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Z.Fiser > Fiser.14.WoundHealing > Flashcards

Fiser.14.WoundHealing Flashcards

1
Q

What is the rate of epithelialization during the first 10 days of wound healing?

A

1-2mm/day

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2
Q

what is the name of the phase of wound healing during days 1-10?

A

inflammation

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3
Q

what are the two cell types seen during the first 10 days of wound healing?

A

PMNs, macrophages

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4
Q

what is the name of the phase of wound healing from 5 days to 3 weeks?

A

proliferation

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5
Q

what type of collagen replacement is seen during the proliferation phase (5 days to 3 weeks)?

A

type III collagen replaced by type I

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6
Q

what type of cell is seen during the proliferation phase of wound healing? (5 days to 3 weeks)?

A

fibroblasts

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7
Q

name three processes that occur during the proliferation phase of wound healing

A

collagen deposition, neovascularization, granulation tissue formation

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8
Q

What is the name of the phase of wound healing occurring from 3 weeks to 1 year?

A

Remodeling

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9
Q

What occurs to collagen during the remodeling phase of wound healing (3 weeks to 1 year)?

A

collagen cross-linking, net amount of collagen does not change with remodeling but you get significant production and degradation

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10
Q

What happens to vascularity of tissue during the remodeling phase of wound healing (3 weeks to 1 year)?

A

decreased vascularity

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11
Q

what is the rate of peripheral nerve regeneration with wound healing?

A

1mm/day

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12
Q

name the order of arrival of cell types to a wound for wound healing? (5 types)

A

platelets; PMNs; macrophages; lymphocytes; fibroblasts

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13
Q

what cell type is essential for wound healing and why?

A

macrophages are essential for wound healing due to release of growth factors, cytokines

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14
Q

what are the two roles of fibronectin in wound healing?

A

chemotactic for macrophages; anchors fibroblasts

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15
Q

what is the function of fibroblasts in wound healing?

A

replace fibronectin-fibrin with collagen

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16
Q

what is the predominant cell type in a wound on days 0-2?

A

PMNs

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17
Q

what is the predominant cell type in a wound on days 3-4?

A

macrophages

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18
Q

what is the predominant cell type in a wound on days >5?

A

fibroblasts

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19
Q

what are the two components of a platelet plug?

A

platelets and fibrin

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20
Q

what are the three components of the provisional matrix in wound healing?

A

platelets, fibrin, and fibronectin

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21
Q

why does reopening a wound result in quicker healing the second time?

A

healing cells are already there, resulting in accelerated wound healing

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22
Q

what is the most important factor in healing open wounds by secondary intention?

A

epithelial integrity

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23
Q

what three sites do cells migrate from in healing by secondary intention?

A

hair follicles (#1 site); wound edges; and sweat glands

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24
Q

Name two problems a/w unepithelialized wounds

A

leak serum and protein ; promote bacterial growth

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25
Q

what is the factor on which wound healing by secondary intention is dependent upon?

A

dependent upon development of granulation tissue within the wound

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26
Q

what is the factor on which wound healing by primary intention is dependent upon?

A

tensile strength

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27
Q

what collagen variables affect wound healing by primary intention? (2)

A

depends on collagen deposition and cross-linking of collagen

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28
Q

what is the strength layer of the bowel?

A

submucosa

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29
Q

what is the weakest time point for a small bowel anastomosis?

A

3-5 days

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30
Q

what is a myofibroblast?

A

a smooth muscle fibroblast

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31
Q

how do myofibroblasts communicate?

A

via gap junctions

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32
Q

what are two wound healing processes that myofibroblasts are involved with?

A

involved in wound contraction and healing by secondary intention

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33
Q

how well does wound contraction occur in the perineum compared to the leg

A

perineum has better wound contraction than the leg

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34
Q

what is the most common type of collagen?

A

Collagen Type I

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35
Q

where is type I collagen found? (3 locations)

A

skin, bone, tendons

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36
Q

what is the primary type of collagen in a healed wound?

A

Type I Collagen

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37
Q

where is type II collagen found?

A

cartilage

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38
Q

where is type III collagen found? (3)

A

increased in a healing wound, blood vessels, skin

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39
Q

where is type IV collagen found?

A

basement membranes

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40
Q

where is type V collagen found?

A

widespread, particularly in cornea

41
Q

name four molecules required for hydroxylation and cross-linking of proline residues

A

alpha keto glutarate, vitamin C, oxygen, iron

42
Q

what amino acid allows cross-linking in collagen

A

cross linking of proline residues

43
Q

how frequently does proline occur in collagen?

A

proline occurs every third amino acid

44
Q

how does collagen’s proline cross-linking affect wound tensile strength?

A

proline cross-linking improves wound tensile strength

45
Q

what is the underlying cause of scurvy?

A

vitamin C deficiency

46
Q

what is the highest tensile strength of a healed wound compared to pre-wound tensile strength?

A

up to 80% of pre-wound tensile strength

47
Q

does a wound’s tensile strength ever reach pre-wound levels?

48
Q

what is the predominant type of collagen healed in days 1-2 of wound healing?

A

Type III collagen

49
Q

what is the predominant type of collagen healed in days 3-4 of wound healing?

A

type I collagen

50
Q

at what time during wound healing is all of the type III collagen replaced by type I collagen

A

by three weeks post-wound

51
Q

at what time during wound healing does a wound reach maximum tensile strength?

A

at 8 weeks at 80% of original wound strength

52
Q

at what time during wound healing does maximum collagen accumulation occur? what occurs afterwards?

A

maximum collagen accumulation at 2-3 weeks –> after that the amount of collagen stays the same but continued cross-linking improves strength

53
Q

what medication inhibits collagen cross-linking?

A

d-penicillamine

54
Q

why is moisture essential for wound healing?

A

prevents dessication

55
Q

what are 5 ways you can improve oxygen delivery for wound healing?

A

optimize fluids, no smoking, pain control, arterial revascularization, supplemental oxyten

56
Q

what is the ideal transcutaneous oxygen measurement for wound healing?

57
Q

how do you avoid leg edema to improve wound healing?

A

leg elevation

58
Q

what concentration of bacteria is an impediment to wound healing?

A

bacteria > 10^5 / cm2

59
Q

what are three causes of increased bacteria concentration in a wound bed?

A

reduced oxygen content, collagen lysis, prolonged inflammation

60
Q

how does devitalized tissue affect wound healing?

A

retards granulation tissue formation and wound healing

61
Q

how do foreign bodies affect wound healing?

A

retards granulation tissue formation and wound healing

62
Q

how do cytotoxic drugs affect wound healing? give four examples of drugs

A

5FU, methotrexate, cyclosporine, FK-506 –> can impair wound healing in the first 14 days after injury

63
Q

how does diabetes affect wound healing?

A

can contribute to poor wound healing by impeding the early phase inflammation response b/c hyperglycemia causes poor leukocyte chemotaxis

64
Q

what albumin level is a risk factor for poor wound healing?

A

albumin < 3.0

65
Q

how do steroids affect wound healing?

A

prevent wound healing by inhibiting macrophages, PMNs, and collagen synthesis by fibroblasts; reduces wound tensile strength as well

66
Q

what is the effect of vitamin A on wound healing for patients on steroids?

A

vitamin A counteracts the adverse effects of steroids on wound healing

67
Q

what daily dose of vitamin A is required to counteract the adverse effects of steroids on wound healing?

A

25,000 IU qd

68
Q

name 8 causes of wound ischemia

A

fibrosis, pressure (sacral decub, pressure sore), poor arterial inflow (atherosclerosis), poor venous outflow (venous stasis), smoking, radiation, edema, vasculitis

69
Q

how does osteogenesis imperfecta affect wound healing?

A

type I collagen defect

70
Q

how does Ehler-Danlos syndrome affect wound healing?

A

10 types have been identified and all are a/w collagen disorders

71
Q

How does Marfan’s syndrome affect wound healing?

A

fibrillin defect (connective tissue protein)

72
Q

how does epidermolysis bullosa affect wound healing?

A

excessive fibroblasts

73
Q

how do you treat epidermolysis bullosa?

74
Q

how does scurvy affect wound healing?

A

vitamin C deficiency prevents collagen cross-linking

75
Q

how does pyoderma gangrenosum affect wound healing?

A

a condition that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. Ulcers usually initially look like small bug bites or papules, and they progress to larger ulcers.

76
Q

what is the MC location of diabetic foot ulcers?

A

at Charcot’s joint (2nd MTP joint), then toes

77
Q

what is the pathophysiology of development of diabetic foot ulcers?

A

2/2 neuropathy, can’t feel feet, pressure from walking leads to ischemia

78
Q

what is the underlying cause of 90% of leg ulcers

A

venous insufficiency

79
Q

what is the treatment for leg ulcers?

A

Unna boot (elastic wrap)

80
Q

name three molecules in high concentration in scars

A

proteoglycans, hyaluronic acid, water

81
Q

how long should you wait before performing a scar revision?

A

wait 1 year to allow maturation, may improve with age

82
Q

how do infants scar?

A

they heal with little or no scarring

83
Q

how is oxygen and nutrients delivered in cartilage and why?

A

cartilage is avascular, so you get O2 and nutrients by diffusion

84
Q

what is the effect of denervation on wound healing?

A

no effect on wound healing

85
Q

what is the timing of the effect of chemotherapy on wound healing?

A

has no effect on wound healing after 14 days

86
Q

how are keloids inherited?

A

autosomal dominant

87
Q

what skin pigmentation is at increased risk for keloids?

88
Q

what occurs to collagen formation in a keloid?

A

collagen goes beyond the original scar

89
Q

how do you treat keloids (4)

A

intra-lesion steroid injection, silicone, pressure garments, XRT

90
Q

what are four risk factors for hypertrophic scar tissue?

A

dark skinned, flexor surfaces of upper torso, burns, wounds that take a long time to heal

91
Q

what occurs to collagen formation in hypertrophic scar tissue?

A

collagen stays within confines of the original scar

92
Q

how do you treat hypertrophic scar tissue? (3)

A

steroid injection, silicone, pressure garments

93
Q

name four contents of alpha granules in platelets

A

platelet factor 4, beta-thrombomodulin, platelet-derived growth factor (PDGF), transforming growth factor beta (TGF beta)

94
Q

what is the function of platelet factor 4 in platelet granules?

A

allows platelet aggregation

95
Q

what is the function of beta thrombomodulin in platelet granules?

A

binds thrombin

96
Q

what is the function of platelet-derived growth factor (PDGF) in platelet granules?

A

chemoattractant

97
Q

what is the function of transforming growth factor beta (TGF beta) in platelet granules?

A

modulates aggregation, thrombin binding, and chemoattractant

98
Q

what are the three contents of dense granules in platelets?

A

adenosine, serotonin, calcium

99
Q

name three platelet aggregation factors

A

TXA2, thrombin, platelet factor 4

Z.Fiser (22 decks)

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