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FRCS > Fundamentals > Flashcards

Fundamentals Flashcards

1
Q

What are the phases and timings of wound healing?

A

Inflammatory (days 1-6)
Fibroproliferative (Day 4 - week 3)
Maturation/remodelling (week 3 - 1 year)

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2
Q

What phase of wound healing 2 weeks post injury?

A

Fibroproliferative

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3
Q

Outline the stages of the inflammatory phase of wound healing

A

Vasoconstriction, coagulation, vasodilation and increased vascular permeability, chemotaxis, cell migration

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4
Q

Outline the stages of cellular migration during the inflammatory phase of wound healing

A

Margination, diapedesis, fibrin deposition

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5
Q

What is the predominate cell type within a wound during the first 48h

A

Neutrophils (24-48h)

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6
Q

What is the predominate cell type within a wound during 48-96 hours?

A

Macrophages (48-96 hours; 2 days - 2 weeks)

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7
Q

Which cell type is most critical for wound healing?

A

Macrophages

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8
Q

What are the hallmark features of a chronic wound?

A

Failure of a wound to progress from the inflammatory to the fibroproliferative phase, resulting in prolonged and unresolved inflammation

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9
Q

What is the role of debridement in the setting of chronic wounds?

A

Remove inflammatory mediators and senescent cells to turn a chronic wound into an acute wound to reset the wound healing process

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10
Q

Outline the stages of the fibroproliferative phase of wound healing

A

Matrix formation, angiogenesis, epithelisation

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11
Q

What is the dominant cell type within a wound one week following an injury?

A

Fibroblasts

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12
Q

When are fibroblasts present in a wound post-injury?

A

Day 2-3

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13
Q

Outline tor production of glycosaminoglycan

A

Hyaluronic acid > chondroitin-4-sulfate, dermatan sulfate, heparin sulfate > collagen

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14
Q

What is the difference between angiogenesis and vasculogenesis?

A

Angiogenesis = formation of new blood vessels from existing ones

Vasculogenesis = formation of new blood vessels de novo

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15
Q

Outline the remodelling phase of wound healing

A

Week 3 to 1 year

Equilibrium in collagen synthesis and breakdown

Type I collagen replaces type III collagen

Decrease in GAGs, water content, vascularity and cellular population

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16
Q

What is the tensile strength of a wound at 1 week?

A

3%

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17
Q

What is the tensile strength of a wound at 3 weeks?

A

30%

18
Q

What is the tensile strength of a wound at 3 months?

A

80%

19
Q

What is the normal ratio of type I to III collagen?

A

4:1

20
Q

Type I collagen

A

90%
Skin, bone and tendon

21
Q

Type II collagen

A

Cornea
Hyaline cartilage

22
Q

Type III collagen

A

Vessel and bowel walls
Uterus
Skin

23
Q

Type IV collagen

A

Basement membrane

24
Q

Where are multipotent epithelial progenitor cells found?

A

Bulge stem cells in hair follicle

25
Q

Outline the stages of epithelisation

A

Mobilisation (loss of contact inhibiton), migration (contact inhibition re-established), mitosis, differentiation

26
Q

What cell type is implicated in Dupuytren’s?

A

Myofibroblasts

27
Q

Mutation in which gene is found in Ehlers-Danlos?

A

COL5A1
COL5A2
COL1A1

28
Q

Mutation in which gene is found in progeria?

A

LMNA

29
Q

Outline features of progeria

A

limited growth, full body alopecia, beaked nose, atherosclerosis

30
Q

Mutation of which gene found in Werner

A

WRN

31
Q

Pseudoxanthoma elasticum

A
32
Q

Cutis laxa

A
33
Q

How does vitamin A deficency effect wound healing?

A

Supplementation reverses delayed wound healing from steroids

34
Q

How is vitamin C involved in wound healing?

A

Vital for hydroxylation of amino acids essential for collagen synthesis

35
Q

What factors affect wound healing?

A

Systemic: co-morbidities, drugs (steroids), smoking, vitamin deficiencies and nutrition
Local: Oxygen delivery, infection, biofilm, radiation,

36
Q

What is a hypertrophic scar?

A

Elevated scar within borders of original scar. Composed of type III collagen orientated parallel to epidermal surface with abundant myofibroblasts. develop 1-2 months post injury.

36
Q

What is a keloid scar?

A

Elevated scar outside borders of original scar. Disorganised type I and III collagen bundles. Form weeks-years post injury.

37
Q

When is peak tensile strength of a wound?

A

41-60 days post injury (80% of original strength)

38
Q

How can methylene blue be used to aid surgical debridement of chronic wounds?

A

Applied on induction, wound wiped clean. Stains eschar, granulation and necrotic tissue thus identifying tissue to be debrided

39
Q

Outline the strength and resorption times of absorbable sutures (VR, monocryl, PDS)

A
40
Q

What are antimicrobial sutures coated in?

A

Triclosan
Blocks bacterial fatty acid synthesis

41
Q
A

FRCS (1 decks)

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