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review cards > 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; PMNs, Macrophages; Epithelialization at 1-2mm/day

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2
Q

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

A

Proliferation; 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; 3 weeks to 1 year

  • Type III collagen replaced with type I
  • Net amount of collagen does not change
  • Collagen cross linking occurs
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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.

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9
Q

What does Thrombin and Fibrin do in wound healing?

A

act as growh 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?

A

platelets, Fibrin, Fibronectin

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15
Q

What is meant by accelerated wound healing?

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 is 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
What is the most important fact in healing open wounds (secondary intention)?
Epithelial integrity; migration from wound edges, sweat glands, hair follicles -dependent on granulation tissue
26
Unepithelialized wounds leak what and promote what?
Leak serum and protein, promote bacteria
27
The most importan factor in healing closed incisions (primary intention) is what?
Tensile strength
28
Tensile strength depends on what?
collagen deposition and cross linking of collagen
29
What is the strength layer of bowel?
Submucosa
30
When is the weakest time point for small bowel anastamosis?
Days 3-5
31
Which has better wound healing, Perineum or leg?
Taint, Nacho, Grundel, Gooch, Banus, et al
32
Type I collagen?
Most common type - skin, bone, tendons - Primary collagen in healed wound
33
Type II Collagen?
Cartilage
34
Type III Collagen?
Healing wound, also in blood vessels and skin
35
Type IV collagen?
Basement Membranes
36
Type V collagen?
Widespread, particularly in the cornea
37
These substances are required for the hydroxylation of proline and crosslinking of proline residues:
- Alpha-ketoglutarate - Vitamin C - Oxygen - Iron
38
Collegen has ________every 3rd amino acid and abundant___________
Proline; Lysine
39
The tensile strength of a sound is only ever what percentage of the prewound strength?
80%
40
The predominant Collagen produced for days 1-2 is?
Type III
41
Predominant Collagen synthesized by days 3-4
Type I
42
At 6 weeks a wound is ____% of final strength and ____% of original
80; 60
43
At what point does a wound reach its maximal tensile strength?
8 weeks
44
When does a wound have maximum collagen accumulation?
2-3 weeks. After than amount stays same but cross linking improves strength
45
What does d-Penacillamine do to collagen?
Inhibits cross-linking
46
What do you want transcutaneous oxygen measurement to be in a healing wound?
25 mmhg
47
What is essential to wound healing?
moist, O2 delivery, no edema, necrotic tissue must be removed
48
What level of Bacteria inhibits wound healing and why?
>10^5 - Decreases O2 content - collagen lysis - Prolonged inflammation
49
What is the effect of devitalized tissue and foreign bodies on wound healing?
retards granulation tissue formation
50
How does diabetes contribute to poor wound healing?
impedes early phase response
51
What level of albumin can be a factor in poor wound healing?
<3.0
52
How do steroids inhibit wound healing?
inhibit macrophages, PMNs, Collagen synthesis by fibroblasts, decrease tensile strength
53
What can be given to counteract steroid effect on wound healing?
Vitamin A
54
Osteogenesis Imperfecta is a defect in what?
Type I collagen
55
Ehlers-Danlos syndrome is what?
Collagen disorder; 10 types identified
56
Marfan's syndrome is a defect in what?
Fibrillin (Collagen)
57
What is Epidermolysis Bullosa, and how is it treated?
Excessive fibroblasts; phenytoin
58
What is Charcot's joint?
2nd MTP- diabetic foot ulcer 2* to neuropathy
59
How long do you wait before doing a scar revision?
1 year
60
Does cartilage contain blood vessels?
No
61
Does Denervation have an effect on wound healing?
No
62
Chemo can be given how many days after surgery and have no effect on wound healing?
14
63
What inheritance is Keloiding?
Autosomal Dominant
64
In Keloids, How far does collagen extend, and what is Tx?
Beyond the original scar; XRT, steroids, silicone, pressure garments
65
Where are hypertrophic scars usually found?
flexor surfaces of upper torso
66
In hypertrophic scars, how far does collagen extend?
Stays within confines of scar, treat with steroids, silicone, pressure garments

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