CH 14 Abnormal Wound Healing and Chronic wound Flashcards
What results when the sequence of events that leads to normal wound closure and healing does not occur?
Chronic wound
What occurs in abnormal wound healing Inflammation (Phase I)?
- Inadequate blood flow and oxygen supply to support cellular life and activity
- Cells may not initiate repair sequence
- Debris and bacteria builds up
- Pathogens spread more rapidly
- Bioburden is greater than 10 organisms/g of tissue
What are the clinical signs for abnormal wound healing Inflammation Phase I
- Increase in amount of drainage
- Change in color or odor
- Lingering smell
- Eschar/necrosis from ischemic conditions
- Periowound maceration
- Chronic inflammation
- Tunneling
- Undermining
- Infection (if host’s immune system is unable to resist impact of bacterial load)
What occurs in abnormal wound healing Proliferation Phase II?
- Skin integrity is poor with delayed collagen synthesis
- Not enough myofibroblasts to initiate wound contraction due to delayed angiogenesis
- Need for oxygen and nutrients are high; without them, available cells are unable to reproduce rapidly (delayed epithelialization)
What are the clinical signs in abnormal wound healing Proliferation Phase II?
- Keratinocytes do not migrate because wound bed isn’t moist, healthy, clean, and granulating
- Epithelial cells build up at wound edge and migrate over edge due to unready wound bed to migrate to
- Granulation tissue is absent, pale, or delayed
- New tissue breaks down, bleeds easily, weak
- Tunneling, eschar, and periwound maceration are evident
- Necrosis delays angiogenesis
- Changes in drainage color, amount, odor, lingering smell signaling return to inflammation stage
What occurs during abnormal healing Maturation/Remodeling Phase III?
-If synthesis and lysis of collagen is out of balance, weakened tissue will break down easily or hypertrophic scarring will build up too rapidly
What are the clinical signs for abnormal healing Maturation/Remodeling Phase III?
- Newly formed skin breaks down with little provocation
- Scar tissue may build up within outline of original wound (hypertrophic) or beyond margins of original wound (keloid)
What is detrimental to wound closure and healing time?
Infection
What has a greater impact on wound healing than most underlying medical conditions?
Bio-burden
What is identified if the presence of bacteria or microorganisms is greater than 10^5 per gram of tissue determined by a quantitative culture?
True infection
What are the effects of infection?
- Risk of wound sepesis, osteomyelitis, gangrene
- Overall decline of body systems contributes to strain on specialized cells
- Increased rate of cell necrosis
- Decreases oxygen in wound bed
- Insufficient oxygen to support regeneration of tissue and assist in prevention of infection
- Inefficient cellular activity
- Decreased collagen metabolism
- Chemical mediators absent or dilute
- Cells absent or confused by lack of instructions from chemical mediators or presence of other cells
- When bio burden is greater that 10^5 organisms/g of tissue, epithelialization may not occur
What are the signs of potential infection?
- Change in wound drainage (amount, color, odor)
- Swelling
- Periwound redness or warmth
- Increase in pain or tenderness
- Change in quality of granulation tissue or failure to produce good quality tissue (pale, soft, easily broken down)
- No measurable wound contraction within 2-4 weeks
- Tissue culture/punch biopsy results in greater than 10^5 organisms/g of tissue
- Fever, nausea, fatigue, loss of appetite
What are the early signs of infection?
- Warmth
- Redness
- Swelling
- Fever
- Malaise
- Loss of appetite
What are conditions within the body that may contribute to abnormal healing?
Intrinsic/Internal factors
What are the intrinsic factors resulting in abnormal wound healing?
- Aging skin
- Inadequate blood flow
- Decreased oxygen supply from underlying disease
- Changes in dermis (decrease in elasticity, collage, mast cell production)
- Underlying disease (diabetes, cancer, circulatory insufficiences, HIV, infection, connective tissue diseases)
