S1L1: Wound and Wound Healing Flashcards
A breakdown in the protective function of the skin
Wound
The loss of continuity of epithelium, with or without loss of underlying connective tissue (i.e. muscle, bone, nerves)
Wound
Following injury to the skin or underlying tissues/ organs caused by surgery, a blow, a cut, chemicals, heat/ cold, friction/ shear force, pressure or as a result of disease, such as leg ulcers or carcinomas
Wound
Refers to the Natural physiologic reaction to tissue injury
Wound healing
T/F: Wound healing is an interplay between numerous cell types, cytokines, mediators, and the vascular system
True
T/F: Wound healing is the process of final point of destruction of the epithelium to scar formation.
False: Process of initial point of destruction of the epithelium to scar formation
T/F: Phases does not overlap with each other and have a set duration
False: Phases often overlap with each other and have no set duration
Enumerate the phases of wound healing (3)
○ Inflammatory phase
○ Proliferative phase
○ Maturation and Remodeling
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Outpouring of lymphatic fluid and blood
A
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Goal is to achieve adequate hemostasis
A
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Aggregation of platelets follows the
arterial vasoconstriction to the damaged endothelial lining
A
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Vasoconstriction is a short-lived process that is
soon followed by vasodilation, which allows the influx of white cells and more thrombocytes.
A
Note:
○ Vasoconstriction prevent further blood loss
○ Vasodilation allows the influx of nutrients to
help with the healing process
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Hemostasis and chemotaxis
B
Inflammatory phase duration:
0-25 days
Regulation of blood loss
Hemostasis
Direct migration of cell in response to a chemical gradient
Chemotaxis
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
White cells and thrombocytes speed up the inflammatory process
B
Note: Inflammation isn’t necessarily a bad thing, its only bad if the inflammatory phase was prolonged
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Mediators and cytokines
B
Promote collagen degradation, transformation
of fibroblasts, neovascularization, and re-epithelialization
Mediators and cytokines
initial destruction of loose collagen strands
Collagen degradation
creation of new blood vessels
Neovascularization
Healing of the layer of skin itself
Re-epithelialization
Help increase inflammation to area
Serotonin and histamine
○ Attracts, enhances the multiplication and
division of fibroblasts
○ Released from platelets
Platelet-derived growth factor
Help to heal wounds and repair damage to
blood vessels wall, help blood vessels grow or
hematopoiesis or neovascularization
Platelet-derived growth factor
○ Phagocytosis of debris and bacteria
○ Allows for the decontamination of the wound
○ Help clear up wound area
Neutrophils
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Serotonin and histamine
B
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Platelet-derived growth factor
B
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Neutrophils, monocytes, and endothelial cells adhere to a fibrin scaffold (initial structure)
B
Proliferative or Granulation Phase duration
2-25 days
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Fibroblasts have laid new collagen and glycosaminoglycans
C
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Re-epitheliazation
C
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Neurovascularization
C
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Wound contraction
C
They lay the building blocks for reepithelialization (collagen & glycosaminogycans)
Fibroblast
Migration of cells from the wound periphery
Re-epithelialization
In re-epitheliazation, Wound starts healing from the () going into the ()
○ Wound starts healing from the peripheral area
going into the center
Neovascularization produces new blood vessels. They are from ______ cells
From endothelial progenitor cells
Wound contraction is Facilitated by the continued deposition of _____ and _______
Facilitated by the continued deposition of
fibroblasts and myofibroblasts
Maturation or Remodeling Phase Duration
15 days to 1 year
Known to be the strongest in terms of tensile strength; best type of collagen for scar formation
Type 1 collagen
Wound contraction peaks at week ___
3
Note: 17-21 days after initial wound, it starts to
close
Maximal tensile strength of the wound occurs about __-__ weeks
11-14 wks
Ultimate scar will have only about ()% maximum strength
80%
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Excess collagen degrades (Type 3 - Type 1)
D
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Wound contraction peaks at week 3
D
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Maximal tensile strength of the wound occurs about 11-14 weeks
D
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Ultimate scar will have only about 80% maximum strength
D
Determine the types of Wound Healing based on location
Bone, skin, dentin, cornea, blood vessels, fibrocartilage and tendon
Type 1
Determine the types of Wound Healing based on location
Cartilaginous tissues
Type 2
Determine the types of Wound Healing based on location
Skin, ligaments, blood vessels and internal organs
Type 3
Determine the types of Wound Healing based on location
Basement membrane in various tissues
Type 4
Determine the types of Wound Healing based on location
Blood vessel wall, synovium, corneal stoma, tendon, lung, bone, cartilage and skeletal muscle
Type V
Initial phase is mostly to decrease blood loss
Hemostasis
During Inflammation there is increase in ___
Vasodilation
formation of scab
Formation of thrombosis
formation of blood vessels
Angiogenesis
start of wound healing
itself
re-epithelialization
building blocks for the start of wound healing
Granulation tissue
Determine the phase of wound healing
a. Immediately after the injury
b. Inflammatory phase
c. Proliferative or Granulation Phase
d. Maturation or Remodeling Phase
Collagen III to Collagen I
Regeneration/Maturation
Factors leading to impaired healing:
Loss of blood flow to area
Hypoxia / Ischemia
Factors leading to impaired healing:
If bacteria has large number, it stunts the
healing process
Bacterial colonization/infection
Factors leading to impaired healing:
The rush of blood could wash away the
presence of helpful cells
Reperfusion injuries
Factors leading to impaired healing:
Example - Pt c diabetes have prolonged period of healing dt microvascular injuries
Altered cellular response
Factors leading to impaired healing
If the area is swollen, other fluids and blood
supply cannot enter
Tissue edema
Factors leading to impaired healing
described as weakening of skin dt prolonged
exposure to moisture
Maceration
Factors leading to impaired healing
Too little fluid or too much fluid are bad
Dehydration
Factors leading to impaired healing:
Too much or too little collagen are both not ideal.
Collagen synthesis defects