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VETM 411 > Lectures 1&2: Wound Healing & Wound Management > Flashcards

Lectures 1&2: Wound Healing & Wound Management Flashcards

1
Q

list 3 functions of the skin

A

protection, sensation, homeostasis/regulation

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2
Q

What are the 3 phases of wound healing?

A

inflammation, proliferation, maturation

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3
Q

what happens during the first phase of healing, inflammation?

A

prevents exsanguination (bleeding out), establishes an immune barrier, debridement and removal of contaminants, attract cells to modulate next phase

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4
Q

What are the 3 phases of inflammation?

A

hemostasis, early inflammation, late inflammation

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5
Q

name 4 things that happen in the hemostasis phase of inflammation

A

vasoconstriction of arteries and capillaries

platelet aggravation and initiation of the coagulation cascade

insoluble fibrin clot becomes a scaffold for cell migration

platelet degranulation, cytokines attracting other cells

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6
Q

in early inflammation, what happens to blood vessels and what is the main cell type doing the work?

A

the vessels vasodilate, bringing the signs of inflammation, and the primary cell to come is neutrophils

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7
Q

name 4 things neutrophils can do

A

kill bacteria via reactive oxygen species

breakdown the ECM

phagocytosis

release cytokines

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8
Q

what is the primary cell type in late inflammation? what is their main function?

A

macrophages

degrade the ECM to facilitate cellular movement into the next phase (mediate angiogenesis and fibroplasia)

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9
Q

how does the inflammatory phase:

* prevent exsanguination

* establish an immune barrier

* debride and remove wound contaminants

* attract cells that will modulate the next phase

A

* hemostasis and clot formation

* neutrophils and macrophages, phagocytosis, ROS, etc

* same as above, mostly macrophages in late stages

* cytokines from every host cell but macrophages mostly signal for next phase

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10
Q

what are the 4 processes that are happening in the proliferation phase of wound healing?

A

angiogenesis

fibroplasia

contraction

epithelialization

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11
Q

what days does proliferation occur?

A

4-12

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12
Q

what is angiogenesis?

A

new capillaries form starting at the edge of the wound and going inwards

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13
Q

angiogenesis depends on and is modulated by ______, _____, and _____

A

platelets, macrophages, keratinocytes

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14
Q

angiogenesis is also dependent on the ______

A

arterial partial pressure of oxygen

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15
Q

what is the ultimate end goal of angiogenesis?

A

to provide the wound with oxygen and nutrients and develop a GRANULATION TISSUE BED

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16
Q

describe the process of fibroplasia

A

mesenchymal cells are activated and transform into fibroblasts which migrate and proliferate into the wound. These fibroblasts rebuild the ECM and lay down building blocks such as collagen.

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17
Q

what is proud flesh?

why is it a problem?

what is it often a result of?

How do you treat it?

A

excessive granulation tissue, it becomes thick and irregular

it interferes with epithelialization

it is often a result of chronic inflammation

treat by excising the tissue and giving antiinflammatories

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18
Q

during wound contraction, fibroblasts become ______

A

myofibroblasts

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19
Q

what do myofibroblasts do?

A

they anchor to each other as well as to the ECM and help the wound contract. they have contractile properties but are NOT muscle cells

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20
Q

what stimulates the myofibroblasts to contract?

A

tension

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21
Q

what is wound contracture?

A

a decrease in motion or function due to excessive scar tissue, muscle atrophy, or fibrosis. Essentially there is too much contraction, forming too much collagen and not enough elasticity for the excessive tension that is occurring

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22
Q

describe epithelialization

A

begins at the wound edge, the keratinocytes detach from the edge and tumble out into the wound. once the cells touch each other, they stop. there is no dermis formed so there are no adnexal structures made.

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23
Q

what is the purpose of maturation?

A

to reorganize and remodel the scar, reorganization of collagen and regression of the myofibroblasts (we don’t need them anymore), and focus on rebuilding as much strength as possible. the scar will never be as strong as the original tissue though

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24
Q

list the 4 types of wound closure

A

1st (primary) intention healing (close right away, wound edges apposed)

delayed primary closure (close it after 3-5 days before granulation tissue is present)

secondary closure (close after 5-10 days after granulation tissue has formed)

second intention (leaving it open to heal naturally with no intervention)

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25
Q

what are the 3 factors that impact wound healing?

A

wound factors

patient factors

environmental factors

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26
Q

what are some examples of wound factors? list at least 3

A

the amount of wound perfusion (is it getting enough oxygen)

tissue viability (is any of the tissue dead?)

fluid accumulation (too much can occlude vessels)

infection (overwhelm the neutrophils and other cells)

mechanical forces

envenomation

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27
Q

what are some examples of patient factors? list at least 3

A

immunosuppression, neoplasia, age, malnutrition, dehydration (the ECM needs fluid for cells to do their job), obesity, species differences

28
Q

what are some examples of environmental factors? list at least 3

A

drugs, radiation therapy, prolonged anesthesia, hyperbaric oxygen, laser therapy, wound dressings

29
Q

what phase of wound healing is the vet likely to have the biggest impact? Why?

A

Inflammation because we can physically change the wound (apply pressure, clean/debride it, etc)

30
Q

why are macrophages more essential than neutrophils for wound healing?

A

because macrophages drive the transition to the proliferation phase

31
Q

what is the VERY FIRST THING you should do when dealing with a wound?

A

PUT ON GLOVES

32
Q

define the following:

abrasion

avulsion

incision

laceration

A

abrasion: skin rubbed or scraped

Avulsion–>

complete: complete displacement/tearing of tissue segment
partial: partial detachment of a tissue segment (like a skin flap)
degloving: traumatic partial avulsion in a circumferential fashion
incision: cut of orderly depth with sharp instrument
laceration: irregular cut of non orderly depth, jagged edges

33
Q

define the following:

puncture wound

penetrating wound

perforating wound

contusion

A

puncture: hole or wound created by a sharp pointed object
penetrating: puncture in which the object enters but does not emerge beyond it
perforating: puncture in which the object enters and exits
contusion: skin not broken but capillaries are ruptured causing pain and swelling as well as discoloration

34
Q

name the 4 wound classifications

A

clean

clean contaminated

contaminated

dirty and infected

35
Q

what classifies as a “clean” wound?

A

not traumatic, not infected, made in aseptic conditions, think surgery

also none of the “tracts” leading to the outside world were entered such as the Gi tract, oropharyngeal, respiratory, urogenital

36
Q

what classifies as a “clean contaminated” wound?

A

the “tracts” are entered in controlled conditions, no unusual contamination (remember contamination just means bacteria are present, it doesn’t mean infection!)

37
Q

define the following:

contamination

colonization

infection

A

contamination: bacteria are present but not replication
colonization: bacteria are present and replicating but are not harmful or pathologic
infection: bacteria are present, replicating, and harmful

38
Q

what classifies a contaminated wound?

A

open and fresh traumatic wounds, maybe a major break in sterile technique, incisions in the colon, spillage of the GI tract like in a FB surgery, wounds less than 6 hours old

39
Q

what classifies a dirty and infected wound?

A

old traumatic wounds, clinical infections with pus, perforated viscera, 10^5 organisms per gram of tissue have contaminated the wound

40
Q

what is the golden period?

A

less than 6 hours from wounding, intervention within this grace period can reduce the risk of infection. it is an outdated idea.

41
Q

what are the basic wound management steps? there are 6

A
  1. prevent futher contamination
  2. debride dead/dying tissue
  3. remove debris and contaminants
  4. provide wound drainage
  5. establish a viable vascular bed
  6. select method of closure

P-prevent
D-debride
R-remove
D-drainage
V-vascular bed
C-closure

please dont run, dogs very cute

42
Q

what are some ways to prevent further contamination of your wound?

A

wear PPE, temporary protective bandages (non adherent), fill wound with sterile lube, clip the fur, evaluate the wound, scrub the wound, rinse the wound

43
Q

what is the difference between nonselective and selective debridement techniques? Give examples of each

A

nonselective: using surgical technique or surgical tools
example: cutting something, mechanical like wet to dry bandage and then tearing it off
selective: facilitate debridement to happen on its own
example: enzymatic, autolytic, biotherapeutic like maggots

44
Q

list the advantages and disadvantages of nonselective vs selective debridement

A

nonselective: fast, good for large necrotic areas, BUT can traumatize healthy viable tissue
selective: necrotic tissue os targeted with minimal damage to viable tissue BUT it is slow and not suited for areas or large necrosis

45
Q

in general, ______ provides optimal drainage for contaminated or infected wounds

A

open wound mnagement

46
Q

can a drain be used INSTEAD of cleaning the wound of debris?

A

NO duh

47
Q

give examples of wounds you can close by primary intention

A

wounds with little to no contamination like an incision

contaminated wounds converted to clean with debridement and lavage

skin defects after excision of smaller areas of infection (just cut the wound out!)

when the skin can close WITHOUT tension

48
Q

give examples of wounds you would close with delayed primary closure

A

wounds with borderline contamination despite debirdement and lavage

wounds with moderate tissue trauma where there is a risk of infection after debridement and lavage

wounds with questionable tissue viability

wounds that require additional debridement

wounds where there is too much tissue swelling (causing tension) preventing primary closure

49
Q

give exmaples of wounds you would close via secondary closure

A

when delayed primary closure isn’t possible usually because of infection

when there is persistent necrotic tissue that requires additional debridement for more than 5 days

when a severe inflammatory response persists

50
Q

give examples of wounds you would let heal via secondary intention

A

skin defects that you can’t reasonably close at all

dirty and infected wounds where other methods are just not advisable

moderate to large trunk wounds on very young animals

surgical wounds you want to heal via secondary itnention

51
Q

a dog is brought to you after a dog fight and has a bite wound. list the steps you would take (in simple terms) to address the wound

A

assess the wound, look for signs of infection

remove gross contamination, debride, and lavage

consider closure

aftercare

52
Q

How would you close a wound with little to no contamination and minimal tissue trauma?

A

primary intention

53
Q

how would you close a wound where there is adjacent skin available to close without tension?

A

primary intention

54
Q

how would you close a skin defect after complete excision of smaller localized areas of contamination and infection?

A

primary intention

55
Q

how would you close a contaminated wound converted into a clean wound with lots of debridement and copious lavage

A

primary intention

56
Q

ow would you close a wound with significant tissue swelling?

A

delayed primary closure

57
Q

ow would you close a wound with borderline contamination despite exploration and debridement/lavage of the wound?

A

delayed primary closure

58
Q

would you close a wound with questionable tissue viability?

A

delayed primary closure

59
Q

w would you close a wound with moderate tissue trauma or one that is at risk of infection after debridement/exploration/lavage?

A

delayed primary closure

60
Q

how would you close a wound that requires serial debridement?

A

delayed primary closure

61
Q

how would you close a wound where delayed primary closure is not possible due to the presence of an infection?

A

secondary closure

62
Q

how would you close a wound that had a persistence of moderate to severe inflammatory response ?

A

secondary closure

63
Q

how would you close a wound where there was a persistence of necrotic tissue requiring additional debridement and care beyond 5 days?

A

secondary closure

64
Q

if you had a moderate to large trunk wound on a very young animal how would you close it?

A

leave it for secondary intention

65
Q

how would you close a skin defect that couldn’t easily be closed?

A

i wouldn’t, i would leave it for secondary intention healing

VETM 411 (5 decks)

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