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Copy ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn > Chapter 14 - Wound Healing+ > Flashcards

Chapter 14 - Wound Healing+ Flashcards

1
Q

This is the first stage of Wound Healing. Days? Cells?

A

Inflammation

  • Days 1-10
  • Hemostasis - immediate, platelets
  • Inflammation - PMNs, Macrophages
  • Epithelialization - finishes ~2 days, 1-2mm/day
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2
Q

This is the second stage of wound healing. Days? cells?

A

Proliferation/Fibroplasia

  • 5 days-3 weeks
  • Fibroblasts - neovascularization; production of collagen and granulation tissue
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3
Q

This is the third stage of wound healing. Days? What happens?

A

Remodeling/Maturation

  • 3 weeks to 1 year
  • Type III collagen replaced with type I
  • Collagen cross-linking occurs
  • Remodeling
  • Contraction
  • Repigmentation
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4
Q

At what pace do peripheral nerves regenerate?

A

1mm/day

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5
Q

The order of cell arrival in a wound:

A
  1. Platelets
  2. PMNs
  3. Macrophages
  4. Fibroblasts
  5. Lymphocytes
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6
Q

What do macrophages do in wound healing?

A

essential for wound healing - release growth factors, cytokines, etc.

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7
Q

What do fibroblasts do in wound healing?

A

replace fibronectin-fibrin with collagen

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8
Q

What does fibronectin do in wound healing?

A

Chemotactic for macrophages

Anchors fibroblasts

Part of the provisional matrix

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9
Q

Besides hemostasis, what do thrombin and fibrin do in wound healing?

A

act as growth factors for endothelial cells and fibroblasts.

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10
Q

These are the primary cells in days 0-2

A

PMN’s

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11
Q

These are the primary cells in days 3-4

A

Macrophages

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12
Q

These are the primary cells in days 5 and on

A

Fibroblasts

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13
Q

What makes up the platelet plug?

A

Platelets and Fibrin

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14
Q

What makes up the provisional matrix (scaffold)?

A

platelets, fibrin, fibronectin

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15
Q

What is meant by accelerated wound healing, and when does it occur?

A

Reopening of a wound results in quicker healing the 2nd time, as cells are already present

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16
Q

Platelet Alpha granules contain what?

A
  • Platelet Factor 4 - aggregation
  • Beta Thrombomodulin - binds thrombin
  • PDGF - chemoattractant
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17
Q

Dense granules of platelets contain what?

A
  • Adenosine
  • Serotonin
  • Calcium
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18
Q

Platelet Aggregation factors include what?

A
  • TXA2
  • Thrombin
  • Platelet factor 4
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19
Q

Where is platelet-activating factor released from?

A

Platelets

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20
Q

Where is transforming growth factor-alpha released from?

A

platelets

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21
Q

Where is fibroblast growth factor released from?

A

Platelets

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22
Q

Where is Beta Lysin released from and what does it do?

A

Platelets; antimicrobial

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23
Q

Where are PGE2 and PGI2 released from, and what do they do?

A

Platelets; Vasodilator

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24
Q

Where is PGF2 released from? What does it do?

A

Platelets; Vasoconstriction

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25
Unepithelialized wounds leak what and promote what?
Leak serum and protein, promote bacteria colonization
26
The most important factor in healing closed incisions (primary intention) is what?
Tensile strength
27
In closed wounds, tensile strength depends on what?
collagen deposition and cross-linking of collagen (occurs in the remodeling/maturation stage)
28
What is the strength layer of the bowel?
Submucosa
29
When is the weakest time point for small bowel anastomosis?
Days 3-5
30
Which has better wound healing - perineum or leg?
perineum
31
Type I collagen: is it more or less common? Where is it found in the human body? What is its role in wound healing?
Most common type Found in skin, bone, tendons Primary collagen in the healed wound (replaces type III)
32
Where is Type II Collagen found?
Cartilage
33
Where is Type III Collagen found?
Healing wound, also in blood vessels and skin
34
Where is Type IV collagen found?
Basement Membranes
35
Type V collagen?
Widespread, particularly in the cornea
36
These 4 substances are required for the hydroxylation of proline and crosslinking of proline residues.
* Alpha-ketoglutarate * Vitamin C * Oxygen * Iron
37
Collegen has ________ every 3rd amino acid and abundant \_\_\_\_\_\_\_\_\_.
Proline; Lysine
38
The final tensile strength of a wound is only ever what percentage of the pre-wound strength?
80%
39
The predominant collagen produced for days 1-2 in wound healing is?
Type III
40
Predominant collagen synthesized by days 3-4
Type I
41
At 6 weeks a wound is \_\_\_\_% of final strength and \_\_\_\_% of original
80; 60
42
At what point does a wound reach its maximal tensile strength?
8 weeks
43
When does a wound have maximum collagen accumulation?
2-3 weeks. After that, amount stays same but cross-linking improves strength.
44
What does d-Penacillamine do to collagen?
Inhibits cross-linking
45
What do you want transcutaneous oxygen measurement to be in a healing wound?
25 mmHg
46
What is essential to wound healing?
* moist environment * O2 delivery * no edema * debridement of necrotic tissue
47
What level of bacteria inhibits wound healing and why?
* \>10^5 * decreases O2 content * collagen lysis * prolonged inflammation
48
What is the effect of devitalized tissue and foreign bodies on wound healing?
slows/inhibits granulation tissue formation
49
How does diabetes contribute to poor wound healing?
impedes early phase response
50
What level of albumin can be a factor in poor wound healing?
\<3.0
51
How do steroids inhibit wound healing?
* inhibit macs, PMNs, collagen synth by fibroblasts * decreases tensile strength
52
What can be given to counteract steroid effect on wound healing?
Vitamin A
53
Osteogenesis Imperfecta is a defect in what?
Type I collagen
54
Ehlers-Danlos syndrome is what?
Collagen disorder; 10 types identified
55
Marfan's syndrome is a defect in what?
Fibrillin (Collagen)
56
What is Epidermolysis Bullosa, and how is it treated?
Excessive fibroblasts; phenytoin
57
What is Charcot's joint?
* 2nd MTP * diabetic foot ulcer 2/2 to neuropathy
58
How long do you wait before doing a scar revision?
1 year
59
Does cartilage contain blood vessels?
No
60
Does Denervation have an effect on wound healing?
No
61
Chemo can be given how many days after surgery and have no effect on wound healing?
14
62
What inheritance is Keloid formation?
Autosomal Dominant
63
In Keloids, how far does collagen extend, and what is Tx? These are benign fibrous growths caused by overproduction of extracellular matrix and dermal fibroblasts.
Beyond the original scar. Intralesional steroids are first line (70% response, some require repeat injections). The earlier the better. Surgery may be necessary if steroids fail. Other options include XRT, silicone, pressure garments.
64
Where are hypertrophic scars usually found?
flexor surfaces of upper torso
65
In hypertrophic scars, how far does collagen extend? How is it managed?
Stays within confines of scar Treat with steroids, silicone, pressure garments
66
What kind of closure can be used for clean or surgical wounds?
Primary intention - deep sutures in collagen rich areas, like fascia and dermis
67
Why is the subcutaneous fat not typically closed?
Not much collagen, can't hold tension
68
When do closed wounds epithelialize?
24-48 hrs. This is the point where the wound is watertight. Ok to remove sterile bandage.
69
In closed wounds, what is the tensile strength (as percentage of normal) at 3 wks and 6 wks? What is the tensile strength of scar?
20%, 70% 80%
70
Compare the healing of open vs closed wounds.
Same processes of closed wounds, including hemostasis, inflammation, proliferation, and remodeling (maturation). It just takes longer.

Copy ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn (50 decks)

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