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
Patient presents w/a painful ulcer that has no blistering and the skin is intact, Stage?
Stage I Non-blanchable erythema
Patient presents w/an ulcer on his sacrum that is blistering and gone beneath the dermis but has no slough/eschar, stage?
Stage II Partial thickness
*loss of dermis, blisters
Patient presents w/a sloughing ulcer on his sacrum with subQ fat exposed but no bone exposed, stage?
Stage III Full thickness SKIN LOSS
Stage of an ulcer that exposes tendon, tissue, or bone and may have tunneling or undermining?
Stage IV Full thickness TISSUE LOSS
Define an unstageable ulcer
full tissue thickness loss with UNKNOWN DEPTH (CANT SEE THE BASE)
