Lecture 11: Wound Healing Flashcards
What are the 6 methods used to maximize wound healing?
- Control infection
- Maximize nutrition (incr protein)
- Oxygenation
- Debride dead tissue
- Clean the wound
- Choose the proper dressing
What is the best measure of long term control of nutrition?
Pre-albumin
Why do wound need to heal in a moist environment and why should you keep patients warm while wounds heal?
moist –> allows for epithelization
warm –> less vasoconstriction
List the 5 steps of wound healing
- Hemostasis
- Inflammation
- Epithelialization
- Fibroplasia
- Maturation
What is ultimately formed during hemostasis?
Fibrin matrix
- blood vessels constrict –> plt aggregation
What occurs during Epithelialization?
Basal cell proliferation, angiogenesis, collagen deposition –> FORM NEW CELLS from the base of the dermis
What occurs during Fibroplasia?
fibroblast proliferate –> angiogenesis, collagen produced –> Granulation tissue/scar formation
What 3 things occurs during Maturation?
- collagen cross linking
- wound contraction
- repigmentation
What is a marker that re-epithilization has occurred?
Pigmentation buds
What are the three types of wound healing?
- Primary
- Delayed Primary
- Secondary
A kid fell off his bike and cut his arm, the PA uses stitches to close the laceration that day, what type of wound healing is this?
Primary
close wound immediately
A child who got bitten by a dog presents to you in the office, how should you tx the wound?
What type of wound healing is this?
Irrigate it, pack it, and close it later
- give ABX
Secondary (contaminated wounds get closed later)
What type of wound healing is assisted with the use of a Wound Vac?
What must happen before you can place a skin graft on this type of wound?
Secondary
Angiogenesis must occur before skin graft –> grafts wont attach to tendon, tissue or bone
How do secondary wounds heal?
Slowly on their own or w/help of surgical adjunct
Difference b/t keloid and hypertrophic scar
Keloid - extends beyond wound borders
Hypertrophic scar - stays w/in wound borders
When is it appropriate to use wet to dry dressings?
Note: place it on wet and rip off when dry to remove dead tissue
Wounds w/fibrinous slough or small areas of devitalized tissue
A wound has moderate to heavy drainage, what dressing should be used?
Foam dressing
- contains silver product (antimicrobial) –> rel into wound
What type of wounds should antibiotic ointments (Bactroban, bacitracin) be used on?
What is a S/E to watch for w/bacitracin?
Open wounds
S/E = pruritus
How does a Wound Vac help close a wound?
vacuum pressure system that promotes neo-vascularization/granulation tissue –> shrinks the wound
helps the wound heal from edges inward
When can a wound vac NOT be used?
infected or necrotic wounds
traps infection/necrosis
What are the 2 Tx options for sloughing wounds?
- Enzymatic debriders
(Santyl, Accuzyme, Panafil)
“sloughing wounds SAP” - Surgical debridement
What should you do to tunneled wounds?
dehisced wounds?
tunneled - Pack them
dehisced - sew up each level
Where do decubitus ulcers typically occur?
Over bony prominences (sacrum, calcaneus, ischium)
List 5 stages of decubitus ulcers
I = Non-blanchable erythema II = Partial thickness III = Full thickness SKIN LOSS IV = Full thickness TISSUE LOSS Unstageable
