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ABSITE Slayer > Cap.9 Cicatrización > Flashcards

Cap.9 Cicatrización Flashcards

1
Q

Name the 3 phases of wound healing:

A
  • Inflammation (1–6 days)
  • proliferation (3 days–3 weeks)
  • maturation (3 weeks–1 year)
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2
Q

Name several factors that can inhibit wound healing:

A
  • Diabetes
  • infection
  • ischemia
  • malnutrition
  • radiation
  • steroids
  • neoplasia
  • anemia
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3
Q

What are the optimal nutrition parameters?

A

Albumin >3 g/dL and prealbumin >16 mg/dL

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4
Q

What is primary wound closure (primary intention)?

A

Immediate closure of a wound with suture or staples

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5
Q

Most important factor in healing closed wounds by primary intention:

A

Tensile strength

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6
Q

What is the most important layer to close for strength in skin lacerations?

A

Dermis

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7
Q

How long does it take a surgical incision become “water tight”?

A

24 to 48 hours

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8
Q

What is secondary wound closure?

A

Leaving a wound open and allowing it to heal by granulation, contraction, and epithelialization over time

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9
Q

Most important factor in the healing of open wounds by secondary intention:

A

Epithelial integrity

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10
Q

What causes contraction in wounds healing by secondary intention?

A

Myofibroblasts

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11
Q

What is delayed primary closure?

A

Closing a wound several days (3–5 days) after incision

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12
Q

Rate of regeneration of a peripheral nerve:

A

1 mm/d or 1 in./mo

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13
Q

Rate of epithelialization:

A

1 to 2 mm/d

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14
Q

The strongest layer of the bowel:

A

Submucosa

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15
Q

The time period that a small bowel anastomosis is at its weakest:

A

3 to 5 days

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16
Q

Name the 2 major events in the process of epithelialization:

A

Migration and mitosis

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17
Q

Name the process by which keratinocytes pile up on top of each other at the leading edge of a migration and tumble forward over the top of the heap:

A

Epiboly

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18
Q

What cell is the most essential for wound healing?

A

Macrophage

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19
Q

This cell is responsible for the movement and contraction of wound edges:

A

Myofibroblast

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20
Q

Name the order of arrival of the different cells involved in wound healing:

A
  • Platelets (not a true cell)
  • Neutrophils (predominant cell type from day 0–2)
  • Macrophages (predominant cell type from day 3–4)
  • Fibroblasts (predominant cell type from day 5 and so on)
  • Lymphocytes
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21
Q

Platelet factor 4, β-thrombomodulin, PDGF, and TGF-β are contained in this type of platelet granule:

A

α granule

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22
Q

Adenosine, serotonin, and calcium are contained in this type of platelet granule:

A

Dense granule

23
Q

Name the predominant cell during days 0 to 2 of wound healing:

A

Neutrophils

24
Q

Name the predominant cell during days 3 to 4 of wound healing:

A

Macrophages

25
Q

Name the predominant cell present after day 5 of wound healing?

A

Fibroblasts

26
Q

When does the maturation phase usually begin?

A

~3 weeks after the injury

27
Q

What is the maximal tensile strength that a wound can reach?

A

80% of original tissue strength

28
Q

Time period for maximum collagen accumulation in a wound:

A

2 to 3 weeks (mostly type III, then gets converted to type I with maturation)

29
Q

Time period for a wound to reach its maximal tensile strength:

A

8 weeks

30
Q

True or false: Denervation negatively affects epithelialization and wound contraction:

A

False; denervation has no effect on epithelialization/wound contraction

31
Q

The number of organisms/cm2 required to retard wound healing:

A

100,000 organisms/g (105 organisms/g)

32
Q

What is the generally recommended period of time to wait for scar maturation before considering scar revision?

A

12 to 18 months

33
Q

What can be given to combat the inhibitory effects of steroids on wound healing and epithelialization? Dose?

A

Vitamin A; 25,000 IU daily

34
Q

Necessary cofactor for hydroxylation and cross-linking of proline and lysine in collagen synt hesis:

A

Vitamin C (deficiency causes scurvy)

35
Q

Type of scar that extends beyond the boundaries of the original wound:

A

Keloid

36
Q

Type of scar that remains confined to the boundaries of the original wound and contains an overabundance of collagen:

A

Hypertrophic scar

37
Q

The most common type of collagen is:

A

Type I collagen

38
Q

Type of collagen predominantly synthesized in the first 48 hours of a healing wound:

A

Type III collagen

39
Q

Type of collagen located in skin, bone, tendon, and is the primary collagen found in a healed wound:

A

Type I collagen

40
Q

Type of collagen found in hyaline cartilage:

A

Type II collagen

41
Q

Type of collagen in arteries, dermis, and increased in wound healing:

A

Type III collagen

42
Q

Type of collagen that is predominant in the basement membrane:

A

Type IV collagen (type IV found on floor)

43
Q

Type of collagen found in the cornea:

A

Type V collagen

44
Q

Stage the pressure sore: nonblanchable erythema of intact skin:

A

Stage I (can be seen after 30 minutes, resolves after 1–2 hours)

45
Q

Stage the pressure sore: partial-thickness skin loss involving epidermis/dermis:

A

Stage II (can present as blister, forms after 2–6 hours, erythema lasts >24 hours)

46
Q

Stage the pressure sore: full-thickness skin loss with involvement of underlying subcutaneous tissue:

A

Stage III (does not extend through fascia)

47
Q

Stage the pressure sore: full-thickness skin loss with tissue necrosis or extensive destruction of underlying structures (muscle/bone):

A

Stage IV

48
Q

Areas at greatest risk for pressure sores:

A
  • Ischium 28%
  • Trochanter 19%
  • Sacrum 17%
  • Heel 9%
  • Occiput of scalp
49
Q

Rules of operative management for pressure sores (name 4):

A
  • Debride all devitalized tissue
  • Excise entire bursa (can use methylene blue to identify entire bursa)
  • Identify and remodel bony prominences
  • Reliable tissue coverage with appropriate flap without burning bridges for future reconstruction
50
Q

Name the amino acid that is found in every 3 residues in collagen:

A

Proline

51
Q

Name the necessary cofactors for the hydroxylation of proline:

A

Vitamin C, oxygen, iron, and α-ketoglutarate

52
Q

What enzyme is the rate-limiting step in collagen synthesis?

A

Propylhydroxylase

53
Q

Albumin level that puts a patient at risk for poor wound healing:

A

<3.0 g/dL

54
Q

Time period to wait for chemotherapy to have no effect on wound healing:

A

14 days

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