Wounds / Healing

Question 1

Wound healing by primary intention

Answer 1

Clean incision, early suture, hairline scar

Fibrin plug > regrowth basal epidermis > lysis of fibrin, re-epithelialization > restoration to intact skin

Question 2

Wound healing by secondary intention

Answer 2

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

Question 3

Wound healing by tertiary intention

Answer 3

Wound > increased granulation > late suturing with wide scar

Question 4

General phases of wound healing

Answer 4

1. Hemostasis and Inflammation
   - immediately&raquo_space; first few days
2. Proliferation
   - after first few days&raquo_space;> several weeks
3. Maturation / Remodeling
   - after 2-3 weeks&raquo_space;> several months

Question 5

Amount of protein needed / day for adequate wound healing

Answer 5

1gm of protein / kg / day

Question 6

Normal ankle-brachial index

Answer 6

0.9-1.2

Question 7

Normal toe-brachial index

Answer 7

0.65

Question 8

Normal transcutaneous O2 measurement

Answer 8

60mmHg

Question 9

Tx for venous ulcers

Answer 9

Compression therapy

Increase external pressure from 20 to 60mmHg

Applied over a wound dressing and usually consists of several layers to provide compression. (Unna boot)

Question 10

Typically associated with moderate to severe pain which is made worse with leg elevation

Answer 10

Arterial ulcers

Question 11

Present with “punched out” ulcer

Answer 11

Arterial ulcers

Question 12

Tx for arterial ulcers

Answer 12

Treatment is with wound care and vascular surgery if possible. DO NOT COMPRESS

Question 13

Ankle brachial index =

Answer 13

ankle BP divided by arm BP. Normal is 0.95 - 1.20

Question 14

With lower extremity arterial disease, the BP at the ankle is ____ than BP at arm

Answer 14

lower than

Question 15

An ABI less than ____ is associated with rest pain and less than____ with tissue necrosis

Answer 15

0. 5

0. 3

Question 16

What may lead to an ABI higher than 1.20

Answer 16

calcified arteries

Question 17

Wagner DFU classification of “superficial ulcer without subcutaneous involvement”

Answer 17

Grade 1

Question 18

Wagner DFU classification of “extensive ulceration with exposed bone”

Answer 18

Grade 3

Question 19

Wagner DFU classification of “penetrates through the subcutaneous tissue; may expose bone, tendon, ligament, or joint capsule”

Answer 19

Grade 2

Question 20

Wagner DFU classification of “gangrene of toes or foot”

Answer 20

Grade 4

Question 21

Wagner DFU classification of “gangrene of whole foot”

Answer 21

Grade 5

Question 22

Ulcerative skin disease of uncertain etiology.

About half the patients will have Crohn’s disease, ulcerative colitis, rheumatoid arthritis

Answer 22

Pyoderma gangrenosum

Question 23

Cause unknown, but most likely an inflammatory disorder with collagen degeneration, granulomata formation in the dermis, and microangiopathy. Seen in diabetics.

Answer 23

Necrobiosis lipoidica

Question 24

Physiologic stress response in acute phase / first 24 hours of surgery

Answer 24

Peripheral vasoconstriction
Concomitant hypothermia
Shunting of blood and substrate to vital organs

Question 25

Cytokines which play major role in inflammatory response to surgery

Answer 25

IL-1 IL-6 TNF alpha