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General Pathology > Exam #1: Wound Healing > Flashcards

Exam #1: Wound Healing Flashcards

1
Q

What is the definition of wound healing?

A
  • Restoration of tissue architecture and function after an injury
  • This is the final stage of response to tissue injury
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2
Q

What is the difference between wound healing and wound repair?

A

Wound healing= anatomical and physiologic restoration to the state prior to injury

Wound repair= functional compromise & NOT complete anatomic restoration

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3
Q

Outline the model of wound healing.

A

N/A

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4
Q

Outline the cell cycle.

A

Key part of interphase is the S-phase, where DNA is replicated

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5
Q

What are the three broad types of cells?

A

Labile
Permanent
Stable

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6
Q

What are labile cells?

A

Cells that normally undergo continuious turnover

E.g. epithelium & bone marrow

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7
Q

What are stable cells?

A

Cells that are NOT normally proliferative but are capable of rapid cell division if needed

E.g. Liver & renal tubule

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8
Q

What are the three types of cells that are permanent?

A

These cells CANNOT undergo regeneration & DO NOT contain stem cells:

1) Neurons
2) Cardiac muscle
3) Skeletal muscle

*Once these die, they cannot regenerate

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9
Q

What are the two general processes that constitute regeneration?

A

1) Proliferation of surviving cells to replace lost tissue

2) Migration of surviving cells into the vacant space

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10
Q

In tissues capable of regeneration what happens when there is limited injury? What about where is extensive injury?

A

Limited= regeneration of normal anatomy

Extensive= partial regeneration and scarring

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11
Q

What happens when tissues that are unable to regenerate are injured?

A

Scarring ONLY

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12
Q

What are the three phases of wound healing?

A

1) Inflammation
2) Proliferation
3) Maturation

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13
Q

What events happen in the inflammation phase of wound healing?

A

1 week

  • Clot formation
  • Chemotaxis
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14
Q

What events happen during the proliferation of wound healing?

A

~Week 2

  • Re-epitheliaization
  • Angiogenesis and granulation tissue deposition
  • Provisional matrix
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15
Q

What events occur during maturation?

A

Week 3

  • Secretion of collagen/ collagen deposition
  • Remodeling
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16
Q

When does angiogenesis occur? What is it? Outline the steps?

A

Angiogenesis= capillary budding via endothelial cell proliferation that occurs in ~ week 2/proliferation

17
Q

What cells dictate angiogenesis? What cytokine do these cells secrete?

A

Macrophages secrete VEGF that is the major regulatory of angiogenesis

18
Q

What is VEGF?

A

Major cytokine/ regulatory molecule of angiogenesis i.e. “Vascular Endothelial Growth Factor”

19
Q

What is fibrogenesis? When does it occur?

A
  • Fibroblast activation and proliferation that leads to collagen deposition.
  • Maturation ~week 3
20
Q

What is the major regulator of fibrogenesis? What cell secretes this cytokine?

A

Macrophages secrete TGF-beta

*****Thus, macrophages are the crucial cell in wound healing

21
Q

What is granulation tissue?

A

Granulation tissue= pink, soft granular gross appearance, such as that seen beneath the scab of a skin wound

22
Q

Describe the histological appearance of granulation tissue.

A

Granulation tissue is characterized by proliferation of fibroblasts & new thin-walled, delicate capillaries, and a loose ECM

23
Q

What is the end result of granulation tissue?

A

Granulation tissue progressively accumulates connective tissue matrix, resulting in dense fibrosis (i.e. scarring)

24
Q

What is the difference between early & late stage granulation tissue?

A

Early= numerous macrophages, myofibroblasts, and blood vessels

Late= less vascular, only scattered macrophages, and more martrix & fibroblasts

25
Q

What is cicatrization?

A

The process that is characterized by collagen deposition, contraction, and devascularization

26
Q

What is trichrome stain used for?

A

Visualization of collagen

–>intense blue staining is an indication of scarring

27
Q

What is first intention?

A

This is the best way for wound healing

  • Close approximation of incision
  • NO infection

*Healing occurs directly with a minimum of granulation tissue

28
Q

What is healing by second intention?

A

This is the type of healing that occurs when the edges of a wound are NOT lined up

  • More granulation
  • More epithelization
  • More fibrosis

*More scarring occurs in healing by second intention

29
Q

What is wound contraction?

A

Reduction in the size of a wound that is healed by second intention as the result of myofibroblasts in granulation tissue

30
Q

How is a contracture different than wound contraction? When is this most commonly seen?

A

Contracture is an exaggeration of contraction that results in severe deformity of the wound surrounding the tissues

*****Seen commonly in the healing of serious burns

31
Q

What happens when there is a contracture of the hollow viscera i.e. urethera, esophagus, intestine…etc.)?

A

Progressive stenosis and stricture formation

32
Q

What are myofibroblasts?

A

Hybrid cells that contain properties of fibroblasts and smooth muscle cells

  • Cells produce collagen
  • Contain contractile properties

*****Note that these are important for the contraction of wounds and the prevention of dehiscence

33
Q

What are factors that retard healing?

A

1) Ischemia–>suturing too tightly can lead to ischemia that prevents appropriate wound healing, the goal is to approximate “loosely”
2) Dry wound environment
3) Infection*****
4) Foreign bodies
5) Anti-inflammatory therapy (i.e. excess corticosteroid therapy)
6) Nutritional deficiency (Vitamin C)

34
Q

What are keloids?

A
  • Late stage accumulation of exuberant amounts of collagen that gives rise to prominent raised scars
  • Hyperplastic scar composed of irregularly deposited collagen in the dermis–>disrupts the normal cells in the dermis e.g. hair cells

**This is more common in African Americans due to genetic predisposition

35
Q

What is “proud flesh?”

A

Early stage that is also called “exuberant granulation tissue”

  • Skin protrudes above the level of surrounding skin
  • Cautery or surgical resection is necessary for resoration
36
Q

What is the different between a hypo and hypertrophic scar?

A

Hypotrophic scar= sunken and often hyperpigmented due to loss of collagen and ground substance

  • Hypertrophic scar= structurally similar to keloid, but if you surgical remove, does NOT come back
37
Q

What is the difference between a keloid and a hypertrophic scar?

A

Keloid= raised beyond boundaries of the original injury
–>Haphazard arrangement of collagen

Hypertrophic= collagen is oriented parallel

General Pathology (33 decks)

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