Wound Healing - Class 5

Question 1

epidermal healing response

Answer 1

begins w/in 24-48 hours

Question 2

what do the epithelial cells do –> epidermal healing

Answer 2

detach from the basal layer

migrate across the wound

proliferate by mitosis

differentiate into mature epidermal cells

Question 3

contact guidance –> epidermal healing

Answer 3

when epithelial cells contact each epithelial cells

they change direction

Question 4

contract inhibition –> epidermal healing

Answer 4

when the epithelial cells are contact on all sides by other epithelial cells

they stop migration

Question 5

dermal healing has

Answer 5

3 phases

Question 6

3 phases of dermal healing

Answer 6

inflammatory

fibroblastic

maturation

Question 7

fibroblastic phase includes

Answer 7

collagen synthesis

wound contraction

Question 8

collagen synthesis

Answer 8

amino acids link together to form polypeptide chains

amino acids are hydroxylated and the chain is called protocollagen

Question 9

protocollagen

Answer 9

3 protocollagen chains are twisted together to form a helix called tropocollagen

Question 10

tropocollagen

Answer 10

multiple tropocollagen units form collagen filaments

Question 11

collagen filaments

Answer 11

bundles of filaments make a fibril

fibrils form a fiber

Question 12

wound contraction

Answer 12

active process d/t fibroblasts/myofibrils

Question 13

what do the fibroblasts and myofibrils do –> wound contraction

Answer 13

attempt to close a wound in which a loss of tissue has occurred

Question 14

amount of contraction is dependent on –> wound contraction

Answer 14

amount of available mobile skin around the defect

Question 15

what would cause wound contraction to stop

Answer 15

edges meet

tension in the surrounding skin equals or exceeds the force of contraction

Question 16

what may decrease contraction

Answer 16

skin grafts

Question 17

scaring

Answer 17

ration of collagen breakdown to production determines the type of scar that forms

Question 18

if rate of breakdown exceeds production

Answer 18

scar becomes softer and less bulky

Question 19

if rate of production exceeds breakdown

Answer 19

then a hypertrophic scar may result

Question 20

hypertrophic scar

Answer 20

enlarged red

raised

rigid scar

stays w/in the boundary of the original wound

Question 21

keloid scar

Answer 21

large

firm scar

extends beyond the boundaries of the initial wound

Question 22

factors which may impede wound healing

Answer 22

age

body structure

stress

nutrition

drugs

smoking

Question 23

age

Answer 23

< 2

> 65

less nutritional stores

inadequate immune system

Question 24

body structure

Answer 24

obese

emaciated

Question 25

obese

Answer 25

blood supply to tissue decreased cell proliferation

Question 26

emaciated

Answer 26

decrease energy stores decreased time metabolism

Question 27

stress

Answer 27

inhibits cell proliferation

Question 28

nutrition

Answer 28

need vitamin C zinc iron for collagen formation

Question 29

drugs

Answer 29

steroids ASA decrease inflammation and epithelialization

Question 30

smoking

Answer 30

decreases oxygenation to tissue vasoconstriction

Question 31

types of wound healing

Answer 31

primary intention secondary intention tertiary intention

Question 32

skin grafting is

Answer 32

surgical procedure w/ dermatome

Question 33

skin grafts can be

Answer 33

allograft xenograft

Question 34

allograft

Answer 34

homograft same species cadaver

Question 35

xenograft

Answer 35

heterograft another species porcine

Question 36

where is an artificial skin graft used

Answer 36

where large areas of burn exist coverage is done for survival

Question 37

split thickness skin graft (STSG)

Answer 37

consists of epidermis and portion of underlying dermis

Question 38

types of artificial skin grafts

Answer 38

meshed sheet

Question 39

meshed skin graft

Answer 39

expands the donor skin to provide more coverage of burn wound w/ less skin

Question 40

what does a meshed skin graft leave

Answer 40

waffle appearance will not go away

Question 41

when is a meshed skin graft better

Answer 41

infected wounds wounds w/ irregular contours

Question 42

sheet skin graft is better for

Answer 42

more cosmetic

Question 43

sheet skin grafts are

Answer 43

more durable contraction is limited

Question 44

STSG --> sheet

Answer 44

may contract more while healing more than FTSG

Question 45

FTSG leave a --> sheet

Answer 45

full thickness lesion

Question 46

what contract less --> sheet

Answer 46

non-meshed

Question 47

PTs shouldnt --> grafts

Answer 47

move a grafted area for 5 days during txs keep elevated

Question 48

LE grafts

Answer 48

can move after 5 days should hold off ambulation for approximately 5-6 days --> depending on how the grafts look

Question 49

dermal implants

Answer 49

integra

Question 50

inhalation injuries

Answer 50

increase severity of the injury

Question 51

types of inhalation injuries

Answer 51

thermal chemical CO poisoning

Question 52

dx of inhalation injuries

Answer 52

facial burns singed nasal hairs tinged sputum closed space injury blood work bronchoscopy findings hoarseness

Question 53

pathophys of inhalation injuries

Answer 53

inflammation can cause mechanical obstruction necrosis of damaged epithelium, mucosal sloughs bronchopneumonia is likely in severe cases decreased pliability of the lungs, aspect of restrictive device

Question 54

rehab considerations --> inhalation injuries

Answer 54

airway should be secure pt should have good O2 sats monitor for respiratory distress promote mobilization of secretions

Question 55

nutrition

Answer 55

requirements are high for the burn pt additional energy is required to promote wound healing

Question 56

if the body's caloric intakes are not met

Answer 56

body may resort to muscle breakdown

Question 57

if pt doesnt meet their caloric requirements

Answer 57

NG tube

Question 58

what may the pt require --> calories

Answer 58

4000-5000 per day children require even greater amount of calories per day