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Surgery and wound healing (MOD) > Principles of wound healing > Flashcards

Principles of wound healing Flashcards

1
Q

What is the aim with wound healing?

A

Restore normal physical form, structure and function

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2
Q

What are some consequences of bad wound technique and management?

A

Delayed healing
Prolonged discomfort
Extra cost

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3
Q

What are the 5 layers of the epidermis?

A 
Stratum basale
Stratum spinous 
Stratum granulosum 
Stratum lucidum 
Stratum corneum
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4
Q

What are the 2 layers of the dermis?

A

Superficial papillary layer

Deep reticular layer

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5
Q

Tension lines of skin are normal. What are they due to?

A

Elastic fibres in the dermis

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6
Q

What is the name of the tension lines in the skin

A

Langer’s lines of tension

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7
Q

What happens if you make an incision along the Langer’s lines of tension?

A

Skin edges retract

Make incision parallel

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8
Q

What are the 3 phases of wound healing?

A

Inflammatory (lag) phase
Proliferative (repair) phase
Remodelling phase

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9
Q

What cells are involved with wound healing?

A 
(Platelets)
Neutrophils, monocytes, macrophages
Endothelial cells
Fibroblasts/myofibroblasts
Keratinocytes
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10
Q

What are the 2 cellular mediators for wound healing?

A

Growth factors

Cytokines/chemokines

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11
Q

What are growth factors and what do they do?

A

Proteins that bind to cell surface receptors

Activate cellular proliferation and differentiation

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12
Q

What are cytokines?

A

Small signalling proteins secreted by cells - cause growth differentiation and activation
Chemokine = type of cytokine with chemotactic function

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13
Q

After injury, tissue strength reaches what % of the original tissue strength?

A

80%
Even after years
(20% at 3 wks, 50% at 3 months)

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14
Q

What are the 3 main processes of the inflammatory phase

A

Haemostasis
Protection against infection
Substrate/cellular signals for next stages

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15
Q

What happens to the blood vessels (in terms of blood flow) after they are injured?

A

Transient vasoconstriction - occludes vessels

Vasodilation minutes after (heat, redness, swelling)

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16
Q

Platelets aggregate at the site of injury in the inflammatory phase. What do platelets release? What is the result of this?

A

Chemoattractants, growth factors, proteases

Attracts other cells whilst providing temporary scaffold

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17
Q

How long does the inflammatory phase tend to last?

A

4 days

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18
Q

After stimulation by factors, how long does it take neutrophils to arrive to the site of injury?

A

24-48 hrs

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19
Q

Neutrophils kill bacteria and are recruited during the inflammatory phase. What pp of O2 do they need? How long do they last?

A

Require high pp of O2

Short lived

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20
Q

Monocytes mature to macrophages in tissue. What are they essential for secreting?

A

Signalling molecules

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21
Q

How many days after injury does it take for the primary WBCs to arrive?

A

2-3 days

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22
Q

What are the main features of the proliferative phase of wound healing?

A

Angiogenesis
Fibroplasia and granulation tissue formation
Epithelialisation
Contraction

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23
Q

When does the proliferative phase tend to occur?

A

4-12 days post injury

24
Q

The duration of the proliferative phase of wound healing depends on what factors?

A

Wound size
Location
Age and health

25
Within the proliferative phase, what do fibroblasts secrete?
Collagen (type III) Glycosaminogylcans Fibronectin
26
Fibroblasts are transformed to myofibroblasts within the proliferative phase. What do myofibroblasts do?
Cause wound contraction
27
What is the proliferative phase of wound healing characterised by?
Development of granulation tissue
28
Epithelial cells move to the site of injury during what phase? What do they do?
Proliferative phase | Minimise fluid loss and bacterial invasion
29
What are the main characteristics of the remodelling phase?
Remodelling and strengthening of collagen | Increase stiffness of tissue and matrix more rigid
30
How long does it take for most of collagen synthesis to be complete after an injury (remodelling phase)?
4-5 weeks | Maturation continues for 12-18 months
31
Phases of wound healing are similar in all tissues, but there are significant difference between skin and which tissues?
GI tract Fascia Bladder Bone
32
What is the difference between ponies and horses in terms of wound healing?
Ponies better at healing | Horses prone to XS granulation - 'proud flesh'
33
What is the difference between cats and dogs in terms of wound healing?
Cats have slower healing of subcutis layer
34
What local factors influence wound healing?
``` Wound perfusion Tissue viability Fluid accumultion Foreign bodies Infection Mechanical factors (movement) ```
35
What systemic factors influence wound healing?
Immune status Drugs (prednisolone weakens immune system) Systemic condiitons (obesity, diabetes, malnutrition)
36
Abrasions and erosions affect which levels of the skin?
Superficial loss of surface epithelium | No exposure of dermis and submucosa
37
What type of cell division is the primary healing mechanism of abrasions/erosions?
Mitosis | Epithelial cells fill the defect without needing inflammatory cells/capillaries etc
38
What is ulceration?
Complete loss of surface epithelium | With exposure and damage to underlying tissue
39
Burns can be thermal, chemical, electrical or radiation burns. How are they classified?
Depth - 1st-4th degree | Extent - % of body surface area
40
What rule of thumb is used to estimate extent of burn wounds?
Rule of 9s | Each limb 9%, head 4.5%, back/belly 18%
41
What history should be asked when assessing wounds?
When and how the injury occured | Concurrent disease, medication
42
What should be done first when assessing wounds?
``` Initial first aid: Control haemorrhage (E.g. pressure) Check CV system Look for other injuries (May need to sedate, particularly in LA) ```
43
How should a wound be cleaned?
Clip area to fully assess Apply sterile gel (hair can be stuck in wound) then gently remove Lavage with sterile saline
44
What is the 'golden period' - the time taken for bacteria to inoculate a wound?
3-5 hrs
45
What is tetanus?
Muscle spasms | Due to Clostridium tetani bacteria entering a wound
46
Tetanus can affect all species. Which species in particular is affected? How is this reduced?
Horses | Vaccination against Clostridium tetani
47
If a horse is not vaccinated against tetanus, what should you do?
Give tetanus antitoxin and tetanus toxoid vaccination
48
What is the characteristic sign of tetanus in horses?
Protruding 3rd eyelid
49
What is the prognosis of tetanus?
Fatal if left untreated | Preventable - antitoxin
50
What aftercare should be given for a wound?
``` Antibiotics (only if contaminated or infection likely) NSAIDs Devices to prevent self-trauma Rest Removal of suture ```
51
When should sutures be removed?
10-14 days post surgery
52
What are the 3 types of wound healing?
``` First intention Secondary intention Third intention (AKA delayed primary closure) ```
53
What is healing by first intention?
Primary closure Wound closed immediately and completely with strict asepsis (No bacterial contamination, removal of dead tissues, FBs, blood clots, dead space, fluid, ischaemia)
54
What is healing by second intention?
When wound cannot heal by first intention due to infection or severe tissue damage
55
How does second intention differ to first intention healing in terms of wound care?
First intention = little/no care | Second intention = regular wound care (dressings, bandaging, debridement)
56
What is healing by third intention?
Delayed primary closure Wound treated initially as open wound (tissue debridement and lavage) Wound then close and heals by primary intention

Surgery and wound healing (MOD) (4 decks)

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