Flashcards in Wounds / Healing Deck (25):
Wound healing by primary intention
Clean incision, early suture, hairline scar
Fibrin plug > regrowth basal epidermis > lysis of fibrin, re-epithelialization > restoration to intact skin
Wound healing by secondary intention
Gaping irregular wound > Granulation > Epithelium grows over scar
large defect filled w fibrin clot >
new blood vessels / fibroblasts from dermis into fibrin >
collagen from granulation tissue > mature collagen and epidermis growth w scar
Wound healing by tertiary intention
Wound > increased granulation > late suturing with wide scar
General phases of wound healing
1. Hemostasis and Inflammation
- immediately >> first few days
- after first few days >>> several weeks
3. Maturation / Remodeling
- after 2-3 weeks >>> several months
Amount of protein needed / day for adequate wound healing
1gm of protein / kg / day
Normal ankle-brachial index
Normal toe-brachial index
Normal transcutaneous O2 measurement
Tx for venous ulcers
Increase external pressure from 20 to 60mmHg
Applied over a wound dressing and usually consists of several layers to provide compression. (Unna boot)
Typically associated with moderate to severe pain which is made worse with leg elevation
Present with “punched out” ulcer
Tx for arterial ulcers
Treatment is with wound care and vascular surgery if possible. DO NOT COMPRESS
Ankle brachial index =
ankle BP divided by arm BP. Normal is 0.95 - 1.20
With lower extremity arterial disease, the BP at the ankle is ____ than BP at arm
An ABI less than ____ is associated with rest pain and less than____ with tissue necrosis
What may lead to an ABI higher than 1.20
Wagner DFU classification of "superficial ulcer without subcutaneous involvement"
Wagner DFU classification of "extensive ulceration with exposed bone"
Wagner DFU classification of "penetrates through the subcutaneous tissue; may expose bone, tendon, ligament, or joint capsule"
Wagner DFU classification of "gangrene of toes or foot"
Wagner DFU classification of "gangrene of whole foot"
Ulcerative skin disease of uncertain etiology.
About half the patients will have Crohn’s disease, ulcerative colitis, rheumatoid arthritis
Cause unknown, but most likely an inflammatory disorder with collagen degeneration, granulomata formation in the dermis, and microangiopathy. Seen in diabetics.
Physiologic stress response in acute phase / first 24 hours of surgery
Shunting of blood and substrate to vital organs