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14 Wound Healing Flashcards

1
Q

Stages in wound healing: inflammation

A

Days 1-10
PMNs, Macrophages
Epithelialization

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2
Q

How fast does epithelialization occur?

A

1-2mm/day

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3
Q

Stage in wound healing: proliferation

A

5 days - 3 weeks
Fibroblasts
Collagen deposition, neovascularization, granulation tissue formation
Type III collagen replaced with type I

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4
Q

Stage in wound healing: remodeling

A

3 weeks - 1 year
Decreased vascularity
Collagen cross-linking - remodeling

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5
Q

How fast do peripheral nerves regenerate?

A

1mm/day

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6
Q

What cells arrive in wounds - what order?

A 
Platelets
PMNs
Macrophages
Lymphocytes
Fibroblasts
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7
Q

What cells are essential for wound healing?

A

Macrophages (release of growth factors, cytokines, etc)

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8
Q

Fibronectin

A

Chemotactic for macrophages

Anchors fibroblasts

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9
Q

Fibroblasts

A

Replaces fibronectin-fibrin with collagen

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10
Q

What is the predominant cell type by days 0-2?

A

PMNs

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11
Q

What is the predominant cell type by days 3-4?

A

Macrophages

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12
Q

What is the predominant cell type by days 5+?

A

Fibroblasts

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13
Q

What makes up a platelet plug?

A

Platelets and fibrin

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14
Q

What forms the provisional matrix?

A

Platelets, fibrin, fibronectin

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15
Q

Accelerated wound healing

A

reopening a wound results in faster healing the second time around - healing cells are already present

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16
Q

What is the most important factor in healing open wounds (secondary intention)?

A

Epithelial integrity

Migration across granulation tissue

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17
Q

Where does epithelization migrate from?

A

Hair follicles*
Wound edge
Sweat glands

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18
Q

Why do unepithelialized wounds promote bacterial growth?

A

They leak serum and proteins

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19
Q

What is the most important factor in healing closed wounds (primary intention)?

A

Tensile strength

Depends on collage deposition and cross-linking of collagen

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20
Q

What is the strength layer of the bowel?

A

Submucosa

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21
Q

What is the weakest time point for small bowel anastamosis?

A

3-5 days

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22
Q

Myofibroblasts

A

Smooth muscle cell-fibroblast
Communicates by gap junctions
Involved in wound contraction and healing by secondary intention

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23
Q

Collagen type I

A

Most common type of collagen
Skin, bone, tendons
Primary collagen in a healed wound

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24
Q

Collagen type II

A

Cartilage

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25
Collagen type III
Increased in healing wounds | Blood vessels, skin
26
Collagen type IV
Basement membranes
27
Collagen type V
Widespread | Cornea
28
What are required collagen co-factors?
Alpha-ketoglutarate, vitamin C, oxygen and iron | HYdroxylation and cross-linking of proline residues
29
What improves the wound tensile strength?
Proline cross-linking
30
Scurvy
Vitamin C deficiency
31
What is the tensile strength of a healed wound compared to normal? When?
80% | By 8 weeks
32
Predominant collagen type synthesized for days 1-2?
Type III collagen
33
Predominant collagen type synthesized for days 3-4?
Type I collagen
34
When is type III collagen replaced by type I collagen?
3 weeks
35
When does a healing wound reach the maximum collagen accumulation?
2-3 weeks | After that, collagen is remodelled, but no extra is added
36
Effect of d-Penicillamine
Inhibits collagen cross linking
37
What is essential for wound healing?
``` Moist environment (avoid desiccation) Oxygen delivery Avoid edema (leg elevation) Remove necrotic tissue ```
38
What transcutatneous oxygen measurement do you want for good healing? how do you improve it?
``` TCOM > 25mmHg Optimize fluids No smoking Pain control Arterial revascularization Supplemental oxygen ```
39
What are impediments to wound healing?
``` Bacteria >10^5/cm2 Devitalized tissue Foreign bodies Cytotoxic drugs Diabetes Albumin < 3.0 Steroids Wound ischemia ```
40
How does ____ effect wound healing? | Bacteria
Decreases oxygen content Collagen lysis Prolonged inflammation
41
How does ____ effect wound healing? | Devitalized tissue and foreign bodies
Retards granulation tissue formation and wound healing
42
How does ____ effect wound healing? | Cytotoxic drugs
5-FU, methotrextae, cyclosporine, FK-506 | Impairs wound healing in the first 14 days of healing
43
How does ____ effect wound healing? | Diabetes
Impedes the earl-phase inflammation response | Hyperglycemia can cause poor leukocyte chemotaxis
44
How does ____ effect wound healing? | Steroids
Inhibit macrophages, PMNs, and collagen synthesis b fibroblasts Decrease wound tensile strength as well
45
How can you counteract the detrimental effects of steroids on healing?
Vitamin A (25,000 IU qd)
46
How does ____ effect wound healing? | Wound ischemia
Hypoxia | Causes: fibrosis, pressure, poor arterial inflow, poor venous outflow, smoking, radiation, edema, vasculitis
47
Osteogenesis imperfecta
Type I collagen defect
48
Ehlers-Danlos syndrome
10 types - all collagen disorders
49
Marfan's syndrome
Fibrillin defect (connective tissue protein)
50
Epidermolysis bullosa
Excessive fibroblasts | Tx: phenytoin
51
Charcot's joint
2nd MTP joint Secondary to neruopathy (can't feel feet, pressure from walking leads to ischemia) Also on toes
52
Most common cause of leg ulcers?
Venous insufficiency | Tx Unna boots (elastic wrap)
53
Contents of scars
Proteoglycans, hyaluronic acid and water
54
When do you perform scar revisions?
Wait 1 year to allow maturation | May improve with age
55
How does cartilage get nutrients/oxygen?
Diffusion | No blood vessels
56
Impact of denervation on wound healing?
Nothing
57
Impact of chemotherapy on wound healing?
Inhibits healing | No effect after 14 days
58
Keloids
Autosomal dominant Dark skin Collagen goes beyond original scar Tx: intra-lesion steroid injection, silicone, pressure garments, XRT
59
Hypertorphic scar tissue
Dark skinned, flexor surfaces of upper torso Collagen stays within confines of original scar Often occurs in burns or wounds that take a long time to heal Tx: steroid injections, silicone, pressure garments
60
Platelet - alpha granules
Platelet factor 4 Beta-thrombomodulin Platelet-derived growth factor Transforming growth factor beta
61
Platelet factor 4
Alpha granules | Platelet aggregation
62
Beta-thrombomodulin
Alpha granules | Binds thrombin
63
Platelet-derived growth factor
Alpha granules | Chemoattractant
64
Transforming growth factor beta
Alpha granules | Modulates the response of the other alpha granules
65
Platelets - dense granules
Adenosine Serotonin Calcium
66
Platelat aggregation factors
TXA2 Thrombin Platelet factor 4

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