Healing Flashcards
resolution
minimal tissue damage –> complete restoration of tissue structure and function after injury
regeneration
damaged tissue replaced with cells that are functional (labile and stable)
replacement
extensive damage; tissue can no longer heal
functional tissue replaced by scar tissue (fibrous CT)
primary intention healing
little tissue lost, minimal scarring, minor wounds
surgical incision (sutures holding edges together)
secondary intention healing
significant tissue loss, severe wounds, tissues produced from bottom and sides
general phases of wound healing
- hemostasis clotting
- inflammation
- epithelial growth
- remodelling/scarring
inflammation
day 0-4
clotting; inflammation; GT formed
formation of granulation tissue
collagen-rich tissue
needed for the next stage of epithelialization (endothelial cell proliferation and migration –> use GT as a framework)
perfect healing environment during inflammatory phase
clean and protected
clean: no strong barrier of skin; do not want bacteria getting across
protected: limit movements; do not want them to reopen
epithelial growth
day 2/3 –> day 14
*seal wound and replace with original tissue or scar tissue (fibrous CT)
key elements of epithelial growth
- dissolve clot
- continue angiogenesis
- increase epithelial growth
- start type 3 collagen deposition
key cells involved in stage II
fibroblasts (ECM, collagen, wound closure)
VEGF (angiogenesis)
free macrophages (phagocytic cells, clean up cellular debris, attract fibroblasts)
how to manage stage II
return gradually to ADLs as tolerated
goals:
increase ROM as tolerated
do proprioception activities to stimulate neurons
gradually increase strength
**movement needed for blood flow to tissue
remodelling and scarring phase
2/3 weeks –> 1+ year
purpose = increase tensile strength of wound
key elements of remodelling
increase in type I collagen; degradation of type 3 collagen
–> collagen reoriented along lines of tension with creation of more stable bonds between fibers
how to manage phase III
goals:
-begin power, speed, agility training as appropriate
- do sport or job specific movements
- continue to increase strength
WOLFs law
tissue responds to physical demands along lines of tensile strength
injured tissue needs to be put under reasonable loads –> collagen deposits along lines of strength
key factors that affect wound healing
- nutritional status: protein; vitamin A and C
- blood flow and o2 delivery
- impaired inflammatory and immune responses;
GCs= interfere with WBC immune response, prone to infection
- infection, wound separation, foreign bodies:
too much movement = wound separation
edema = bacteria thrive in warm fluid filled environment
unclean environment = foreign bodies
