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Flashcards in wounds! Deck (47)
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1

Skin has two main layers:

Epidermis
Superficial and thinner epithelial layer

Dermis
Deeper and thicker connective tissue layers
Combined, 2-3mm thick

2

Hypodermis

Storage site for fat, containing blood vessels that surround the skin

3

Skin anatomy: epidermis top and bottom layers

stratum corneum --> stratum basale

4

Majority of epidermal cells
Produce fibrous protein called keratin
Make our skin tough (strength and resilience)
Allow tissue to resist damage
Involved in wound healing and in the immune system

keratinocytes

5

Produce pigment granules called melanin: a brown to black pigment occurring in the skin
Found in the stratum basale

melanocytes

6

They are macrophages: Immune cells that play a role during the inflammatory phase of acute wound healing
Produced in the bone marrow and migrate to the epidermis
Found in the stratum spinosum and stratum granulosum

Langerhans cells

7

Function mainly as touch receptors
Found in the stratum basale

Merkel cells

8

dermis includes what 2 layers?

Papillary Dermis and Reticular Dermis

9

Dermal dendrocytes are involved in

Involved in wound healing, blood clotting and inflammation

10

Innervation of dermis

Supplied with sensory receptors for temperature, pain, and touch

11

Phases of Wound Healing

Hemostasis
Inflammation (1-3 days)
Proliferation (1-2 weeks)
Remodeling or maturation (1-2 years)

12

Process to prevent and stop bleeding (blood clots) in damaged blood vessel

Vasoconstriction (brief and intense)

Activation of keratinocytes and platelets

Hemostasis

13

Inflammation:
Contains
Neutralizes
Dilutes the injury-causing agent or lesion
Hemoattractant molecules released by platelets also increase

Inflammatory Phase: 1-3 days

14

Initial process of inflammation common to all tissue types
Neutrophils (WBCs immunity) and other inflammatory cells migrate into tissue
Overall tissue strength of a wound is minimal, since tissues do not regain their normal functional strength until inflammation transitions into repair
Scar tissue will be swollen, tender, and red

Inflammatory Phase: 1-3 days

15

Wound contracts:
Myofibroblasts help contract the wound, pulling edges together

Wound ‘rebuilt’ with new granulation tissue comprised of collagen and extracellular matrix and into which a new network of blood vessels develop (known as angiogenesis)

Proliferation: 1-2 Weeks

16

Healthy granulation tissue is granular and uneven in texture
does not bleed easily and is pink/red in color

Scar tissue is deposited
Scar is RED, RAISED and RIGID
Epithelial cells finally form on wound surface
a process known as ‘epithelialisation’

Proliferation: 1-2 Weeks

17

Final phase and occurs once the wound has closed
May take up to 2 years
Dermal tissues enhance their tensile strength

Remodeling or Maturation Phase

18

Scar tissue matures as collagen disappears
Presents as softened and flattened

Remodeling or Maturation Phase

19

Non-functional fibroblasts are replaced by functional ones

Remodeling or Maturation Phase

20

Cellular activity declines with time and the number of blood vessels in the affected area decreases and recede
Even after maturation, wound areas tend to remain up to 20 percent weaker than they initially were

Remodeling or Maturation Phase

21

Occur suddenly, rather than over time
Heal at a predictable and expected rate, according to the normal wound healing process

acute wounds

22

Can vary from superficial scratches to deep wounds damaging blood vessels, nerves, muscles, other tissue
Surgical wounds
Traumatic wounds
Abrasion, puncture, laceration, incision

acute wounds

23

TX: Cleaning with tap water, sterile saline solution, or antiseptic solution twice a day
Most clean open wounds do not require any antibiotics unless the wound is contaminated, or the bacterial cultures are positive
Once cleaned, wound should be covered with moist gauze
followed by application of dry gauze and then the wound covered with a bandage

Simple Laceration Wound Treatment

24

Wounds less than 12 hours old can be closed with sutures or staples
Wounds more than 24 hours old should be suspected to be contaminated and not closed completely

Simple Laceration Wound Treatment

25

Removing dead tissue from wounds
Wounds can heal faster
Dead tissue can trap bacteria leading to infections
Bacteria can cause odor
Infection can be life threatening or lead to an amputation

Wound Debridement

26

Types of Wound Debridement

Autolytic (body’s own healing process to remove tissue – moist dressing)
Enzymatic (chemical enzymes, such as an ointment, to help slough off dead tissue – ointment – can strip healthy tissue away)
Surgical (surgical removal of dead tissue)
Mechanical (wet to dry dressing regularly changed – can strip healthy tissue away)
Maggot (using larvae to remove dead tissue)

27

OT’s Role in Wound Healing

Wound care
Dressing changes
Removal of stitches
Observation skills to detect possible infection

Manual therapy
Scar management
Scar massage

28

Develop when any acute wound fails to heal in the expected time frame for that type of wound

Important aspect in caring for wounds is to remove the causing agent

Chronic Wounds

29

Can be due to lack of one or more of the main requirements for healing
good supply of blood, oxygen and nutrients
clean and infection-free environment

Chronic Wounds

30

Whether bacterial, fungal or viral, cause of the infection must be treated with the proper medication
Typically have bad odor, pus drainage, debris (dead tissue), and ongoing symptoms of inflammation (fever, pain, redness, hotness and swelling)

Infected wounds