Healing

Question 1

resolution

Answer 1

minimal tissue damage –> complete restoration of tissue structure and function after injury

Question 2

regeneration

Answer 2

damaged tissue replaced with cells that are functional (labile and stable)

Question 3

replacement

Answer 3

extensive damage; tissue can no longer heal

functional tissue replaced by scar tissue (fibrous CT)

Question 4

primary intention healing

Answer 4

little tissue lost, minimal scarring, minor wounds

surgical incision (sutures holding edges together)

Question 5

secondary intention healing

Answer 5

significant tissue loss, severe wounds, tissues produced from bottom and sides

Question 6

general phases of wound healing

Answer 6

1. hemostasis clotting
2. inflammation
3. epithelial growth
4. remodelling/scarring

Question 7

inflammation

Answer 7

day 0-4

clotting; inflammation; GT formed

Question 8

formation of granulation tissue

Answer 8

collagen-rich tissue

needed for the next stage of epithelialization (endothelial cell proliferation and migration –> use GT as a framework)

Question 9

perfect healing environment during inflammatory phase

Answer 9

clean and protected

clean: no strong barrier of skin; do not want bacteria getting across
protected: limit movements; do not want them to reopen

Question 10

epithelial growth

Answer 10

day 2/3 –> day 14

*seal wound and replace with original tissue or scar tissue (fibrous CT)

Question 11

key elements of epithelial growth

Answer 11

1. dissolve clot
2. continue angiogenesis
3. increase epithelial growth
4. start type 3 collagen deposition

Question 12

key cells involved in stage II

Answer 12

fibroblasts (ECM, collagen, wound closure)

VEGF (angiogenesis)

free macrophages (phagocytic cells, clean up cellular debris, attract fibroblasts)

Question 13

how to manage stage II

Answer 13

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

Question 14

remodelling and scarring phase

Answer 14

2/3 weeks –> 1+ year

purpose = increase tensile strength of wound

Question 15

key elements of remodelling

Answer 15

increase in type I collagen; degradation of type 3 collagen

–> collagen reoriented along lines of tension with creation of more stable bonds between fibers

Question 16

how to manage phase III

Answer 16

goals:
-begin power, speed, agility training as appropriate

• do sport or job specific movements
• continue to increase strength

Question 17

WOLFs law

Answer 17

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

Question 18

key factors that affect wound healing

Answer 18

1. nutritional status: protein; vitamin A and C
2. blood flow and o2 delivery
3. impaired inflammatory and immune responses;

GCs= interfere with WBC immune response, prone to infection

4. infection, wound separation, foreign bodies:

too much movement = wound separation

edema = bacteria thrive in warm fluid filled environment

unclean environment = foreign bodies