Lecture 15 3/31/25 STAR SLIDES Flashcards
What are the wound healing stages?
-inflammatory and debridement phase
-repair/proliferative phase
-maturation phase
What are the characteristics of the inflammatory/debridement phase?
-0 to 5 days after wounding with clean incisions
-can be exudative or dry
-glucocorticoids and chemotherapy impair this phase and delay the rest of wound healing
-leukocytes migrate into the wound within 6 hours
What are the steps of the inflammatory/debridement phase?
-hemorrhage
-vasoconstriction
-vasodilation
-blood clot formation
-growth factor release
-capillary growth into fibrin of clot
-fibroblast migration
What is the role of neutrophils in the inflammatory/debridement phase?
arrive early to remove and degrade organisms, debris, and necrotic tissue
What is the role of monocytes in the inflammatory/debridement phase?
arrive later in the phase to release a majority of the factors needed for healing
What are the characteristics of the repair/proliferative phase?
-starts around day 3-5 and can last for 2-4 weeks for clean incisions
-proliferation of endothelial cells, fibroblasts, and epithelial cells
-inhibited by infection, poor blood supply, hypoxia, and malnutrition
-want moisturizing, antimicrobial, protective bandages in this phase
What are the characteristics of the maturation phase?
-begins around day 17-20
-includes crosslinking and reorientation of collagen fibers
-new epithelium can dry out
-bandages should be moisturizing and protective
-scar is only 70-80% of normal tissue strength
What are the characteristics of the patient evaluation?
-first step to assessing a wound
-ensure systemic stabilization, esp. cardiovascular and resp. stabilization
-check for polytrauma
-investigate for diseases/conditions that could cause delayed wound healing
What are the characteristics of wound cleaning?
-scrub solutions (>/= 2%) should be used on intact skin only
-scrub solutions inhibit epithelialization, kill keratinocytes, and inhibit fibroblasts
-antiseptic DO NOT work on organic debris
-dilute chlorhexidine and povidone iodine are broad spectrum and safe for wounds and healing
-tap water is worse for wound healing than saline, but infection rates are about equal
What are the characteristics of chlorhexidine?
-used for gram+ bacteria, gram- bacteria, and yeast
-not effective against mycobacteria and spores
-TOXIC to eyes, ears, and meninges
What are the characteristics of povidone iodine?
-used for gram+ bacteria, gram- bacteria, fungi, yeast, and mycobacteria
-not effective against spores
-can be used around eyes, ears, and meninges
What is the recommended scrub time for wound cleaning?
5 to 7 minutes
How can a 0.05% chlorhexidine solution be made for use in wound beds?
add 25 mL of 2% chlorhex. to 1 L of sterile saline
What is important regarding wound lavage?
-want 8 to 12 psi to reduce infection without damaging tissue
-methods include:
*35 mL syringe with 16-22 g needle
*fluid bag under pressure with attached fluid line and 3-way stopcock
*bottle of sterile saline with holes in lid
What are the characteristics of topical antiseptics?
-can use dilute iodine or chlorhex.
-never use high conc. for wounds!
What are the characteristics of topical antibiotics?
-gentamicin is commonly used
-triple antibiotic ointment common, but may have resistance
-mupirocin ointment is used for Staph. and Strep.
-solutions can be made with antibiotics
What are the topical antimicrobial options?
-antiseptics
-antibiotics
-honey/sugar
-polyhexamethylene biguanide
-silver
-hypochlorous acid
What are the characteristics of polyhexamethylene biguanide?
-impregnated in dressings
-spectrum is similar to chlorhex.
-currently no bacterial resistance
-low toxicity
What are the characteristics of silver?
-elemental in dressings and silver sulfadiazine
-many resistant organisms
-may leave a brown colored exudate on wound surface; can be lavaged away
What are the characteristics of hypochlorous acid?
-comes in a spray or gel
-causes bacterial death through multiple mechanisms
-minimal to no toxicity
What are the characteristics of honey?
-used in the inflammatory and early repair phases
-maintains moisture and stimulates exudate
-causes osmotic desiccation of bacteria
-hyperosmolarity reduces edema and improves blood flow
-supports wound healing
-anti-inflammatory and immunostimulatory
-requires frequent bandage changes
What are the characteristics of sugar?
-similar osmotic effects on bacteria and wound edema as honey
-maintains moisture
-highly effusive
What are the characteristics of passive wound drains?
-work via gravity
-proximal drain should be buried into wound and secured with suture
-exit the drain at most dependent portion of wound pocket
-fluid flows around drain rather than through it
-bandage needed to absorb fluid drainage
What are the indications for passive drains?
-superficial (skin or SQ) wounds
-multiple wounds left open (like bite wounds)
