Skin and Tissue Healing and Wound Pics<3 Flashcards
Which layer?
avascular
multilaminar
melanocytes
merkel discs
Langerhans cells
Epidermis
What is the function of Keratinocytes and Melanocytes and what layer are they in?
Produce keratin
Produce Melanin
Stratum basale in the epidermis
What is the function of the Merkel cells and the langerhans cells?
What layer are they in?
Merkel: light touch - statum basale
Langerhans: skin immune response - stratum spinosum
Which layer?
thicker
dermal appendages
highly vascular
fibroblasts/macrophages/WBCs
Mast Cells
Dermis
What are the dermal appendages
Sweat Glands
Sebaceous Glands (oil)
Fair follicles
What are fibroblasts responsible for in the dermis?
collagen/elastin
Which layer?
adipose tissue
fascia
highly vascular
Hypodermis
Which layer allows skin to move freely?
Hypodermis
If a wound is superficial what layer is it through?
epidermis
If a wound is partial thickness what layer is it through?
epidermis and some dermis
If a wound is full thickness what layer is it through
all 3 layers
What is the most common type of wound, what will it look like?
Venous
brawny, edema, weepy
What is the 1st phase of healing?
whats going on here
Hemostasis:
transudate leaks out
brief vasoconstriction and platelet aggregation for blood clotting
beginning of immune response
What is the 2nd phase of healing?
whats going on here and how long?
Inflammatory Phase:
0-3 days
vasodilate for histamine response
Mast cells
polymorphonuclear neutrophils (PMNs) - clean
macrophages - kill bacteria to allow cellular growth
What is the 3rd phase of healing?
whats going on here and how long
Proliferative phase:
4-12 days
fibroblasts proliferate
angiogenesis and vascularization
granulation tissue
epithelialization
When does granulation and epithelialization occur in healing?
4-12 days (proliferative phase)
What has to be present for epithelialization to occur? Where does it happen first?
the 3 appendages (hair, oil, sweat)
at the borders of wound
What is the 4th phase of healing? What is going on and how long
Maturation/Remodeling
up to 2 years
reorganize matrix
collagen from III to I
reorient along lines of stress
80% of original elasticity
What is healing by primary intention
clean cut and sewn back together
What is healing by secondary intention?
more gaping
closing on its own
not sewn or sitiched
what is healing by tertiary intention?
(delayed primary)
left open until it is ready to be sewn
What kind of wounds would be healed with tertiary intension?
contaminated wounds
cant sew closed until the infection/yuckies are out
Wagner Ulcer Grade
0:
1:
0: pre-ulcer, healed, or at risk
1: superficial, w/o subcutaneous
Wagner Ulcer Grade
2:
3:
2: through the skin, bone, ligament
3: osteotitis, abcess, osteomylitis
Wagner Ulcer Grade
4:
5:
4: gangrene of digit
5: gangrene of foot –> need amputation
UT classification of Diabetic Foot Ulcers:
I:
II:
III:
I: superficial
II: capsule
III: bone/osteomyelitis/deep abscess
UT classification of Diabetic Foot Ulcers:
A:
B:
C:
D:
A: non infected, non ischemic
B: infected, non ischemic
C: non infected, ischemic
D: infected and ischemic
National Pressure Injury Staging:
Stage 1:
Stage 2:
1: non blanchable erythema, skin not exposed
2: skin expoed, partial thickness (epi and part of dermis)
National Pressure Injury Staging:
Stage 3:
Stage 4:
3: Full thickness, nothing exposed, slough
4: full thickness, bone/ligament/muscle exposed
National Pressure Injury Staging:
Unstageable:
Deep pressure injury:
Unstageable: full thickness, depth unknown bc eschar covering it
deep pressure: sever black and blue, depth unknown
What is a keloid and who’s most at risk?
bubbled up scar, beyond original bounds
people who are darker skinned
Venous Wound
What kind of bacteria causes green slough
Pseudomonas bacteria
Venous Wound
Venous Wound
Pressure Wound
Cellulitis
Venous
Arterial
Arterial
Dry gangrene
Arterial?
Arterial
Arterial
Cellulitis
Corns
Neuropathic Ulcer
Charcot foot
Neuropathic
How does HbA1c effect healing
lower HbA1c = faster healing
When would you use toe brachial index on a patient?
if they have microvascular disease and/or calcified proximal vessels
What is normal ankle systolic? what range is difficult? what is the goal for diabetics?
norm: > 60mmhg
difficulty with 60-80
diabetics >90
What toe systolic do we want for healing?
> 30mmhg
What is normal, equivocal, and abnormal TBI
<0.7-0.9
<0.65 - 0.7
<0.65
What ABI is unlikely to heal with someone with PAD
< 0.5
What ABI is associated with impending tissue necrosis
< 0.3
What is PreAlbumin and what level in unlikely to heal
last 2-4 days nutritional status
< 5