Integumentary System and Wound Healing Flashcards by Josef Mikael Oclarit

Phases of wound healing

Hemostasis
Inflammatory
Proliferative
Maturation/Remodelling

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Timeline of the inflammatory phase

Onset of injury to 10 days

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Timeline of the proliferative phase

Day 3 - Day 10

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Timeline of the maturation phase

Day 9 - 2 years

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What are released during the Hemostasis phase of wound healing?

Serotonin
Histamine
Prostaglandin

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What happens during Hemostasis?

Clot formation

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Type of leukocytes that acts on a wound

Neutrophil
Macrophages
Platelet-derived GF

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Stages of inflammatory phase

Vascular
Exudate
Reparative

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The phase where true wound healing begins

Inflammatory phase

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In this stage of the inflammatory phase there is blood rushing or hyperremia

Vascular stage

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In this stage of the inflammatory phase there is a presence of blisters, pus, clots, and bleeding

Exudative stage

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In this stage of the inflammatory phase damage cells are replaced

Reparative stage

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What happens during the Proliferative phase?

(+) Angiogenesis
(+) Re-epithelialization and contraction
Extensive growth of epithelial cells beneath the scab

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What do fibroblasts secrete during the proliferative phase?

Type I collagen

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A phase where collagen is organized into a more definite pattern

Remodelling/Maturation phase

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Characteristics of an immature scar

Red/pink, raised, rigid
Hypertrophic or Keloid are examples
Requires 20-30 mmHg of pressure for 23 hours for 2 years to flatten

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Characteristics of a mature scar

White, flat, and flexible

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Surgical closure brings the wound edges
in close proximity

Primary intention wound closure

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Tissue loss status in primary intention wound closure

No tissue loss, minimal scarring

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Types of Primary Intention Wound Closure

Direct side-to-side
Flaps
Grafts

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Differentiate flaps from grafts

Flaps: has intact blood supply
Grafts: has no blood supply

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Occurs when the wound is left open to heal
by regenerating tissue that has been
destroyed

Secondary intention wound closure

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Tissue loss status in secondary intention wound closure

Some tissue loss

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Examples of conditions where secondary intention wound closure is utilized

Burns
Pressure ulcers
Traumatic injuries

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Initially allowed to heal by secondary intention Primary intention as final treatment

Tertiary intention wound closure

Factors for wound healing

Moisture Oxygenation Nutrition

Abn passage between an organ or vessel

Fistula

Channel that passes through a wound

Sinus tract/Tunneling

Tissue destruction around the wound edges. Separation of skin from the base of the wound

Undermining

Antiseptic used for S. Aureus infections

Povidone-Iodine

Antiseptic used for wounds with purulent exudate

Dakin's solution/Na Hypochloride

Antiseptic used for P. Aeruginosa infections

Acetic acid

Least effective antiseptic

Hydrogen peroxide

Removal of necrotic or infected tissue that interferes with wound healing

Wound debridement

When is hydrotherapy used?

wounds with large amount of exudate

Effects of wound debridement

Decreases bacterial concentration Improves wound healing Decrease spread of infection

It is a conservative approach of debridement that targets only dead tissues

Selective debridement

An approach of debridement that removes both healthy and unhealthy tissue from the wound bed. It is used in more severe cases.

Non-selective debridement

The most selective type of debridement that uses the body's own enzymes to moisture, re-hydrate, soften, and liquify eschar and slough

Autolytic debridement

Examples of autolytic debridement

hydrogels hydrocolloids foams

Contraindications of Autolytic debridement

Immunosuppressed pts

A debridement that uses scalpel, scissors, and tweezers

Sharp debridement

Contraindication of Sharp debridement

pts taking anti-coagulants

A type of debridement that utilizes fibrotic and proteolytic enzymes

Enzymatic debridement

A type of enzymatic debridement that breaks down fibrin protein, used in glassy edematous wounds, and used in pts with venous insufficiency.

Elase

A type of enzymatic debridement that is used for Eschars

Travase

Wound dressing used for dry wounds

Wet-to-wet Hydrogel products

Wound dressing for minimally exudative wounds

wet-to-dry hydrocolloid wafer dressing

Wound dressing for moderate to heavy exudative wounds

Calcium alginate Dry-to-dry Collagen dressing

Helps maintain a constant body temperature, protects body, and provides sensory information about the surrounding environment

Integumentary system

Functions of the integumentary system

Regulates body temperature Stores blood Protects body from external environment Synthesizes vitamin D Excretes and absorbs substances

Another name for the skin

Cutaneous membrane

How big is the skin?

2 square meters 4.5-5 kg about 7% of the total BW

4 principal types of cells found in the epidermis

Keratinocytes Melanocytes Intraepidermal macrophages Tactile epithelial cells

Layers of the epidermi

Corneum Lucidum Granulosum Spinosum Basale

Type of cell that produces keratin and lamellar granules which release a water-repellant sealant that decreases water entry and loss and inhibits the entry of foreign materials

Keratinocytes

A tough, fibrous protein that helps protect the skin and underlying tissues from abrasions, heat, microbes, and chemicals

Keratin

Cells that produce melanin

Melanocytes

What does Melanin do?

Contributes to the skin color absorbs damaging UV light

Aka Langerhans cells

Intraepidermal macrophages

Functions of Intraepidermal Macrophages

Helps other cells recognize an invading microbe and destroy it

Another name for Tactile Epithelial Cells

Merkel cells

Functions of Tactile Epithelial cells

detects touch sensations

Characteristics of Tactile Epithelial Cells

least numerous of the epidermal cells

where are Merkel cells located?

deeper layer of the epidermis

Layer of the epidermis that is composed of 25-30 layers of dead keratinocytes; it is the most superficial layer.

Stratum Corneum

Layer of the epidermis that is only present in thick skin such as fingertips, palms, and soles. It consists of 4-6 layers of flattened dead keratinocytes

Stratum Lucidium

Layer of epidermis responsible for water retention and heat regulation. It consists of 3-5 layers of keratinocytes undergoing apoptosis

Stratum Granulosum

The thickest epidermal layer consisting of 8-10 layers of keratinocytes

Stratum Spinosum

Layer of the epidermis that contain melanocytes and enables it to regenerate.

Stratum Basale

Another name for stratum basale

Stratum Geminativum

More superficial layer of the dermis

Papillary (1/5)

Deeper layer of the dermis

Reticular (4/5)

Where are sebaceous glands located in?

Thin skin

Where are Sudoriferous glands more abundant in?

Thick skin

Where can hair follicles and arrector pili muscles be located?

Thin skin

Part of the skin that guards openings against particles and insects

Hair

Part of the skin located deep in the dermis producing non-living hairs and wrapped in a dense connective tissue sheath.

Hair follicle

Involuntary smooth muscle that causes the hair to stand up or produces "goose bumps".

Arrector pili

Accessory structure that lubricates the hair and controls bacteria

Sebaceous glands

Where are free nerve endings located?

Epidermis and dermis

What are the sensations detected by free nerve endings?

Pain Touch Pressure Tickle Itch

Where are Merkel's disk located?

Stratum spinosum

What are the sensations detected by Merkel's disk?

Light touch Touch localization Texture

Where is Meissner's corpuscle located?

Papillary dermis

Sensations detected by Meissner's corpuscle

Touch localization Texture 2-pt discrimination

Where are Ruffini's endings and Krause end bulb located?

Deeper epidermis

What sensation can Ruffini's endings detect?

Warmth

What sensation can Krause end bulb detect?

Cold

Where is Pacinian corpuscle located?

Reticular dermis

What sensations can Pacinian corpuscle detect?

Pressure and Vibration

Tightly packed, hard, dead, keratinized epidermal cells

Nails

Visible portion of the nail

Nail body

Average growth in the length of fingernails

1mm/wk

May extend past the distal end of the digit that has a white appearance

Free edge

Buried in a fold of skin

Nail root

Whitish crescent-shaped area of the proximal end of the nail body

Lunula

Secures the nail to the fingertip

Hyponychium

Skin below the nail plate; extends from the lunula to the hyponychium

Nail bed

Narrow band of epidermis; extends from and adheres to the margin of the nail wall

Eponychium

Located proximal to the nail root

Nail matrix