytes
44
Spans 4-12 days
Proliferative Phase
45
Last to infiltrate the healing wound
Fibroblast and endothelial cells
46
Strongest chemotactic factor for fibroblasts
PDGF
47
Selective depletion of the CD8+ suppressor subset of T lymphocytes leads to
Enhanced wound healing
48
Activation of fibroblasts
Cytokines and GFs released by wound healing
49
Potent regulator of collagen synthesis through a mechanism involving ADP-ribosylation
Lactate
50
Ridges transition from inflammatory to proliferative phase of healing
T-lymphocytes
51
Main function of fibroblasts
Matrix synthesis and remodelling
52
Re-establishment of tissue continuity
Proliferative Phase
52
Fibroblasts isolated from wound (3)
Synthesize more collagen than nonwound fibroblasts
Proliferate less
Carry out matrix contraction
53
Most abundant protein in the body
Collagen
54
Type of collagen which is the major component of ECM in skin
Type I
55
Migration, replication and new capillary tube formation are under the influence of (2)
Cytokines
| Growth factors as TNF-a, TGF-b and VEGF
56
Collagen is secreted by
Fibroblasts
57
Release of protocollagen results in
Hydroxylation of proline to hydroxyproline and of lysine to hydroxylysine
58
Type of collagen normally present in skin, becomes more prominent and important during the repair process
Type III
60
Composition of collagen
Glycine (in every third position)
Proline
Proline/lysine (2nd position)
61
Contains nonhelical peptide domains at both ends
Procollagen
62
Cleaves the nonhelical registration peptides extracellularly
Procollagen peptidase
62
Comprise a large portion of the ground substance that makes up granulation tissue
Glycosaminoglycans
63
Prolyl hydroxylase requires (3)
Oxygen and iron as cofactors
Alpha ketoglutarate as cosubstrate
Ascorbic acid as an electron donor
64
Major glycosaminoglycans present in wounds
Dermatan and chondroitin sulfate
65
Nonhelical peptide domains at both ends of procollagen
Registration peptides
66
Entwined three alpha-helical chains and is a right-handed superhelical structure
Procollagen
67
Breaks down collagen during maturation and remodelling
Matrix metalloprotinases
68
Net wound collagen content is a result of a balance between
Collagenolysis and collagen synth sis
69
Comprise a large portion of the ground substance that makes up granulation tissue
Glycosaminoglycans
70
Glycosaminoglycans couple with protein to form
Proteoglycans
71
A class of metalloproteinases that require activation and is a result of collagenase activity
Collagenolysis
72
Major glycosaminoglycans present in wounds
Dermatan and chondroitin sulfate
73
Factors that affect both aspects of collagen remodeling
Inc. new collagen transcription
Dec. collagen breakdown
By stimulating synthesis of tissue inhibitors of metalloproteinase
74
Continues for months postinjury, resulting in a mature, avascular and acellular scar
Scar remodelling
75
Postulted as the major cell responsible for wound contraction
Myofibroblast
76
Begins during the fibroblastic phase and is characterized by reorganization of previously synthesized collagen
Maturation and remodelling
77
Glycosaminoglycans couple with protein to form
Proteoglycans
78
Characteristic pattern of deposition of matrix at wound site
1. Fibronectin and collagen type III constitute the early matrix scaffolding
2. Glycosaminoglycans and proteoglycans
3. Collagen type I is the final matrix
79
Ultimate determinant of wound strength d integrity
Balance of collagen deposition and degradation
80
Undetectable until day 6 and then is increasingly expressed for the next 15 days of wound healing
Alpha smooth smooth muscle actin
81
Components of collagen
Hydroxyproline and hydroxylysine
82
Characterized primarily by proliferation and migration of epithelial cells adjacent to the wound
Epithlialization
83
Step of wound healing impaired by steroids and other immunosuppressants, congenital or acquired immune-deficient states
Inflammation
84
Begins during the fibroblastic phase and is characterized by reorganization of previously synthesized collagen
Maturation and remodelling
85
T/F: mechanical strength of the scar achieves that of the uninjured tissue after scar remodelling
False
86
T/F: the presence of granulation tissue is reassuring evidence that the healing process is under way
True
87
Step in wound healing impaired by anticoagulants, antiplatelet agents, and coagulation factor deficiency
Coagulation
88
Epithelialization of surgical wounds closed primarily is usually complete by
24-48 hours
89
Synthesis and hydroxylation of hydroxyproline and hydroxylysine are dependent on
Fe, alpha ketoglutarate and ascorbate
90
For a wound to be considered clean
1. Wound created in a sterile and nontraumatic fashion, in an area that is free of preexisting inflammation
2. The respiratory, alimentary, genital, or urinary tract was not entered
3. All persons involved in the case maintained strict aseptic technique
91
Signs of inflammation
Pain, swelling, heat, erythema, loss of function
92
For a wound to be considered contaminated
1. There was gross spillage from GIT
2. Genitourinary and biliary tracts were entered in the presence of local infection
3. Major break in aseptic technique
93
Wounds that heal in a predictable manner and time frame
Acute wounds
94
Gives granulation tissue its characteristic beefy red appearance
Angiogenesis
95
Wounds that have proceeded through the repair process without producing an adequate anatomic and functional result
Chronic wounds
96
Integrity of basement membrane is restored to which type of collagen during epithelialization
Type IV
97
In primary intention, wound strength reaches its maximum at about how many months and how many % that of normal skin?
3 months
| 70-80%
98
Gives myofibroblast contractile ability
Alpha smooth muscle actin in thick bundles
99
Occurs after wound repair has ceased and can lead to undesirable effects
Scar contracture
100
Reasons for not using sutures
1. Wounds edges cannot be apposed because the defect is very large
2. Surgeon chooses not to close the wound primarily because of high risk of infection
101
For a wound to be considered clean-contaminated
Respiratory, alimentary, genital or urinary tract was entered, but there was no significant spillage of its contents and there was no established local infection; minor break in aseptic technique
102
Consisting of the placement of sutures, allowing the wound to stay open for a few days, and the subsequent closure of sutures
Third intention
103
Majority of wounds that have not healed in 3 months
Chronic wounds
104
Wound healing characterized by decreased wound-breaking strength compared to normal
Delayed healing
105
Incised wound that is clean and closed by sutures
Primary (first) intention
106
Wound healing characterized by a constant and continual increase that reaches a plateau at some point postinjury
Normal healing
107
Wound healing characterized by a failure to achieve mechanical strength equivalent to normally healed wounds
Impaired healing
108
T/F: Superficial injury of the cartilage is fast to heal.
False
109
T/F: delayed healing eventually achieve the same integrity and strength as wounds that heal normally
True
110
Type of healing seen following closure of wounds that are not approximated with sutures
Second intention
111
For a wound to be considered dirty/infected
1. The wound was the result of remote trauma and contains devitalized tissue and/or purulent material
2. There is established infection or perforated viscera prior to the procedure
112
3 crucial steps in healing
1. Survival of axonal bodies
2. Regeneration of axons that grow across transected nerve to reach the distal stump
3. Migration and connection of the regenerating nerve ends to the appropriate nerve ends or organ targets
113
Accumulation of blood at fracture site containing devitalized soft tissue, dead bone and necrotic marrow
Initial stage of hematoma formation
114
Distinguishing feature of fetal wound healing
Lack of scar formation
115
T/F: Hypovascular tendons tend to heal with less motion and more scar formation than tendons with better blood supply
True
116
Effect of vitamin a deficiency in wound healing
Impaired fibroplasias, collagen synthesis, cross-linking and epithelialization
117
Fibril formation and crosslinking results in
Dec. collagen solubility
Inc. strength
Inc. resistance to enzymatic degradation of collagen matrix
118
Effect of corticosteroids in wound healin
Reduce wound inflammation, collagen synthesis and contraction
119
Effect of diabetes mellitus in wound healing
Impair keratinocyte growth factor and platelet-derived growth factor functions in the wound
120
T/F: degree of nutritional impairment need not be long standing in humans to affect wound healing
True
121
Types of nerve injuries and definition
1. Neurapraxia - focal demyelination
2. Axonotmesis - interruption of axonal continuity but preservation of Schwann cell basal lamina
3. Neurotemesis - complete transection
122
T/F: supplemental vitamin a can reverse the inhibitory effects of corticosteroids on wound healing
True
123
Phagocytic removal of degenerating axons and myelin sheath from distal stump
Wallerian degeneration
124
Effects of zinc deficiency in wound healing
Dec. fibroblast proliferation, dec. collagen synthesis, impaired overall wound strength, delayed epithelialization
125
Breaks down collagen during maturation and remodelling
Matrix metalloprotinases
126
Net wound collagen content is a result of a balance between
Collagenolysis and collagen synth sis
127
T/F: Immediate use of steroids postop does not affect wound healing severely
False
128
Most common organisms responsible for wound infection (in order of frequency)
1. Staphylococcus species
2. Coagulase-negative streptococcus
3. Enterococci
4. Escherichia coli
129
Most well-known element in wound healing
Zinc
130
Definition of wound infection (3)
1. All wounds draining pus, whether or not the bacteriologic studies are positive
2. Wounds that are opened by the surgeon
3. Wounds that the surgeon considers infected
131
Basis of selection of antibiotics for use in prophylaxis (3)
1. Type of surgery to be performed
2. Operative contaminants that might be encountered during the procedure
3. The profile of resistant organisms present at the institution where the surgery is performed
132
Wound infection that involves skin and subcutaneous tissue only
Superficial incisional
133
Most dangerous of the deep infections
Necrotizing fasciitis
134
Differentiate contamination, colonization, infection
Contamination - presence of bacteria without multiplication
Colonization - multiplication without host response
Infection - presence of host response in reaction to deposition and multiplication of bacteria
135
Effect of vitamin c deficiency in wound healing
Inadequate collagen production
136
Organisms most commonly responsible for CGD (5)
```
S. Aureus
Aspergillus
Klebsiella
Serratia
Candida
```
137
Effect of vitamin b6 deficiency in wound healing
Impaired collagen cross-linking
138
Factors affecting the level of vasoconstriction of the subcutaneous capillary bed
Fluid status, temperature, hyperactive sympathetic tone
139
Major component of chronic wounds
Skin ulcers
140
Used to diagnose CGD
Nitroblue tetrazolium reduction test
141
T/F: mild to moderate normovolemic anemia does not appear to adversely affect wound oxygen tension and collagen synthesis unless the hematocrit falls below 10%
False (15%)
142
Wound infection that arise immediately adjacent to fascia, either above or below it, and may often have an intraabdominal component
Deep incisional
143
Ulcers that occur due to a lack of blood supply
Ischemic arterial ulcers
144
An ulcer that fails to re-epithelialize despite the presence of adequate granulation tissue
Venous stasis ulcer
145
Antibiotic prophylaxis is most effective when (2)
1. Adequate concentrations of antibiotic are present in the tissues at the time of incision
2. Adequate preoperative antibiotic dosing and timing
146
Ischemic arterial ulcers are usually present at
Most distal portions of the extremities such as the interdigital clefts
147
Most common site of stasis ulcer
Above the medial malleolus, over Cockett's perforator
148
Treatment of venous ulcers
Compression therapy
149
Type of wound healing used following removal of ruptured appendix in which there is leakage of pus into the peritoneal cavity
Third intention
150
Localized area of tissue necrosis that develops when soft tissue is compressed between a bony prominence and an external surface
Decubitus or pressure ulcers
151
Effect of oxygenation in wound healing
Augment collagen synthesis
152
Differentiate sensory neuropathy from motor neuropathy
Sensory - allows unrecognized injury to occur from ill-fitting shoes, foreign bodies, or other trauma
Motor (Charcot's foot) - leads to collapse or dislocation of the interphalangeal or metatarsophalangeal joints, causing pressure on areas with little protection
153
Ulcer which is a site of incompetent perforators
Stasis ulcers
154
Malignant wounds are differentiated clinically from nonmalignant wounds by
Presence of overturned wound edges
155
Infection of any anatomical structure remote from the incisional site but manipulated during the procedure
Organ/space surgical site infection
156
Dose of contaminating microorganisms required to result in an increased risk of wound infection
10^5
157
Type of healing seen following closure if wounds in which there is obvious gross contamination at the incisional site
Third (delayed primary) intention
158
Poor operative techniques that may lead to wound failure
Suture material with inadequate tensile strength
Inadequate. Umber of sutures
Too small bite size
159
Similarities of hypertrophic scars and keloids
Both occur after trauma to the skin and may be tender, pruritic and cause a burning sensation
Histologically - demonstrate increased thickness of the epidermis with absence of rete ridges, abundance of collagen and glycoprotein deposition
160
Major contributors of diabetic ulcers
Neuropathy (60-70%) secondary to persistently elevated glucose
Foot deformity
Ischemia (15-20%)
161
T/F: vitamin a have absolutely helps in normally healing wounds
False
162
Four stages of pressure ulcer formation
Stage I - nonblanching erythema of intact skin
Stage II - partial-thickness skin loss involving epidermis or dermis or both
Stage III - full-thickness skin loss, but not through the fascia
Stage IV - full-thickness skin loss with extensive involvement of muscle and bone
163
Removes pericellular transudate and wound exudate as well as deleterious enzymes
Negative pressure wound therapy
164
Absorption characteristics of dressings
None - films
Low - hydrogels
Moderate - hydrocolloids
Hig - foams, alginates, collagen
165
Genetically heterogeneous group of diseases in which the reduced NADPH-dependent oxide enzyme is deficient
Chronic granulomatous disease
166
Characteristic pattern of deposition of matrix at wound site
1. Fibronectin and collagen type III constitute the early matrix scaffolding
2. Glycosaminoglycans and proteoglycans
3. Collagen type I is the final matrix
167
T/F: negative pressure wound therapy cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy
True
168
T/F: Wound dressing is contraindicated in infected and/or highly exudative wounds since it may enhance bacterial growth
True
169
Early surgical site infections that occur in the first 24 hours postop are most commonly due to
streptococcus or clostridium
170
Signs of infection to look for before administration of antibiotics
Erythema, cellulitis, swelling, purulent discharge
171
Differentiate dehiscence and incisional hernia
Dehiscence - if wound failure occurs early in the postop course before all stages of wound healing have occurred
Incisional hernia - if months or years postop
172
T/F: Occlusive and semiocclusive dressings are water-proof and impermeable to microbes, water vapor and oxygen
False
173
Guidelines for wound dressing
If nondraining - semi-occlusive dressing
If drainage (<1-2 ml/d) - semi-occlusive or absorbent nonadherent dressing
If moderately draining (3-5 ml/d) - nonadherent primary layer plus as absorbent secondary layer plus an occlusive dressing to protect normal tissue
If heavily draining (>5 ml/d) - same as above with the addition of a highly absorbent secondary layer
174
Tyoe of dressing designed to match the exudative properties of the wounds
Absorbent dressing
175
T/F: epinephrine can be used in wounds of the fingers, toes, ears, nose or penis due to risk of tissue necrosis secondary to terminal arteriole vasospasm
False
176
Basics of wound management
```
Optimize systemic parameters
Debride nonviable tissue
Reduce wound bioburden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with grafts/flaps as indicated
```
177
Hypertrophic scars vs keloids
Hypertrophic scar - subside spontaneously, in areas under tension, formed along the incisional line
Keloids - spread beyond the margins of original wound and are painful, require treatment, around earlobes and the deltoid, presternal and upper back regions
178
Commonly painless ulcer which results from incompetence of the deep venous system
Chronic venous ulcer
179
Septic thrombosis of the vessels between the skin and the deep layers
Necrotizing fasciitis
180
Fibril formation and crosslinking results in
Dec. collagen solubility
Inc. strength
Inc. resistance to enzymatic degradation of collagen matrix
181
T/F: cancers arising de novo in chronic wounds include squamous cell carcinoma only
False (basal cell also)
182
Continues for months postinjury, resulting in a mature, avascular and acellular scar
Scar remodelling
183
T/F: mechanical strength of the scar achieves that of the uninjured tissue after scar remodelling
False
184
A class of metalloproteinases that require activation and is a result of collagenase activity
Collagenolysis
185
Factors that affect both aspects of collagen remodeling
Inc. new collagen transcription
Dec. collagen breakdown
By stimulating synthesis of tissue inhibitors of metalloproteinase
186
Ultimate determinant of wound strength d integrity
Balance of collagen deposition and degradation
187
Characterized primarily by proliferation and migration of epithelial cells adjacent to the wound
Epithlialization
188
Postulted as the major cell responsible for wound contraction
Myofibroblast
189
Gives myofibroblast contractile ability
Alpha smooth muscle actin in thick bundles
190
Undetectable until day 6 and then is increasingly expressed for the next 15 days of wound healing
Alpha smooth smooth muscle actin
191
Step in wound healing impaired by anticoagulants, antiplatelet agents, and coagulation factor deficiency
Coagulation
192
Signs of inflammation
Pain, swelling, heat, erythema, loss of function
193
Step of wound healing impaired by steroids and other immunosuppressants, congenital or acquired immune-deficient states
Inflammation
194
Components of collagen
Hydroxyproline and hydroxylysine
195
Synthesis and hydroxylation of hydroxyproline and hydroxylysine are dependent on
Fe, alpha ketoglutarate and ascorbate
196
Gives granulation tissue its characteristic beefy red appearance
Angiogenesis
197
T/F: the presence of granulation tissue is reassuring evidence that the healing process is under way
True
198
Integrity of basement membrane is restored to which type of collagen during epithelialization
Type IV
199
Epithelialization of surgical wounds closed primarily is usually complete by
24-48 hours
200
Occurs after wound repair has ceased and can lead to undesirable effects
Scar contracture
201
For a wound to be considered clean
1. Wound created in a sterile and nontraumatic fashion, in an area that is free of preexisting inflammation
2. The respiratory, alimentary, genital, or urinary tract was not entered
3. All persons involved in the case maintained strict aseptic technique
202
For a wound to be considered clean-contaminated
Respiratory, alimentary, genital or urinary tract was entered, but there was no significant spillage of its contents and there was no established local infection; minor break in aseptic technique
203
For a wound to be considered contaminated
1. There was gross spillage from GIT
2. Genitourinary and biliary tracts were entered in the presence of local infection
3. Major break in aseptic technique
204
For a wound to be considered dirty/infected
1. The wound was the result of remote trauma and contains devitalized tissue and/or purulent material
2. There is established infection or perforated viscera prior to the procedure
205
Wounds that heal in a predictable manner and time frame
Acute wounds
206
Majority of wounds that have not healed in 3 months
Chronic wounds
207
Wounds that have proceeded through the repair process without producing an adequate anatomic and functional result
Chronic wounds
208
Incised wound that is clean and closed by sutures
Primary (first) intention
209
In primary intention, wound strength reaches its maximum at about how many months and how many % that of normal skin?
3 months
| 70-80%
210
Type of healing seen following closure of wounds that are not approximated with sutures
Second intention
211
Reasons for not using sutures
1. Wounds edges cannot be apposed because the defect is very large
2. Surgeon chooses not to close the wound primarily because of high risk of infection
212
Type of healing seen following closure if wounds in which there is obvious gross contamination at the incisional site
Third (delayed primary) intention
213
Consisting of the placement of sutures, allowing the wound to stay open for a few days, and the subsequent closure of sutures
Third intention
214
Type of wound healing used following removal of ruptured appendix in which there is leakage of pus into the peritoneal cavity
Third intention
215
T/F: delayed healing eventually achieve the same integrity and strength as wounds that heal normally
True
216
Wound healing characterized by decreased wound-breaking strength compared to normal
Delayed healing
217
Wound healing characterized by a constant and continual increase that reaches a plateau at some point postinjury
Normal healing
218
Wound healing characterized by a failure to achieve mechanical strength equivalent to normally healed wounds
Impaired healing
219
Accumulation of blood at fracture site containing devitalized soft tissue, dead bone and necrotic marrow
Initial stage of hematoma formation
220
T/F: Superficial injury of the cartilage is fast to heal.
False
221
T/F: Hypovascular tendons tend to heal with less motion and more scar formation than tendons with better blood supply
True
222
Types of nerve injuries and definition
1. Neurapraxia - focal demyelination
2. Axonotmesis - interruption of axonal continuity but preservation of Schwann cell basal lamina
3. Neurotemesis - complete transection
223
3 crucial steps in healing
1. Survival of axonal bodies
2. Regeneration of axons that grow across transected nerve to reach the distal stump
3. Migration and connection of the regenerating nerve ends to the appropriate nerve ends or organ targets
224
Phagocytic removal of degenerating axons and myelin sheath from distal stump
Wallerian degeneration
225
Distinguishing feature of fetal wound healing
Lack of scar formation
226
Effect of vitamin c deficiency in wound healing
Inadequate collagen production
227
Effect of vitamin a deficiency in wound healing
Impaired fibroplasias, collagen synthesis, cross-linking and epithelialization
228
Effect of vitamin b6 deficiency in wound healing
Impaired collagen cross-linking
229
Effect of oxygenation in wound healing
Augment collagen synthesis
230
Effect of corticosteroids in wound healin
Reduce wound inflammation, collagen synthesis and contraction
231
Effect of diabetes mellitus in wound healing
Impair keratinocyte growth factor and platelet-derived growth factor functions in the wound
232
T/F: degree of nutritional impairment need not be long standing in humans to affect wound healing
True
233
T/F: supplemental vitamin a can reverse the inhibitory effects of corticosteroids on wound healing
True
234
Most well-known element in wound healing
Zinc
235
Effects of zinc deficiency in wound healing
Dec. fibroblast proliferation, dec. collagen synthesis, impaired overall wound strength, delayed epithelialization
236
T/F: Immediate use of steroids postop does not affect wound healing severely
False
237
Antibiotic prophylaxis is most effective when (2)
1. Adequate concentrations of antibiotic are present in the tissues at the time of incision
2. Adequate preoperative antibiotic dosing and timing
238
Basis of selection of antibiotics for use in prophylaxis (3)
1. Type of surgery to be performed
2. Operative contaminants that might be encountered during the procedure
3. The profile of resistant organisms present at the institution where the surgery is performed
239
Most common organisms responsible for wound infection (in order of frequency)
1. Staphylococcus species
2. Coagulase-negative streptococcus
3. Enterococci
4. Escherichia coli
240
Definition of wound infection (3)
1. All wounds draining pus, whether or not the bacteriologic studies are positive
2. Wounds that are opened by the surgeon
3. Wounds that the surgeon considers infected
241
Wound infection that involves skin and subcutaneous tissue only
Superficial incisional
242
Wound infection that arise immediately adjacent to fascia, either above or below it, and may often have an intraabdominal component
Deep incisional
243
Septic thrombosis of the vessels between the skin and the deep layers
Necrotizing fasciitis
244
Most dangerous of the deep infections
Necrotizing fasciitis
245
Differentiate contamination, colonization, infection
Contamination - presence of bacteria without multiplication
Colonization - multiplication without host response
Infection - presence of host response in reaction to deposition and multiplication of bacteria
246
Genetically heterogeneous group of diseases in which the reduced NADPH-dependent oxide enzyme is deficient
Chronic granulomatous disease
247
Used to diagnose CGD
Nitroblue tetrazolium reduction test
248
Organisms most commonly responsible for CGD (5)
```
S. Aureus
Aspergillus
Klebsiella
Serratia
Candida
```
249
Factors affecting the level of vasoconstriction of the subcutaneous capillary bed
Fluid status, temperature, hyperactive sympathetic tone
250
T/F: mild to moderate normovolemic anemia does not appear to adversely affect wound oxygen tension and collagen synthesis unless the hematocrit falls below 10%
False (15%)
251
Major component of chronic wounds
Skin ulcers
252
Malignant wounds are differentiated clinically from nonmalignant wounds by
Presence of overturned wound edges
253
T/F: cancers arising de novo in chronic wounds include squamous cell carcinoma only
False (basal cell also)
254
Ulcers that occur due to a lack of blood supply
Ischemic arterial ulcers
255
Ischemic arterial ulcers are usually present at
Most distal portions of the extremities such as the interdigital clefts
256
An ulcer that fails to re-epithelialize despite the presence of adequate granulation tissue
Venous stasis ulcer
257
Commonly painless ulcer which results from incompetence of the deep venous system
Chronic venous ulcer
258
Ulcer which is a site of incompetent perforators
Stasis ulcers
259
Most common site of stasis ulcer
Above the medial malleolus, over Cockett's perforator
260
Treatment of venous ulcers
Compression therapy
261
Major contributors of diabetic ulcers
Neuropathy (60-70%) secondary to persistently elevated glucose
Foot deformity
Ischemia (15-20%)
262
Differentiate sensory neuropathy from motor neuropathy
Sensory - allows unrecognized injury to occur from ill-fitting shoes, foreign bodies, or other trauma
Motor (Charcot's foot) - leads to collapse or dislocation of the interphalangeal or metatarsophalangeal joints, causing pressure on areas with little protection
263
Localized area of tissue necrosis that develops when soft tissue is compressed between a bony prominence and an external surface
Decubitus or pressure ulcers
264
Four stages of pressure ulcer formation
Stage I - nonblanching erythema of intact skin
Stage II - partial-thickness skin loss involving epidermis or dermis or both
Stage III - full-thickness skin loss, but not through the fascia
Stage IV - full-thickness skin loss with extensive involvement of muscle and bone
265
Early surgical site infections that occur in the first 24 hours postop are most commonly due to
streptococcus or clostridium
266
Infection of any anatomical structure remote from the incisional site but manipulated during the procedure
Organ/space surgical site infection
267
Dose of contaminating microorganisms required to result in an increased risk of wound infection
10^5
268
Poor operative techniques that may lead to wound failure
Suture material with inadequate tensile strength
Inadequate. Umber of sutures
Too small bite size
269
Differentiate dehiscence and incisional hernia
Dehiscence - if wound failure occurs early in the postop course before all stages of wound healing have occurred
Incisional hernia - if months or years postop
270
Hypertrophic scars vs keloids
Hypertrophic scar - subside spontaneously, in areas under tension, formed along the incisional line
Keloids - spread beyond the margins of original wound and are painful, require treatment, around earlobes and the deltoid, presternal and upper back regions
271
Similarities of hypertrophic scars and keloids
Both occur after trauma to the skin and may be tender, pruritic and cause a burning sensation
Histologically - demonstrate increased thickness of the epidermis with absence of rete ridges, abundance of collagen and glycoprotein deposition
272
Basics of wound management
```
Optimize systemic parameters
Debride nonviable tissue
Reduce wound bioburden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with grafts/flaps as indicated
```
273
Removes pericellular transudate and wound exudate as well as deleterious enzymes
Negative pressure wound therapy
274
Absorption characteristics of dressings
None - films
Low - hydrogels
Moderate - hydrocolloids
Hig - foams, alginates, collagen
275
T/F: vitamin a have absolutely helps in normally healing wounds
False
276
T/F: negative pressure wound therapy cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy
True
277
Guidelines for wound dressing
If nondraining - semi-occlusive dressing
If drainage (<1-2 ml/d) - semi-occlusive or absorbent nonadherent dressing
If moderately draining (3-5 ml/d) - nonadherent primary layer plus as absorbent secondary layer plus an occlusive dressing to protect normal tissue
If heavily draining (>5 ml/d) - same as above with the addition of a highly absorbent secondary layer
278
T/F: epinephrine can be used in wounds of the fingers, toes, ears, nose or penis due to risk of tissue necrosis secondary to terminal arteriole vasospasm
False
279
Signs of infection to look for before administration of antibiotics
Erythema, cellulitis, swelling, purulent discharge
280
T/F: Wound dressing is contraindicated in infected and/or highly exudative wounds since it may enhance bacterial growth
True
281
Tyoe of dressing designed to match the exudative properties of the wounds
Absorbent dressing
282
T/F: Occlusive and semiocclusive dressings are water-proof and impermeable to microbes, water vapor and oxygen
False
