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MODULE 7 - Skin and Bones > PATHOLOGY - Skin and Wound Healing > Flashcards

PATHOLOGY - Skin and Wound Healing Flashcards

1
Q

What are the two possible outcomes for tissue repair?

A

Tissue regeneration
Scar formation

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2
Q

What are the two main reasons scar formation will occur?

A

Injured tissue is incapable of regeneration
Supporting structures of the tissue are too severely damaged

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3
Q

What are the three components required for tissue repair?

A

Cell proliferation
Cell to cell interactions
Cell to extracellular matrix (ECM) interactions

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4
Q

What drives cell proliferation in tissue repair?

A

Growth factors

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5
Q

What are the four functions of macrophages in tissue repair?

A

Phagocytose pathogens and debris
Secrete growth factors
Secrete cytokines
Secrete matrix metalloproteinases (MMPs)

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6
Q

What are the three types of cell proliferation involved in tissue repair?

A
  1. Remnants of injured tissue proliferation to attempt to restore normal structure
  2. Vascular endothelial cells to form new blood vessels to provide nutrients for tissue repair
  3. Fibroblasts producing fibrous tissue to fill defects that cannot be restored
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7
Q

What are the three functions of the extracellular matrix (ECM)?

A

Mechanical support for cells
Regulates cell proliferation
Scaffolding for tissue renewal

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8
Q

Which cell type synthesises the extracellular matrix (ECM)?

A

Mesenchymal cells

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9
Q

What are the three mian components of the extracellular matrix (ECM)?

A

Fibrous structural proteins (collagen/elastin)
Water-hydrated gels (proteoglycans)
Adhesive glycoproteins

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10
Q

What are the functions of the fibrous structural proteins within the extracellular matrix (ECM)?

A

Tensile strength and recoil

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11
Q

What are the functions of the water-hydrated gels within the extracellular matrix (ECM)?

A

Compressive resistance and lubrication

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12
Q

What are the functions of the adhesive glycoproteins within the extracellular matrix (ECM)?

A

Connect different components of the extracellular matrix (ECM) and cells together

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13
Q

What are the two forms of the extracellular matrix (ECM)?

A

Interstitial matrix
Basement membrane

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14
Q

Where is the interstitial matrix found?

A

The interstitial matrix is found in the spaces between cells and connective tissue

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15
Q

What are the five main components of the interstitial matrix?

A

Fibrillar collagen
Non-fibrillar collagen
Fibronectin
Elastin
Proteoglycans

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16
Q

What are the two main components of the basement membrane?

A

Type IV collagen
Laminin

Laminin is a type of glycoprotein

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17
Q

Where are basement membranes found?

A

Basement membranes are the supporting structure underlying epithelial, endothelial and smooth muscle cells

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18
Q

What are the three phases of tissue repair?

A

Acute inflammation
Proliferation
Remodelling

19
Q

What occurs during the acute inflammatory phase of skin tissue repair?

A

Chemotactic agents trigger the recruitment of neutrophils to the injury site. Neutrophils carry out phagocytosis to remove any pathogens and debris

20
Q

What are the three important physiological processes that occur during the proliferation phase of skin tissue repair?

A

Re-epithelialisation
Angiogenesis
Granulation tissue formation

21
Q

Describe the process of re-epithelialisation that occurs during the proliferation phase of skin tissue repair

A

Wound-edge keratinocytes and basal cells proliferate and migrate while depositing basement membrane

22
Q

Why is angiogenesis an essential component of skin tissue repair?

A

Angiogenesis is the synthesis of new blood vessels which provide the nutrients and oxygen essential for skin tissue repair

23
Q

Describe the process of angiogenesis that occurs during the proliferation phase of skin tissue repair

A

Angiogenesis is initiated by growth factors which stimulate the proliferation and migration of endothelial cells from existing blood vessels to the injury site

24
Q

How can angiogenesis result in oedema?

A

These newly formed blood vessels have increased vascular permeability and this allows fluid to escape from the vessels into the interstitium, resulting in oedema

25
Q

Describe the process of granulation tissue formation that occurs during the proliferation phase of skin tissue repair

A

In response to cytokines and growth factors, fibroblasts migrate to the provisional wound matrix and proliferate. Macrophages produce matrix metalloproteinases (MMPs) which degrade the provisional wound matrix, allowing the fibroblasts to deposit collagen and other extracellular matrix (ECM) components to form granulation tissue which now replaces the provisional wound matrix and fills the wound space

26
Q

What occurs during the remodelling phase of tissue repair?

A

There will be maturation and reorganisation of the connective tissue and extracellular matrix (ECM), along with vascular regression and more collagen being deposited to increase tensile strength

27
Q

Which structures are not recovered following skin tissue repair?

A

Adnexal structures

28
Q

What is the maximum percentage of the original tensile strength that can be recovered following skin tissue repair?

A

80% is the maximum percentage of the original tensile strength that can be recovered following skin tissue repair

29
Q

What is the most common factor that negatively influences tissue repair?

A

Infection

30
Q

What are the eight classifications of skin wounds?

A

Incision
Laceration
Abrasion
Ulceration
Puncture
Penetration
Contusion (bruise)
Haematoma

31
Q

What is the difference between abrasion and ulceration?

A

Abrasion is a superficial injury to the epidermis which only requires epithelial regeneration to heal whereas ulceration is a deeper injury into the level of the dermis which results in fibrous scarring

32
Q

In which type of wounds does healing by first intention occur?

A

Healing by first intention occurs in clean, uninfected surgical incisions that have been approximated by sutures

33
Q

Describe the six steps of healing by first intention

A
  1. Haemostasis and fibrin clot formation occur (which acts as provisional wound matrix)
  2. Within **24 hours **chemotactic agents stimulate neutrophils to migrate to the provisional wound matrix to phagocytose debris and pathogens. Basal cells begin to exhibit mitotic activity
  3. Within 24 - 48 hours, wound-edge keratinocytes and basal cells proliferate and migrate while depositing basement membrane
  4. By day 3, neutrophils are replaced by macrophages and in response to growth factors and cytokines, angiogenesis and granulation tissue formation commences
  5. By day 5, peak of oedematous granulation tissue formation occurs and the epidermis is now at normal thickness and can begin maturation
  6. During week 2, there is decreased oedema, inflammation and vascularity (stitches can be removed at 10 days)
34
Q

In which type of wounds does healing by second intention occur?

A

Healing by second intention occurs in wounds with extensive tissue loss such as lacerations and ulceration

35
Q

Describe the five steps of healing by second intention

A
  1. Haemostasis and larger firbin clot formation occurs (which acts as provisional wound marix)
  2. There is increased inflammation which can result in inflammatory-mediated damage
  3. There will be haphazard granulation and connective tissue deposition which can prevent/delay keratinocyte proliferation and migration
  4. By the end of the first month, the granulation tissue is replaced with avascular fibrous tissue
  5. Wound is contracted by myofibroblasts to reduce wound size by 5 - 10%
36
Q

What is fibrosis?

A

Fibrosis is the excessive deposition of collagen

37
Q

What causes fibrosis?

A

Fibrosis is caused by persistent injurious stimuli

38
Q

What is the major cytokine which drives fibrosis?

A

TGF-β is the major cytokine which drives fibrosis

39
Q

What is ‘proud flesh’?

A

‘Proud flesh’ is excessive granulation tissue which protrudes from the wound

40
Q

Why is ‘proud flesh’ such a common complication in horse skin wound healing?

A

‘Proud flesh’ is very common in horse skin wounds as horses have a continuous low level inflammatory response and prolonged fibroblast proliferation, all of which contribute to excessive granulation tissue formation

41
Q

Why do skin wounds in ponies heal quicker and more efficiently than they do in horses?

A

Horses have slower and less effective epithelialisation, fibroblast growth, and wound contraction compared to ponies. This is due to the weaker initial inflammatory response seen in horses

42
Q

When can stitches be removed in mammals following a surgical procedure?

A

In mammals, stitches can be removed 10 days following a surgical procedure

43
Q

When can stitches be removed in reptiles following a surgical procedure?

A

In reptiles, stitches can be removed 4-6 weeks following a surgical procedure

44
Q

Why should sutures be left in for longer in reptiles compared to mammals?

A

Reptile wound healing is very slow in comparison to mammals

MODULE 7 - Skin and Bones (22 decks)

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