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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
Q

Unepithelialized wounds leak what and promote what?

A

Leak serum and protein, promote bacteria colonization

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26
Q

The most important factor in healing closed incisions (primary intention) is what?

A

Tensile strength

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27
Q

In closed wounds, tensile strength depends on what?

A

collagen deposition and cross-linking of collagen (occurs in the remodeling/maturation stage)

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28
Q

What is the strength layer of the bowel?

A

Submucosa

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29
Q

When is the weakest time point for small bowel anastomosis?

A

Days 3-5

30
Q

Which has better wound healing - perineum or leg?

A

perineum

31
Q

Type I collagen: is it more or less common?

Where is it found in the human body?

What is its role in wound healing?

A

Most common type

Found in skin, bone, tendons

Primary collagen in the healed wound (replaces type III)

32
Q

Where is Type II Collagen found?

A

Cartilage

33
Q

Where is Type III Collagen found?

A

Healing wound, also in blood vessels and skin

34
Q

Where is Type IV collagen found?

A

Basement Membranes

35
Q

Type V collagen?

A

Widespread, particularly in the cornea

36
Q

These 4 substances are required for the hydroxylation of proline and crosslinking of proline residues.

A
  • Alpha-ketoglutarate
  • Vitamin C
  • Oxygen
  • Iron
37
Q

Collegen has ________ every 3rd amino acid and abundant _________.

A

Proline; Lysine

38
Q

The final tensile strength of a wound is only ever what percentage of the pre-wound strength?

A

80%

39
Q

The predominant collagen produced for days 1-2 in wound healing is?

A

Type III

40
Q

Predominant collagen synthesized by days 3-4

A

Type I

41
Q

At 6 weeks a wound is ____% of final strength and ____% of original

A

80; 60

42
Q

At what point does a wound reach its maximal tensile strength?

A

8 weeks

43
Q

When does a wound have maximum collagen accumulation?

A

2-3 weeks. After that, amount stays same but cross-linking improves strength.

44
Q

What does d-Penacillamine do to collagen?

A

Inhibits cross-linking

45
Q

What do you want transcutaneous oxygen measurement to be in a healing wound?

A

25 mmHg

46
Q

What is essential to wound healing?

A
  • moist environment
  • O2 delivery
  • no edema
  • debridement of necrotic tissue
47
Q

What level of bacteria inhibits wound healing and why?

A
  • >10^5
  • decreases O2 content
  • collagen lysis
  • prolonged inflammation
48
Q

What is the effect of devitalized tissue and foreign bodies on wound healing?

A

slows/inhibits granulation tissue formation

49
Q

How does diabetes contribute to poor wound healing?

A

impedes early phase response

50
Q

What level of albumin can be a factor in poor wound healing?

A

<3.0

51
Q

How do steroids inhibit wound healing?

A
  • inhibit macs, PMNs, collagen synth by fibroblasts
  • decreases tensile strength
52
Q

What can be given to counteract steroid effect on wound healing?

A

Vitamin A

53
Q

Osteogenesis Imperfecta is a defect in what?

A

Type I collagen

54
Q

Ehlers-Danlos syndrome is what?

A

Collagen disorder; 10 types identified

55
Q

Marfan’s syndrome is a defect in what?

A

Fibrillin (Collagen)

56
Q

What is Epidermolysis Bullosa, and how is it treated?

A

Excessive fibroblasts; phenytoin

57
Q

What is Charcot’s joint?

A
  • 2nd MTP
  • diabetic foot ulcer 2/2 to neuropathy
58
Q

How long do you wait before doing a scar revision?

A

1 year

59
Q

Does cartilage contain blood vessels?

A

No

60
Q

Does Denervation have an effect on wound healing?

A

No

61
Q

Chemo can be given how many days after surgery and have no effect on wound healing?

A

14

62
Q

What inheritance is Keloid formation?

A

Autosomal Dominant

63
Q

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.

A

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
Q

Where are hypertrophic scars usually found?

A

flexor surfaces of upper torso

65
Q

In hypertrophic scars, how far does collagen extend? How is it managed?

A

Stays within confines of scar

Treat with steroids, silicone, pressure garments

66
Q

What kind of closure can be used for clean or surgical wounds?

A

Primary intention - deep sutures in collagen rich areas, like fascia and dermis

67
Q

Why is the subcutaneous fat not typically closed?

A

Not much collagen, can’t hold tension

68
Q

When do closed wounds epithelialize?

A

24-48 hrs. This is the point where the wound is watertight. Ok to remove sterile bandage.

69
Q

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?

A

20%, 70%

80%

70
Q

Compare the healing of open vs closed wounds.

A

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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