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Case 1 > Cutaneous Wound Healing > Flashcards

Cutaneous Wound Healing Flashcards

1
Q

Name some areas of constant regeneration

A

Liver, Kidney, Haematopoietic, Skin, GIT

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2
Q

What is needed for regeneration?

A
  1. Stem cells intact

2. CT framework intact

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3
Q

Describe stages in healing

A
  1. Inflammatory response - removal of dead + damaged tissue
  2. Prolif + migration of neutrophils, macrophages, skin cells, fibroblasts
  3. Angiogenesis - capillary sprouting + recruiting EPC’s
  4. Collagen deposition
  5. Tissue remodelling, wound contraction + strengthening
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4
Q

What is the role of macrophages in wound healing?

A
  • remove wound debris by. phagocytosis
  • produce collagenase + elastase
  • produce NO + ROS = antimicrobial
  • cause chemotaxis + prolif of fibroblasts + keratinocytes by release GF
  • release VEGF for angiogenesis
  • aid in deposition + remodelling of ECM
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5
Q

What factors influence wound healing?

A
  • tissue enviro + extent of tissue damage
  • intensity + duration of stimulus
  • foreign bodies + inadequate blood supply
  • diabetes, steroids (inhibit)
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6
Q

What is angiogenesis/neovascularisation?

A
  • branching + extension of adjacent blood vessels

- recruitment of endothelial progenitor cells from bone marrow -> form new BV’s

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7
Q

Describe wound healing by second intention

A
  • For wounds with separated edges
  • Healing by granulation
  • Slower, broader scar
  • Wound contraction
  • Risk of infection
  • Regular cleaning required
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8
Q

Describe healing by first intention

A
  • For wounds with opposed edges
  • Wound edges Brough together
  • Epithelialisation
  • Minimal scarring
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9
Q

How is second intention wound healing different from first?

A
  • more extensive inflammatory reaction
  • more granulation tissue
  • wound contraction + substantial scar formation - some of the fibroblasts develop ability to contract = myofibroblasts
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10
Q

What systemic factors influence wound healing?

A
  • nutrition
  • metabolic status
  • circulatory status
  • hormones
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11
Q

What are the complications in cutaneous wound healing?

A
  • deficient scar formation
  • excessive formation repair components
  • excessive contraction
  • calcification, pigmentation, pain
  • incisional hernia
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12
Q

What triggers the extrinsic and intrinsic clotting pathways and what happens next?

A

Extrinsic = triggered by tissue damage
Intrinsic = triggered by exposed collagen
End product = prothrombinase (Xa) = breaks down prothrombin -> thrombin = converts fribinogen -> fibrin

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13
Q

What does the binding of thrombin to protease activated receptors cause?

A
  • P selection mobilisation
  • Chemokine production
  • Endothelial adhesion molecule expression
  • COX2 induction
  • PG.PAF.NO production

All = involves in wound healing + inflammation

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14
Q

When are neutrophils replaced by macrophages?

A

48-96 hours

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15
Q

Describe the timeline for recovery of tensile strength

A
  • 10% by end of week 1
  • 20-80% 3 month plateau
  • Initial excess collagen synthesis
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16
Q

What is the effect of old age on wound healing?

A
  • reduced inflam response
  • delayed angiogenesis
  • reduced collagen synthesis, degradation
  • slower epithelialisation
17
Q

What is the effect of diabetes on wound healing?

A
  • ulcers/neuropathy = unable to sense + relieve cutaneous pressure
  • ischaemia secondary to vascular disease
  • prone to infection - impaired granulocyte function + chemotaxis
  • prolonged inflammation
  • impaired neovascularisation
  • decreased collagen synthesis
  • increased levels of proteinases - inactivate haemostat system
  • defective macrophage function
18
Q

Describe fatal wound healing

A
  • re-epithelialize rapidly
  • heal without scarring - TGFB1
  • skin rich in metalloproteinases
19
Q

What is a hypertrophic scar?

A
  • rapid growth
  • regress
  • Myofibroblasts
  • Collagen fibres parallel to skin surface
  • Vertically orientated blood vessels
20
Q

What is a keloid scar?

A
  • constant growth
  • no spontaneous regression
  • extent beyond margins of tissue damage
  • genetic predisposition
  • thick, haphazardly orientated collagen bundles
21
Q

How are wound infections classified?

A
  • Contamination - organisms in wound
  • Colonisation - replicating organisms in wound without inflam. response
  • Local infection/critical colonisation - organism + tissue response
  • Spreading invasive infection - organisms + inflammation + spread
22
Q

What is a biofilm?

A
  • fibrin, thrombin, albumin, collagen, bacteria
  • risk factor for infection
  • no blood supply so cannot be treated with antibiotics

Case 1 (9 decks)

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