Acute/Chronic Healing

Question 1

cascade of acute wound healing

Answer 1

hemostasis
inflammation
proliferation
maturation

Question 2

what is a characteristic of hemostasis

Answer 2

platelet aggregation and clot formation
- allows for movement of cells in and out of the wound space

fibrinolysis

Question 3

timeline of inflammatory phase

Answer 3

begin immediately and continues for upto 25 days

Question 4

what capillary changes occur in the inflammatory phase

Answer 4

dilation and become permeable

Question 5

role of cytokines in the inflammation phase

Answer 5

draw neutrophils and macrophages to the wound

Question 6

macrophages attract which types of cells?

Answer 6

cytokines
growth factors
bioactive lipids
proteolytic enzymes

Question 7

how are cytokines characterized in the healing process

Answer 7

additive
synergistic
inhibitory

Question 8

what do cytokines regulate

Answer 8

cell proliferation
cell migration
cell matrix synthesis
cell deposition and degradation
inflammatory response

Question 9

what to cytokines come from

Answer 9

platelets
fibroblasts
monocytes
macrophages
endothelial cells

Question 10

timeline of proliferative phase

Answer 10

within 3 days of injury and lasts a few weeks

Question 11

what is the proliferative phase characterized by

Answer 11

granulation tissue formation

Question 12

what cell types assists in the formation of granulation tissue

Answer 12

fibrin
fibronectin
collagen
proteoglycans
glycosaminoglycans
glycoproteins

Question 13

when does fibroblast proliferation peak

Answer 13

a week post injury

Question 14

role of fibroblast in proliferation

Answer 14

synthesize and deposit extracellular proteins

Question 15

how does fibroblast proliferation occur

Answer 15

growth and angiogenic factors cause granulation to occur

Question 16

what is a risk in the proliferative phase

Answer 16

dehiscence and evisceration

Question 17

what is dehiscence

Answer 17

wound separation after being closed

Question 18

what is evisceration

Answer 18

when organs protrude through a wound

Question 19

what is epithelization

Answer 19

marginal basal cells detaching from the dermis and migrating across the provisional matrix on each side of a wound.

Question 20

when do fibroblasts enter the wound

Answer 20

within 3 days
peak levels at 7 days

Question 21

what do fibroblasts do

Answer 21

proliferation and synthetic activity to produce
extracellular proteins
growth factors
angiogenic factors

Question 22

what is the result of fibroblasts entering the wound

Answer 22

granulation tissue
new capillaries embedded in loose ECM

Question 23

what is the resultant ECM composed of as fibroblasts enter the wound

Answer 23

collagen
fibronectin
proteoglycans
glycosaminoglycans

Question 24

cells of the wound bed

Answer 24

proteins
polysaccharides

Question 25

what types of proteins are in the ECM

Answer 25

matrix - collagen adhesive - elastin, laminin, fibronectin

Question 26

what does elastin allow

Answer 26

elasticity and resilience

Question 27

what does laminin/fibronectin allow for

Answer 27

structural and metabolic support mediation of tissue remodeling

Question 28

what forms the ground substance

Answer 28

proteoglycans glycosaminoglycans

Question 29

what cells arise at the beginning of angiogenesis? where at? what is their job?

Answer 29

vascular endothelial cells edges of the wound from damaged vessels and capillaries penetrate the matrix and form a vascular bud

Question 30

vascular buds grow until

Answer 30

they reach another capillary -- connect and form a vascular loop

Question 31

when does epithelization occur

Answer 31

few hours post injury

Question 32

what is contact inhibition related to? what does it form?

Answer 32

epithelization rolled edges on a wound

Question 33

where may epithelial cells come from to complete epithelization

Answer 33

epidermis basement layer sweat glands oil glands hair follicles

Question 34

where do epithelial cells come from for shallow wounds

Answer 34

epidermal basement membrane

Question 35

where do epithelial cells come from for medium depth wounds

Answer 35

glands and hair follicles - form tiny circles of skin

Question 36

where do epithelial cells come from for deeper wounds

Answer 36

no epithelial cells available instead granulation tissue forms and fills the base and the epithelial cells come from epidermal layer

Question 37

when does epithelization occur in deep wounds

Answer 37

will not until the wound is nearly level with normal undamaged tissue

Question 38

when does wound contraction occur

Answer 38

5 days after wound occurs

Question 39

how does wound contraction occur

Answer 39

fibroblasts and myofibroblasts rearrange themselves to share the ECM

Question 40

what is the myofibroblast theory

Answer 40

myofibroblasts attach to collagen in ECM and bring it across the wound via actin each time the collagen is brought across the wound, the wound bed shrinks

Question 41

what is the traction theory

Answer 41

many fibroblasts exert traction forces on ECM fibers without coordinated contraction to shorten occurring

Question 42

when does the maturation phase occur

Answer 42

week out from injury up until a year or more after

Question 43

what occurs in the maturation phase

Answer 43

fibronectin ECM fills the wound collagen is laid and forms bundles that provide stiffness and tensile strength

Question 44

chronic wound healing definition

Answer 44

one that deviates from expected sequence of repair in terms of time, appearance, and response to appropriate treatment

Question 45

factors that affect wound healing

Answer 45

comorbidities medications/antibiotic resistance circulation nutrition/hydration lifestyle age gender race

Question 46

what is biofilm

Answer 46

microbial colony incased in a matrix that attaches to a wound surface

Question 47

what is a danger of biofilm

Answer 47

production of destructive enzymes and toxins that promote a chronic inflammatory state in the wound

Question 48

what is the pneumonic used for wound bed prep

Answer 48

T - tissue assessment I - infeCtion assessment M - moisture imbalance E - edge assessment

Question 49

what symptoms/symptom clusters can occur from a wound

Answer 49

pain cognitive changes fatigue depression anxiety