Clinical Wound Management I and II Flashcards
What are the 4 phases of wound healing?
- Inflammatory
- Debridement
- Proliferative
- Maturation
What are the 4 types of wound closures?
- Primary
- Delayed primary
- Secondary
- Second intention
What phases of wound healing overlap with eachother?
– inflammatory phase and debridement phases overlap; these two phases have pretty consistent timelines
– proliferative phase overlaps with all of the other phases; it takes a variable time to occur and has 3 sub-phases.
what are the 3 subphases of the proliferative phase of wound healing?
- granulation tissue formation
- epithelialization
- contraction
T/F: time in the various phases of wound healing depends on the size of the wound
true
The healing body has to ________________ before it can build it back up.
break stuff down
In the inflammatory and debridement phases, _______ decreases which weakens the wound.
collagen
During the ________ phase, collagen increases and strengthens the wound.
proliferative
The inflammatory phase of wound healing begins with hemostasis in which a blood clot forms. The platelets within this clot attract what cells for the next portion of the inflammatory phase to occur?
platelets attract neutrophils, which kill bacteria and debride necrotic tissue. This is the 2nd step of the inflammatory phase called early inflammation.
The last step of the inflammatory phase is known as the “late inflammation” step.
This step takes place on day 3-5 and is when phagocytosis occurs. What is the major cell involved in this step?
macrophages
What are the 5 cardinal signs of inflammation?
- heat
- redness
- pain
- loss of function
- swelling
what causes heat and redness in inflamed wounds?
increased blood flow
what causes swelling and pain in inflamed wounds?
exudation of fluids and influx of cells and chemical mediators.
what causes loss of function in cases of inflammation?
disruption of tissue structure
fibroplasia
metaplasia
pain
how long does the inflammatory phase typically last?
5-6 days
The following are gross characteristics of what phase of wound healing?
cardinal signs of inflammation present
purulent exudate
necrotic tissue
inflammatory phase
when does the proliferative phase typically begin?
around day 4
The following are key characteristics of what phase of wound healing?
granulation tissue formation
epithelialization
contraction
proliferative phase
Grossly, granulation tissue is bright red-pink and has a granular/cobblestone surface.
What 3 things does granulation include on a microscopic level?
- capillaries
- collagen
- fibroblasts
Do you typically need to prescribe antibiotics to patients with wounds that are in the proliferative phase – why or why not?
No, granulation tissue is highly resistant to infection. This is also the phase in which tissue contains collagen and is therefore stronger.
Which of the following is true about epithelialization?
A. epithelial cells begin forming at the center of the wound and grow outward
B. there are adnexal structures
C. epithelialization is halted by contact inhibition
C. epithelialization is halted by contact inhibition
As the epithelial cells grow inwards from the margin, they will touch each other. Once they have contact with each other, growth is inhibited.
What cells allow for wound contraction (the third step of the proliferative phase)?
myofibroblasts
these cells contain actin filaments which allow them to contract the wound in size.
Describe the difference between contraction and contractures.
Contraction – normal process in wound healing in which myofibroblasts decrease the size of the wound
Contracture – an abnormal process; occurs around highly movable areas such as joints and orifices
_________ phase of wound healing is characterized by the closed wound strengthening.
maturation phase
In the inflammatory phase, tissue oxygen tension is low, whereas it is much higher during the proliferative phase.
Why is oxygen so important in wound healing?
Neutrophils need oxygen to kill bacteria, without it infection is likely to occur.
Collagen production requires oxygen and without it, wound healing would be delayed.
T/F: inflammation can delay or reverse the proliferative phase
true
What are the 3 elements of initial wound management (day 1)?
- clip and clean the skin
- lavage the wound
- debride the wound
What should you use to scrub the wound after you clip?
Bonus if you know what to NEVER use and why
chlorohex solution or povidone-iodine solution.
NEVER use scrub or anything that creates bubbles because bubbles inhibit fibroblasts.
Debridement is important because it reduces risk of infection and reduces time of the inflammatory phase.
What are the 3 goals of initial wound debridement?
Remove necrotic tissue
Reduce contamination
Rid foreign material
What are the 4 types of debridement?
Bonus: For each, tell whether they are selective or non-selective
- surgical (by us) – selective
- autolytic (by their body) – selective
- bandage-associated (wet/dry bandage) – non-selective
- chemical – topical medications, unsure about selectivity
T/F: debridement speeds up the transition from inflammatory phase to the proliferative phase.
true
What is the most preferred method of sterilization?
steam
_________ is the most effective way to reduce bacterial numbers on the surface of a wound.
lavage
When lavaging a wound, you can use either tap water or 0.9% saline solution. Why might the saline solution be preferred over the tap water?
tap water is hypotonic to the wound and can subsequently cause edematous skin post-lavage.
0.9% saline is isotonic, therefore this is not a problem seen.
what 2 lavage solutions should NEVER be used?
- hydrogen peroxide
- scrub solutions
what is the ideal pressure to lavage at?
8 psi
__________ closure is closing a wound days later, but PRIOR to the formation of granulation tissue.
delayed primary
_______ closure is closing skin over granulation tissue.
secondary
___________ is allowing a wound to heal by contraction and epithelialization.
second intention healing
Do not close a wound unless…
you think it is going to resist infection and heal.
Never close dirty wounds
What are a few types of wounds that you should not utilize primary closure with?
burns
bite wounds
gunshot wounds
snake bites
what are the 3 layers of a bandage?
- primary layer – dressing/contact layer; goes onto the wound itself and manipulates the wound environment
- secondary layer – cast padding for absorption, stabilization, and pressure
- tertiary layer – vet wrap; for additional protection and pressure
How do the goals of the primary layer of bandaging differ between the inflammatory phase versus the proliferative phase?
in the inflammatory phase, the goal is to debride and reduce bacterial contamination
whereas in the proliferative phase, the goal is to support new tissue and hold cells/cytokines in.
What are desirable properties for a primary layer to have during the inflammatory phase?
good debridement
antibacterial
examples include: wet-to-dry (although non-selective debridement) and honey/sugar.
what are desirable properties for a primary layer to have during the proliferative phase?
Does not stick (Nonadherent)
Occlusive (holds moisture in)
examples include: tefla + TAB, petroleum infused gauze, honey/sugar, hydrogel, polyurethane foam, and calcium alginate
Wet-to-dry bandages are extremely painful to remove and require sedation to do so.
When/how often should you change a wet-to-dry bandage?
as soon as you see strike-through (once daily at least).
what makes honey and sugar “antimicrobial”?
high osmolarity dehydrates bacteria
Which dressing requires LARGE amounts of wound fluid to be effective?
calcium alginate
this dressing promotes autolytic debridement and granulation tissue formation.
What is the “poor mans” moist wound healing dressing?
tefla pad + triple antibiotic ointment
or
petroleum-infused gauze
If a dogs leg is small, what do you need to consider when placing the secondary layer of a bandage?
tension and pressure of the bandage.
Do NOT put too much tension on this bandage because the size of the leg is so small and the pressure will be too great. This could create a tourniquet effect.
What are tie-over bandages best for?
wounds in highly movable areas
How often should you change bandages in the inflammatory phase of healing versus in the proliferative phase of healing?
inflammatory phase – every day
proliferative phase – slowly transition from every day, to every other day, to every 3 days, to every 5-7 days.
What are the downsides to second intention healing?
takes longer
the new epithelium with be alopecic, thin, shiny, and very fragile.
Why are topical antibiotics good for wounds?
- get high concentration at site
- can use antibiotics that are not available in systemic formulation
- less bacterial resistance
when are topical antibiotics indicated versus systemic?
topical – during inflammatory/debridement phase, not necessary during the proliferative phase
systemic – when there is INFECTED tissue.
