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IP 11 Equine Medicine > Exam 1 - Wounds > Flashcards

Exam 1 - Wounds Flashcards

1
Q

4 phases of wound healing

A
  1. inflammatory
  2. debridement
  3. proliferative
  4. maturation
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2
Q

What is the timeline of inflammatory phase?

A

0-6 hours

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3
Q

What kind of response occurs in the inflammatory phase?

A

vascular and cellular - immediate vasoconstriction to stop bleeding and capillary dilataion to bring cells in to area

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4
Q

What is the timeline of the debridement phase?

A

6-18 hours typically (may continue for days - depending on contamination of wound)

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5
Q

What effect does surgical incision have on debridement phase length and why?

A

Shortens length of debridement phase b/c the incision is clean

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6
Q

What is the timeline of the proliferative (repair) phase?

A

12+ hours

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7
Q

What are 4 processes that occur during the proliferative/repair phase?

A

collagen production, granulation tissue formation, wound contraction, re-epithelialization

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8
Q

what process characterize the maturation (remodeling) phase?

A

wound contraction and collagen remodeling

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9
Q

what is the timeline of the maturation/remodeling phase?

A

6 d - 2 yrs

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10
Q

during the maturation/remodeling phase, what causes the strength of the skin to increase?

A

the formation of of larger collagen bundles AND more intermolecular cross links btwn collagen bundles

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11
Q

Why will remodeled tissue not regain the same breaking strength as uninjured skin?

A

although the scar itself and the uninjured skin around it are strong, the interface btwn the two is not - this is where re injury most commonly occurs

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12
Q

What are the MAJOR cells involved in wound healing?

A

platelets and monocytes/macrophages

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13
Q

What are the primary cells involved in the inflammatory phase?

A

platelets and leukocytes

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14
Q

what is the role of platelets in the inflammatory phase?

A

hemostasis, provisional matrix, keep foreign material and debris out

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15
Q

what is the role of leukocytes in inflammatory phase?

A

control infection [mast cells] and remove foreign bodies and debris AND nerve sensitization

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16
Q

in addition to hemostasis, what other role do platelets play in inflammatory phase?

A

release chemo attractants and mitogens

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17
Q

what is a mitogen?

A

stimulate mitosis and lymphocyte transformation

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18
Q

what is a chemoattractant?

A

brings other cells to the party

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19
Q

what cells doe platelets attract to the wound?

A

monocytes and fibroblasts

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20
Q

what is MCP? and what secretes it?

A

monocyte chemoattractant protein - secreted by platelets

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21
Q

what is MIP and what secretes it?

A

macrophage inflammatory protein - secreted by platelets

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22
Q

what MAJOR cells are involved in debridement phase?

A

WBCs - NTs, lymphocytes, monos/macros, mast cells

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23
Q

what phases are NTs 1* involved in?

A

inflammatory and debridement

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24
Q

what is the function of NTs?

A

cleanse wound of foreign particles and bacT

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25
Q

when do NTs arrive?

A

day 1 [begin to leave on day 2 usually]

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26
Q

what processes occur during the proliferative/repair phase?

A

ECM deposition, angiogenesis, epithelialization

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27
Q

what are some cells involved in the proliferative/repair phase?

A

monos/macros, fibroblasts, epidermal cells, endothelial cells, T-lymphocytes, mast cells

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28
Q

without this cell, wound healing is very poor - this cell is THE MAJOR player in ALL wound healing

A

macrophages

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29
Q

what happens to macrophages after they arrive at the would site?

A
  • adhere to ECM

- monocytes activated to be inflammatory OR repairative macrophages

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30
Q

what are 3 things that macrophage adherence stimulates the expression of?

A

colony stimulating factor 1
TNFalpha
PDGF

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31
Q

what is CSF-1?

A

cytokine necessary for survival of monocytes and macrophages

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32
Q

what is TNFa?

A

potent inflammatory cytokine

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33
Q

what is PDGF?

A

a potent chemoattractant and mitogen for fibroblasts

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34
Q

what do macrophages activate and release that is critical to wound healing?

A

growth factors (over 100) - to stimulate proliferation of mesenchymal cells, angiogenesis, ECM/granulation tissue production

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35
Q

when does graunlation tissue begin to develop

A

about 4 days post injury

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36
Q

what cells make up granulation tissue?

A

macros, fibroblasts, endothelial cells

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37
Q

what do macros provide for granulation tissue

A

growth factors

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38
Q

what do fibroblasts provide for granulation tissue

A

ECM

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39
Q

what do endothelial cells provide for granulation tissue?

A

form vessels to carry o2 and nutrients to the site

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40
Q

what type of healing dooes granulation tissue promote?

A

second intention healing

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41
Q

what bacT often grows on surface of granulation tissue?

A

pseudomonas

42
Q

why does granulation tissue typically NOT get infected?

A

b/c it is highly vascular

43
Q

4 benefits of granulation tissue

A
  1. surface for epithelial migrations
  2. resist infection
  3. essential for wound contraction
  4. collagaen production
44
Q

what kind of surface do endothelial cells require to migrate?

A

smooth => NO hills/valleys

45
Q

what do fibroblasts do?

A
  • synthesis, deposition and remodeling of ECM
  • produce GFs and MMPs - to replace provisional ECM with collagenous matrix
  • wound contraction
46
Q

what do macros, platelets, endo cells and epi cells secrete that stim fibroblasts to prod ECM?

A

TGFb
PDGF
FGF

47
Q

what does TGFb1 do?

A
  • stim fibroblasts to convert ECM to a more collagenous matrix
  • converts fibroblasts to myofibroblasts
48
Q

what do myofibroblasts do?

A

aid in wound contraction

49
Q

what stimulates angiogenesis?

A

EGF (epi GF), PDGF (platelet derived GF), VEGf (vascular endothelial GF)

50
Q

what stops angiogenesis?

A

programmed cell death when wound is filled w new granulation tissue

51
Q

when does epithelialization begin?

A

about 12 hours post injury

52
Q

what must be present for epithelial cells to migrate?

A

granulation tissue [if sutured, migration is immediate - if not, lag phase of 4-5 d]

53
Q

is migration rate of epithelial cells slower on the upper body or distal limbs?

A

distal limbs (0.1 vs 0.2 mm/day)

54
Q

when does epithelial cell proliferation begin?

A

1-2 days post injury

55
Q

describe epithelial cell proliferation through wound

A
  • begin at wound margin, behind migrating cells

- migrate or restratify to restore the original epidermis to close wound

56
Q

some limiting factors to epithelialization

A 
infection
excess granulation tissue
repeated dressing changes
extreme hypothermia
desiccation of wound surface
reduced o2 tension
57
Q

1* cells involved in remodeling/maturation phase ?

A

macros, fibroblasts/myofibroblasts, epidermal and endothelial cells

58
Q

process during remodeling/maturation phase?

A

wound contraction
collagen remodeling
inc wound strength

59
Q

when does wound contraction begin to occur?

A

3-4 days post injury [independent of epithelialization]

60
Q

what cell is responsible for movement of tissue during wound contraction?

A

myofibroblasts

61
Q

upper body wounds heal primarily by wound contraction or epithelialization?
and distal limb wounds?

A

upper body: contraction

distal limb: epithelialization

62
Q

when does collagen remodeling begin?

A

5 days post injury

63
Q

these collagen fiber types are replaced by these fiber types

A

type 1 [mature] collagen => type 3 collagen

64
Q

how long does collagen accumulation continue for? what happens after that?

A

3 weeks - after that, synthesis is balanced by degradation

65
Q

2 main goals of traumatic wound treatment:

A

preserve life

prevent infection

66
Q

goals of debridement:

A

remove damaged tissue, foreign bodies and bacT

obtain fresh skin edge for 1* closur

67
Q

light debridement vs surgical debridement:

A 
light = wet to dry wraps
surgical = removing fat, fascia and muscles
68
Q

how to facilitate autolytic debridement:

A

maintain warm, moist environment - bandage wound to accomplish this

69
Q

benefits of keeping exudate around wound?

A

rich in endogenous enz, GFs, cytokines - stim migration of fibroblasts, epithelial cells, vascular tissues, NTs, macros

70
Q

what is an Acemannan hydrogel used for?

A

prod from aloe vera leaves - facilitates autolytic debridement - promotes collagenase prod - nonadherent and occlusive

71
Q

how does Calcium Alginate product work?

A

a dry 3D fabrick that absorbs exudate to form gel like substance - hemostasis and bioabsorbable

72
Q

2 ideal lavage fluids?

A

saline or LRS

73
Q

goals for wound closure - to minimize what 3 things?

A

skin loss
tension
infection or contamination

74
Q

4 types of wound closures?

A

primary
delayed primary
secondary
none (2nd intention)

75
Q

what is the window for delayed primary closure?

A

up to 5 days post injury

76
Q

describe secondary closure

A

after granulation tissue appears - about 5-6 days post injury

77
Q

process of second intention healing?

A

granulation tissue formation, wound contraction, epithelialization

78
Q

indications for 2nd intention healing?

A

contaminated or infected wound, extensive tissue loss, excessive skin tension

79
Q

common issues with lower limb wounds that make healing difficult:

A

tight skin, lack of supporting deep tissues, wound contraction limited, reduced rate of epithelialization, predisposes to proud flesh

80
Q

what is proud flesh?

A

exuberant granulation tissue

81
Q

what makes up proud flesh?

A

1* fibroblasts and capillaries

82
Q

where does proud flesh commonly occur?

A

distal limb

83
Q

why does proud flesh occur?

A
  • infection / chronic inflammation
  • collagen metabolism imbalance
  • lack of muscle/soft tissue
  • poor blood supply
84
Q

Tx of granulation tissue?

A

surgical excision, corticosteroids +/- abx, equine amnion, chemical debridement

85
Q

benefits of bandages?

A
  • protect from contamination
  • absorbs exudate
  • px (prevent) swelling
  • stabilize wound margins
  • control granulation tissue
  • maintain moist environment
86
Q

how do occlusive dressings work?

A
  • retain wound exudate and px opportunistic bacT infections

- impermeable so dec o2 tension in wound

87
Q

how do non occlusive dressing work?

A

allow wounds to drain and breathe

88
Q

how are bandage casts applied?

A

applied over half limb or full limb bandage, set then split either front and back or medial and lateral

89
Q

how does vacuum assisted closure work?

A

sub atmospheric pressure creates mild suction to pull wound together - keep margins from expanding - continuously removing excess fluid - inc local blood flow and tissue oxygenation by dec pressure on small vessels

90
Q

benefits of VAC?

A

dec edema, dec bacT counts, remove inflammatory mediators, promote formation of granulation tissue, promote angiogenesis, dec need for bandage changes, dec need for maintaining intact skin

91
Q

what is hyperbaric o2 therapy?

A

intermittently administered 100% o2 at pressure greater than atmospheric pressure

92
Q

when is hyperbaric o2 therapy good?

A

if blood flow diminished, o2 supply compromised, anaerobic infections

93
Q

when is skin grafting used?

A

defect greater than ability to epithelialize and contract, large lower limb wounds, defect under neoplasm

94
Q

what is necessary for acceptance of graft?

A

ability to establish arterial/venous network w/in graft

95
Q

why do grafts fail?

A 
poor revascularization due to:
-blood/serum accumulation
-insufficient immobilization 
baccT infection b/c:
- slow cell migration
- cell destruction
- destroys fibrin film

inadequate recipient bed [fat, tendon, bone, infection, old granulation tissue, etc]

96
Q

how to stimulate granulation tissue?

A

hydrotherapy, wet saline bandages, dilute povidone-iodine dressings, waater soluble antimicrobial ointments

97
Q

ideal granulation tissue is?

A

smooth, slightly convex, immobile

98
Q

chronic granulation tissue appearance?

A

grey/red, edametous, exudate, fibrotic,, less vasacular

99
Q

advantages to pinch graft?

A

local anesthesia, minimal trauma, physiologic covering, no bandaging

100
Q

pinch graft dis advantages?

A

cobblestone appearance, poor quality healing of skin w tendency to bleed and crack

101
Q

punch graft advantages?

A

easy revascularization, resistant to motion, resists infection

102
Q

punch graft dis advantages?

A

multi directional growth, needs bandage, graft may come off with bandage removal

IP 11 Equine Medicine (10 decks)

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