Day 1-wound healing Flashcards
When doing O of SOAP, which do I consider first-radiographs or clinical assessment?
CLINICAL ASSESSMENT first!
What are the 3 A’s that are basic necessities for surgery?
1.Adequate visibility 2.Assistance 3.Aseptic technique
Which class of surgical wound and what is its description? An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or urinary tract is not entered
Class I, Clean
Which class of surgical wound and what is its description? Open, fresh, accidental wounds. Acute, non-purulent inflammation is encountered.
Class III, Contaminated
Which class of surgical wound and what is its description? Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection.
Class IV, Dirty-Infected
Which class of surgical wound and what is its description? An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination
Class II, Clean-Contaminated
**Which surgical classification (I-IV) do we as dentists and oral surgeons usually work with?
Class II, clean-contaminated
What 2 types of injury can be caused by surgery?
physical and chemical
Incision, Crushing, Thermal, Drying, Disruption of blood flow are all examples of WHAT TYPE of injury caused by surgery?
physical
Non physiologic pH, Protein denaturation (hypo- or hyper- tonic), Vascular constriction (eg. By epinephrine) are all examples of WHAT TYPE of injury caused by OS?
Chemical
For best healing: incisions- use the blade _______ to the surface you are cutting
perpendicular
For best healing: incisions- we want to place our incisions through attached ______ and over sound _____
gingiva….bone
A _____ is a segment of soft tissue which can be moved to gain surgical access or to permit reorientation of the tissue.
FLAP
What are the 3 potential complications of flaps?
1.necrosis 2. dehiscence 3.tearing
Proper flap design: _____ of flap should be wider than the ____
base….tip
Proper flap design: Base should be greater than or equal to ___X the height
2X
Proper flap design: When possible, an _____ blood supply should be included in the base of the flap
AXIAL (mucosa?)
Proper flap design: Make releasing incisions ___-___ teeth away from the extraction site
1-1.5
Proper flap design: Incisions heal _____, not end-to-end, so ______ incision (wider flap, better access) is better
ACROSS from each open flap….. LONGER
Tissue handling- IRRIGATION is GOOD, what do I irrigate with? Especially when cutting what tissue?
Sterile Saline…BONE
POORLY CONTROLLED BLEEDING ALSO ALLOWS FORMATION OF ________, WHICH INCREASE TENSION ON THE WOUND EDGES, DECREASE VASCULARITY, AND PROVIDE A CULTURE MEDIUM WHICH INCREASE RISK OF POSTOP INFECTION.
HEMATOMAS
_________ : (ANY SPACE THAT REMAINS EMPTY OF TISSUE AFTER WOUND CLOSURE) USUALLY FILLS WITH ______ - HIGH POTENTIAL FOR INFECTION
DEAD SPACE….blood
Eliminate dead space! 1.suture tissue _____ together 2.pressure dressing 3.packing 4.drains
planes
As bacteria quickly contaminate any wound open to the environment, risk of infection can be decreased by _______ the wound during surgery and closure.
IRRIGATING
Control edema (swelling caused by Transudation of fluid from injured vessels)1) Careful surgery 2) Elevation of operated area 3) Systemic _______(drugs) 4) Ice
steriods
Wound repair: _________- Injured epithelium is “programmed” to reestablish continuity by proliferation, migration and ______ inhibition.
epithelialization…CONTACT
_________: Any free edge of epithelium advances until it touches another free edge of epithelium, at which time it stops growing.
contact inhibition
The free edge of epithelium (which does not contain ______ vessels) migrates along over the vascularized tissue underneath, and under the _____ (dessicated blood clot) above until the edges meet. (Contact inhibition)
(Reestablishes epithelial continuity)…ALL THIS IS A ______ THING FOR HEALING
BLOOD..scab…GOOD
A SOMETIMES BAD result from contact inhibition….This results in an epithelialized tract between the oral cavity and the sinus – an oroantral _____
FISTULA
What are the 3 stages of wound healing?
1.inflammatory 2.fibroplastic 3. remodeling
Inflammatory stage of wound healing: usually lasts __-__ days…what are the two phases?
3-5days…vascular THEN cellular
Inflammatory stage I: ______ vasoconstriction slows blood flow and promotes Coagulation within minutes, _____ and __E1 & PgE2 cause vasodilation And “leakiness” of endothelial cells, causing _____
EDEMA…histamine..Prostaglandin (Pg)
What are the 5 signs of inflammation IN LATIN DAMN IT! and which 3 do we typically check in a post-op appointment?
1.Rubor 2.Calor 3.Dolor 4.Tumor 5.Humor….Post-Op-Rubor, Tumor, and Humor
Phase II of inflammation: _______ - Complement cascade - PML margination, diapedesis, degranulation(proteases) - recruitment of phagocytes - lymphocytes (antibodies)
cellular
What holds wound together during inflammatory stage is _____ - not strong
FIBRIN
What color is your clot going to be once the RBCs clear out?
White!
Which stage of wound healing? Fibrin strands form latticework on which fibroblasts lay down ground substance & tropocollagen
Fibroplastic
How long does the Fibroplastic stage last?
2-3 weeks
Fibroplastic stage: Wound at this stage is ____ due to excessive haphazard arrangement of Collagen, erythematous due to high degree of vascularization, and about ___-___% as strong as uninjured tissue
STIFF…70-80%
How long does the Remodeling stage last?
continues INDEFINITELY!
In remodeling, “_________” collagen fibers replaced by well-oriented fibers
haphazard
Remodeling: (Note - ______ is not replaced during wound healing, so a scar will never be as flexible as normal tissue.)
ELASTIN
EVERY wound, every incision results in a ____.
SCAR
What are the 4 factors that impair wound healing?
1.Forigen material 2.Necrotic tissue 3.Ischemia 4.WOund tension
A poorly DESIGNED flap can lead to this factor of impaired wound healing….
ISCHEMIA
Incising over a CANINE EMINENCE will most likely cause WHAT TYPE of impaired wound healing?
TENSION
Failure to UNDERMINE wound edges can lead to ______ which can impair wound healing…
tension
_________ reapproximation and stabilization of “uninjured” wound edges in anatomic position – heals with minimal scarring because less reepithelialization, collagen deposition, contraction and remodeling needs to occur.
PRIMARY INTENTION
_________ allowing a gap between edges of epithelium, mucosa, or bone and necessitating large amounts of epithelia migration, collagen deposition, contraction and remodeling
SECONDARY INTENTION
What type of soft tissue healing is EXTRACTION SOCKETS an example of?
secondary intention
________ - wounds treated by coverage with tissue grafts
TERTIARY intention
When should I see granulation tissue after an extortion?
Week 2
When can I expect new bone to begin to form in an extraction site?
3-8 weeks
What are the 3 stages of BONE wound healing?
SAME AS SOFT TISSUE! 1.Inflammation 2.Fibroplastic 3.Remodeling
Bone healing ________= healing of bone requires bone edges
PRIMARY intention
_______ intention bone healing - (edges more than 1 mm apart) Excess fibrous Tissue is produced and extends beyond free edges of bone
Secondary
What is the term for secondary intention in bone when excess fibrous tissue extends beyond the free edges of the bone?
CALLUS
How much bone is placed per day in osseointegration of an implant? (in um of bone/day)
40um/day
________-Using a membrane with pore size that oxygen & nutrients can get through, but not fibroblasts, can exclude soft tissue and “guide” bone into a desired position
GTR—Guided Tissue Regeneration
Epithelium stops when it reaches titanium and secretes ground substance that attaches soft tissue to the metal – “__________” system forms
hemidesmosomal
What are the 3 most commonly injured nerve branches of the trigeminal nerve?
1.IA/Mental 2.Lingual 3.IO
Nerve injuries- _______ axons severed but not epineurial sheath. usually caused by severe blunt trauma, crushing, or extreme traction… Recovery may occur in ___-____ MONTHS
AXON-OT-MESIS….2-6 months
Nerve injuries-_________ - contusion. Continuity of fibers maintained. usually caused by blunt trauma or traction on nerve Recovery usually spontaneous in days or weeks
NEURA-PRAXIA
Nerve injuries-_________ - complete LOSS of nerve continuity. usually caused by badly displaced fractures, bullets or knives during assault, or iatrogenic transection Recovery unlikely unless nerve ends reapproximated
NEURO-T-MESIS
What is the painful problem sometimes encountered in nerve healing?
Neuroma
Growth rate ___-___mm/day until target reached or growth is blocked by fibrous tissue or bone
1-1.5mm COOL
