Lecture 11: Wound Healing

Question 1

What are the 6 methods used to maximize wound healing?

Answer 1

1. Control infection
2. Maximize nutrition (incr protein)
3. Oxygenation
4. Debride dead tissue
5. Clean the wound
6. Choose the proper dressing

Question 2

What is the best measure of long term control of nutrition?

Answer 2

Pre-albumin

Question 3

Why do wound need to heal in a moist environment and why should you keep patients warm while wounds heal?

Answer 3

moist –> allows for epithelization

warm –> less vasoconstriction

Question 4

List the 5 steps of wound healing

Answer 4

1. Hemostasis
2. Inflammation
3. Epithelialization
4. Fibroplasia
5. Maturation

Question 5

What is ultimately formed during hemostasis?

Answer 5

Fibrin matrix

- blood vessels constrict –> plt aggregation

Question 6

What occurs during Epithelialization?

Answer 6

Basal cell proliferation, angiogenesis, collagen deposition –> FORM NEW CELLS from the base of the dermis

Question 7

What occurs during Fibroplasia?

Answer 7

fibroblast proliferate –> angiogenesis, collagen produced –> Granulation tissue/scar formation

Question 8

What 3 things occurs during Maturation?

Answer 8

1. collagen cross linking
2. wound contraction
3. repigmentation

Question 9

What is a marker that re-epithilization has occurred?

Answer 9

Pigmentation buds

Question 10

What are the three types of wound healing?

Answer 10

1. Primary
2. Delayed Primary
3. Secondary

Question 11

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?

Answer 11

Primary

close wound immediately

Question 12

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?

Answer 12

Irrigate it, pack it, and close it later
- give ABX

Secondary (contaminated wounds get closed later)

Question 13

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?

Answer 13

Secondary

Angiogenesis must occur before skin graft –> grafts wont attach to tendon, tissue or bone

Question 14

How do secondary wounds heal?

Answer 14

Slowly on their own or w/help of surgical adjunct

Question 15

Difference b/t keloid and hypertrophic scar

Answer 15

Keloid - extends beyond wound borders

Hypertrophic scar - stays w/in wound borders

Question 16

When is it appropriate to use wet to dry dressings?

Note: place it on wet and rip off when dry to remove dead tissue

Answer 16

Wounds w/fibrinous slough or small areas of devitalized tissue

Question 17

A wound has moderate to heavy drainage, what dressing should be used?

Answer 17

Foam dressing

- contains silver product (antimicrobial) –> rel into wound

Question 18

What type of wounds should antibiotic ointments (Bactroban, bacitracin) be used on?
What is a S/E to watch for w/bacitracin?

Answer 18

Open wounds

S/E = pruritus

Question 19

How does a Wound Vac help close a wound?

Answer 19

vacuum pressure system that promotes neo-vascularization/granulation tissue –> shrinks the wound

helps the wound heal from edges inward

Question 20

When can a wound vac NOT be used?

Answer 20

infected or necrotic wounds

traps infection/necrosis

Question 21

What are the 2 Tx options for sloughing wounds?

Answer 21

1. Enzymatic debriders
   (Santyl, Accuzyme, Panafil)
   “sloughing wounds SAP”
2. Surgical debridement

Question 22

What should you do to tunneled wounds?

dehisced wounds?

Answer 22

tunneled - Pack them

dehisced - sew up each level

Question 23

Where do decubitus ulcers typically occur?

Answer 23

Over bony prominences (sacrum, calcaneus, ischium)

Question 24

List 5 stages of decubitus ulcers

Answer 24

I = Non-blanchable erythema 
II = Partial thickness 
III = Full thickness SKIN LOSS
IV = Full thickness TISSUE LOSS
Unstageable

Question 25

Patient presents w/a painful ulcer that has no blistering and the skin is intact, Stage?

Answer 25

Stage I Non-blanchable erythema

Question 26

Patient presents w/an ulcer on his sacrum that is blistering and gone beneath the dermis but has no slough/eschar, stage?

Answer 26

Stage II Partial thickness

*loss of dermis, blisters

Question 27

Patient presents w/a sloughing ulcer on his sacrum with subQ fat exposed but no bone exposed, stage?

Answer 27

Stage III Full thickness SKIN LOSS

Question 28

Stage of an ulcer that exposes tendon, tissue, or bone and may have tunneling or undermining?

Answer 28

Stage IV Full thickness TISSUE LOSS

Question 29

Define an unstageable ulcer

Answer 29

full tissue thickness loss with UNKNOWN DEPTH (CANT SEE THE BASE)