healing + repair - exam 1 Flashcards
healing
process of restoration to normal structure + function
repair
remedy, replace or heal as in a would or a fracture
what are the 2 ways that healing + repair process progresses
total reconstruction + partial reconstruction
what structure is the universal repair tissue
fibrous connective tissue scar
labile cells
continuously multiply through life
examples of labile cells
surface epithelial cells, lymphoid cells, hemopoietic cells, + all other cells
stable cells
low level of replication
examples of stable cells
kidney, liver, + smooth muscle
permanent cells
cannot be replicated, do not undergo mitotic division
examples of permanent cells
nerves, cardiac, + skeletal muscle
what is the most abundant regenerative cells
labile
which type of cell has the poorest regenerative capability?
permanent
what are the 4 phases of repair by connective tissue
angiogenesis, fibroblast activity, deposition, + remodeling
angiogenesis
endothelial cells from damaged blood vessels migrate + proliferate
fibroblast activity
fibroblasts migrate to damaged area + proliferate
deposition
extracellular matrix deposited in damaged area
remodeling
change to connective tissue by shrinking of damaged area
what is granulation tissue made of
small capillaries, fibroblasts, extracellular fluid, + macrophages
granulation tissue
hallmark tissue of early healing by fibrosis
what is the function of granulation tissue
fills in tissue gaps, remove dead cell debris, aids in wound contraction, forms early “pre-scar”
what are the tissue healing phases
hemostasis, inflammation, granulation/proliferation, + remodeling/maturation
hemostasis
day 1 to 3. stop bleeding
inflammation
day 3 to 30. new frame work for blood vessel growth
proliferation/granulation
week 1 to 6. pulls the wound closed
remodeling/maturation
week 6 to 2 years. final proper tissue
primary intention healing
small, usually sutured, small granulation tissue, rapid healing, small scar, rare complications
secondary intention healing
large in size, no sutures, large granulation tissue, slow healing, large scar size, keloids
diabetes mellitus is a local factor to wound healing. true or false
what vitamin deficiency is necessary in would healing due to its ability to help in collagen synthesis?
vitamin c
what are the factors affecting wound healing
proud flesh, keloid formation, wound dehiscence, contracture
proud flesh
excessive granulation tissue protruding above surrounding skin
keloid formation
hypertrophic scar w/excessive collagen deposition
what population are keloids more common in?
african americans
wound dehiscence
inadequate formation of granulation tissue resulting in rupture
contracture
exaggeration of contraction resulting in deformity or wound contraction
where is contracture most often seen?
third degree burn wounds
where is the vascular supply greater? and does that area heal quick or slow?
the scalp; heal faster
What type of complication of wound healing occurs when a wound has “burst
open” due to a forceful sneeze?
wound dehiscence; mechanical stress bursting open a wound
What type of complication of wound healing occurs with a severe burn injury?
contracture
open/compound fracture
bone breaks and bony fragments have pierced the skin
closed/simple fracture
bone breaks but skin is intact
complete fracture
bone breaks all the way through
incomplete fracture
bone is fractured but not fully separated
transverse fracture
break is horizontal
oblique fracture
fracture line passes through long axis of the bone at an angle
spiral fracture
rotational force is applied through the long axis of the bone
comminuted fracture
bone breaks into 2+ pieces
impacted fracture
ends are driven into each other
avulsion fracture
bony fragments pulled off by tendon/ligament
pathological fracture
caused by disease
traumatic fracture
caused by injury or external force
stress fracture
caused by repetitive strain
what are the 4 phases of bone fracture healing
reactive, reparative 1, reparative 2, + remodeling
reactive phase
hematoma is formed + replaced by granulation tissue
reparative phase 1
deposition of cartilaginous tissue by migrating chondroblasts
reparative phase 2
cartilaginous callus is infiltrated by osteoblasts + bony callus is formed
remodeling phase
removal of excess bony tissue in the bony callus by phagocytic multinucleated giant osteoclasts
In which stage of fracture healing is a cartilaginous callus formed?
reparative phase 2
Which specific cells are involved in the remodeling phase of bone fracture
healing?
phagocytic multinucleated giant osteoclasts
local factors that affect bone healing
type of fracture, presence of foreign bodies, type of bone, blood supply, immobilization, location, separation of the ends, infection, presence of underlying pathology
systemic factors that affect bone healing
excess hormones, malnutrition, age, diseases
A highly vascularised bone has a better chance of healing than a
poorly vascularlised bone. true or false
True
An 81-year-old diabetic who has a fracture at the femoral head of
the hip has a good chance of fracture healing within a reasonable time. true or false
False
malunion
bone fragments healed but were not aligned properly
how does a malunion of a fracture occur?
results in angulation of the bone
delayed healing
a fracture that does not heal in the expected time for the type of fracture + type of patient
what are reasons for delayed healing of a fracture
infection, inadequate blood supply, poor nutrition, movement, old age
nonunion
fracture is not healed + is unlikely to heal w/o intervention
what is the normal healing time for most fractures
9 months
which type of fracture complication may result in cystic degeneration
nonunion
pseudo-arthrosis
no hyaline cartilage covering the articular surface
