Second intention healing

Question 1

What are the key components of second intention healing?

Answer 1

1. granulation
2. contraction
3. epithelialization

Question 2

How does the phases of wound healing in second intention differ from first intention (sutured wounds)

Answer 2

The phases are identical but the magnitude and duration of the CELLULAR phase is longer

Question 3

How does contraction occur?

Answer 3

myfibroblasts (actin, fibronectin)

Question 4

What are the two contraction theories?

Answer 4

1. picture frame theory

2. pull theory

Question 5

What are the limits to contraction? (3)

Answer 5

1. contact inhibition
2. opposing tension
3. myofibroblasts disappear (large old wounds)

Question 6

What is usually the greatest limit to contraction on limbs?

Answer 6

opposing tension

Question 7

What can be done to old, large wounds to stimulate contraction?

Answer 7

scrape the granulation tissue/wound to cause upregulation of myofibroblasts

Question 8

What is the rate of contraction on the body?

Answer 8

1mm/day (each side)

Question 9

What is the rate of contraction on the limbs?

Answer 9

0.2mm/day

Question 10

why is contraction slower on the limb?

Answer 10

1. inelasticity of skin
2. vascular insufficiency
3. fewer myofibroblasts
4. cytokines

Question 11

What is the rate of epithelialization on the body?

Answer 11

0.2mm/day

Question 12

What is the rate of epithelialization on the limb?

Answer 12

0.09mm/day

Question 13

Why is epithelialization slower on the limb?

Answer 13

unknown

Question 14

Why don’t you see epithelialization until contraction has pretty well stopped?

Answer 14

because contraction occurs faster than epithelialization so it is just like the trickle in front of a wave and don’t see significant epithelialization until contraction pretty well stops

Question 15

How do you prevent exuberant granulation tissue?

Answer 15

1. debridement
2. sterile dressing
3. pressure bandages

Question 16

Why is prevention better than treatment with exuberant granulation tissue?

Answer 16

because once a wound becomes exuberant, it tends to keep being exuberant

Question 17

What is the bandage philosophy in second intention healing?

Answer 17

1. pressure bandage early to minimize swelling and reduce wound size–less retraction

Question 18

What is the bandage philosophy in second intention healing?

Answer 18

1. pressure bandage early to minimize swelling and reduce wound size–less retraction b.c less swelling
2. after inflammatory phase it’s a catch 22-may stimulate more granulation tissue and slow healing but also provides mechanical protection–abandon bandage when can!

Question 19

Which of the following healed best 1) no treatment 2) cryosurgery 3) bandage 4) cast

Answer 19

1) no treatment

Question 20

What can be a problem with wound medications?

Answer 20

t get a medication passed for wound healing, just have to show that causes no harm

Question 21

When is immobilization indicated?

Answer 21

1. wounds in high motion areas

Question 22

What requires critical observation?

Answer 22

equine sarcoids–horses are prone to develop equine sarcoids in areas of wounding. NOT granulation tissue–if trimmed will become more aggressive

Question 23

How could you distinguish equine sarcoids and exuberant granulation tissue?

Answer 23

exuberant granulation tissue will eventually become exuberant over the whole wound

Question 24

What are two ways that exuberant granulation tissue can be managed?

Answer 24

1. sharp debridement

2. topical medicaments

Question 25

What are 2 advantages of surgical debridement? How is hemostasis acheived?

Answer 25

1. predictable result 2. can repeat as needed achieve hemostasis by pressure bandage. (minimize by doing a fast debridement)

Question 26

In what direction do you go when performing wound debridement?

Answer 26

start from bottom and work way up

Question 27

What are two advantages of topical medications for the management of exuberant granulation tissue?

Answer 27

1. owner friendly | 2. control granulation tissue

Question 28

What is a disadvantage of topical medications for the treatment of exuberant granulation tissue?

Answer 28

1. impede healing (slow contraction, slow epithelialization)

Question 29

Does sharp debridement of exuberant granulation tissue slow healing?

Answer 29

no

Question 30

What does topical corticosteroids do?

Answer 30

inhibit granulation tissue (also slows epithelialization) (judicious use)

Question 31

What are common preparations of topical corticosteroids?

Answer 31

1. panalog--$ 2. green wound cream--penicillin + corticosteroid--sensitization? 3. 0.1% dexamethasone :)

Question 32

What is white wound lotion?

Answer 32

lead acetate and zinc sulfate

Question 33

Why is white wound lotion not good to use on wounds?

Answer 33

1. metabolic toxins (lead acetate, zinc sulphate) 2. kill fibroblasts 3. slow epithelialization 4. lead poisoning--not bandaged--lick--poisoned

Question 34

What is the cheapest topical medication

Answer 34

copper sulfate (10% concentration mix with corn starch)

Question 35

What is a negative effect of copper sulfate?

Answer 35

it is astringent/caustic and kills fibroblasts

Question 36

What is a negative effect of copper sulfate?

Answer 36

it is astringent/caustic and kills fibroblasts

Question 37

Which is preferred, topical corticosteroids or copper sulfate to manage exuberant granulation tissue? (if must be topical?)

Answer 37

corticosteroids

Question 38

Is Furacin (nitrofurazon) a good choice for topical application on open wounds?

Answer 38

no, 1. it causes granulation tissue. not a good choice on open wounds 2. inhibits epithelialization 3. harbors pseudomonas

Question 39

What is preparation H?

Answer 39

it is yeast extract

Question 40

What can preparation H (yeast extract) be used for?

Answer 40

to stimulate the production of granulation tissue early on (n long effects)

Question 41

What is a negative consequence of preparation H?

Answer 41

slows contraction and epithelialization

Question 42

What is a negative consequence of preparation H?

Answer 42

slows contraction and epithelialization

Question 43

What is the effect of amnion as a topical medication?

Answer 43

as a wound dressing 1. inhibits granulation tissue 2. promotes epithelialization 3. speeds healing

Question 44

What is a problem with amnion:

Answer 44

not available commercially

Question 45

What is the effect of honey as a topical medication?

Answer 45

1. osmotic effect on bacteria--antibacterial 2. unpasteurized my have enzymes to activate hydrogen peroxide good to use in early wound management

Question 46

What is the current data on collagen preparations as topical medications?

Answer 46

1. no negative effects demonstrated 2. so far no benefits 3. expensive

Question 47

What is biosyst?

Answer 47

procine small intestinal submucosa

Question 48

What does biosyst have?

Answer 48

1. collagen 2. protepglycans 3. cytokines

Question 49

What is biosyst promoted as doing? Is there evidence of this?

Answer 49

1. scaffold 2. healing modifier no good research to support

Question 50

What are two benefits of using split thickness skin grafts?

Answer 50

1. inhibit granulation tissue | 2. promote wound contraction

Question 51

What are three types of skin grafts?

Answer 51

1. zenographs (pig) 2. allografts 3. autograft

Question 52

Give an example where the medical preparation had an effect on wound healing

Answer 52

1. gentamicin cream vs solution | trial revealed that the cream affected contraction and inhibited epithelialization. The solution caused faster healing

Question 53

What is a good saying for what to put on a wound?

Answer 53

If you wouldn't put it in your eye, don't put it on a wound

Question 54

What are examples of topical medications?

Answer 54

1. corticosteroids 2. white wound lotion 3. copper sulfate 4. furacin 5. preparation H 6. amnion 7. honey 8. collagen preparation 9. biosyst 10. split thickness skin grafts

Question 55

If you see exuberant granulation tissue, what should you do?

Answer 55

look for a reason!