Pain and healing

Question 1

What types of tissue need healing

Answer 1

All types of tissue

Question 2

What affects how these tissues will heal

Answer 2

Type of tissue
Blood flow
Function of the tissue
Location
Comorbidities

Question 3

What are the 4 stages of healing

Answer 3

Bleeding
Inflammation
Proliferation
Remodelling

Question 4

What is meant by more vascular tissue

Answer 4

Muscle

Question 5

What is meant by less vascular tissue

Answer 5

Ligaments

Question 6

What occurs in the bleeding phase

Answer 6

More vascular tissues will bleed for longer and greater escape of blood
Less vascular tissues will bleed less
Average 4-6hrs
Platelet clot occurs
Thrombin initiates formation of a fibrin mesh to strengthen the clot

Question 7

What is the inflammation phase

Answer 7

Rapid onset from injury
Consists of both vascular and cellular responses
Approx. 3-5 days

Question 8

What are the 2 stages of inflammation

Answer 8

Early
Late

Question 9

What occurs in the early stage of inflammation

Answer 9

Blood flow resumes, bringing nutrients and proinflammatory cells
Neutrophils infiltrate to destroy and remove bacteria
Neutrophils are pushed out from the surface of the wound

Question 10

What occurs in the late stage of inflammation

Answer 10

Macrophages appear to remove debris
Macrophages secrete growth factors
Fibroblasts and endothelial cells begin to form new tissue
Lymphocytes appear to regulate collagen deposition

Question 11

What are the signs of inflammation

Answer 11

Heat
Redness
Swelling
Pain
Loss of function

Question 12

What occurs in the proliferation stage

Answer 12

24-48hrs after injury
Continues for weeks to months
Macrophages stimulate production of collagen through fibroblasts
Angiogenesis occurs in avascular tissues
Further collagen is laid down and deposited in an unorganised way
Repair starts to contract

Question 13

What occurs in the remodelling stage

Answer 13

2 wks - 18mths
Collagen is laid down increasing the strength of the scar
Tissue loading leads to fibre realignment usually through functional means
Input may be required for excessive scarring

Question 14

What are some factors which delay healing

Answer 14

Age
Adhesions to tissues
Prolonged inflammation
Infection

Question 15

What are the stages of bone healing and timings

Answer 15

Hematoma (week 1)
Soft Callus (week 2-3)
Hard callus (1-4mths)
Bone remodelling (4-12mths)

Question 16

What is primary bone healing

Answer 16

Achieved through rigid fixation and no callus is formed (intramembranous ossification)