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Integ Fall 2024 > Skin and Wound healing > Flashcards

Skin and Wound healing Flashcards

1
Q

How much resting cardiac output does the skin receive?

A

1/3 resting cardiac output

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2
Q

What gives skin its color?

A

Melanocytes which contain melanin found mostly in the basal layer of the epidermis

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3
Q

What causes different shades of skin?

A

Size and activity of melanocytes

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4
Q

What are melanocytes?

A

contain melanin that protect & give skin its color

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5
Q

What are Merkel cells?

A

light touch sensation cells

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6
Q

What are Langerhans cells?

A

infection fighting cells

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7
Q

Where are the epidermal appendages housed?

A

in the dermis and move through the epidermis

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8
Q

What are the epidermal appendages?

A

hair and sebaceous (oil secreting) & sudoriferous (sweat) glands

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9
Q

What are nails made of and where do they begin?

A
  • made of hard keratin
  • start in stratum basale
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10
Q

What are the roles of the epidermis?

A
  • avascular
  • provides physical and chemical barrier
  • regulates fluid
  • assists with thermoregulation
  • provides light touch sensation
  • assists with waste deposit
  • critical to endogenous Vit D production
  • contributes to cosmesis/appearance
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11
Q

How thick is the dermis and how many layers is it made of?

A

2-4mm thick
- papillary layer (superficial layer)
- reticular layer (deep layer)

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12
Q

Is the dermis vascularized or avascular?

A

vascularized (HIGHLY)

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13
Q

What cells are located in the dermis?

A
  • fibroblasts: for toughness & stretchability (w/ collagen & elastin fibers)
  • Macrophages & WBC’s
  • Mast cells: secrete mediators for inflammation (i.e. histamine)
  • Sensory receptors: temp, vibration, pressure, tough (hair root & follicle)
  • sebaceous & sweat glands
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14
Q

What are the functions of the dermis?

A
  • support and nourish epidermis
  • house epidermal appendages
  • assist with infection control
  • assist with thermoregulation
  • provide sensation
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15
Q

How do blisters occur?

A
  • from friction b/w epidermis and dermis which causes a collection of fluid b/w the two layers
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16
Q

What is considered in subcutaneous tissue?

A
  • adipose tissue
  • fascia
  • deeper lymphatics
  • muscles
  • tendon
  • bone
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17
Q

What tissue is involved with a superficial wound and what are some examples?

A

Epidermis

  • abrasion/skinned knee
  • superficial 1st degree burn
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18
Q

What tissue is involved with a partial-thickness wound and what are some examples?

A

Epidermis & superficial dermis

  • blister
  • superficial & deep partial-thickness burn (2nd degree
  • stage 2 pressure injury
  • Wagner grade 1 ulcer
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19
Q

What tissue is involved with a full-thickness wound and what are some examples?

A

Epidermis, Dermis, subcutaneous tissue, also could extend to subdermal layers

  • Full-thickness burn
  • stage 3 pressure injury
  • Wagner grade 1 ulcer
  • subdermal (4th degree) burn
  • Wagner grade 2-5 ulcer
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20
Q

What are the 3 stages of wound healing?

A
  • inflammatory phase
  • proliferation phase
  • maturation & remodeling phase
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21
Q

How long is the inflammatory phase and what is its purpose?

A

3-6 days could be prolonged

control bleeding & fight germs & bacteria that have entered via the wound

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22
Q

What 2 responses occur during the inflammatory phase?

A
  • Vascular response
  • Cellular Response
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23
Q

What is the vascular response during the inflammatory phase?

A
  • localized edema
  • vessel constriction
  • platelet aggregation: to stop bleeding
  • chemical mediators: platelets release to promote healing to area
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24
Q

What is the cellular response during the inflammatory phase?

A
  • platelets
  • PNMs: come to wound via chemical signals
  • fibroblasts: for vascular growth
  • macrophages
  • mast cells: produce histamine
  • vasoDILation after constriction: about 30 minutes after
  • exudate formation: thicker, yellow color
  • prostaglandin release (long term vasodilation)
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25
Q

What are the cardinal signs and symptoms of inflammation?

A
  • Tumor: swelling
  • Rubor: redness
  • Calor: heat
  • Dolor: pain
  • decreased function due to swelling
26
Q

How long and what is the purpose of the proliferation phase?

A

48hrs - days after size & health of wound determine this

  • produce tissues required to close the wound
27
Q

What are the 4 critical events during the proliferation phase?

A
  • angiogenesis: formation of new BV’s
  • Granulation tissue formation: temporary vascularized connective tissue to help allow for contraction and epithelialization
  • Wound contraction: pulls together & become smaller (fibroblasts change to myofibroblasts shape and depth determines this
  • Epithelialization: keratinocytes come across the wound & close it completely
28
Q

How does the shape and depth affect healing time?

A
  • circular wounds contract slowest
  • full-thickness contract more than partial-thickness
  • MUST be filled from the bottom up
29
Q

What cells are involved in the proliferation phase?

A
  • angioblasts: build new blood vessels
  • fibroblasts: build granulation tissue
  • myofibroblasts: cause wound contraction
  • keratinocytes: re-epithelize the surface of wound
30
Q

How long and what is the purpose of the maturation and remodeling phase?

A

can continue for several months to 2 years after closure

  • Rapid collagen synthesis
  • old collagen destroyed
  • correct collagen orientation (via induction or tension theory)
31
Q

What is the induction theory for tissue remodeling?

A
  • scar tissue tries to mimic the surrounding tissue
32
Q

What is the tension theory for remodeling tissue?

A

Davis’s Law

  • due to forces/stretches the collagen will lay down in correct direction
33
Q

What is the strength of scar tissue?

A

80% strength of normal healthy tissue

drops to 64% with repeated healing (second opening)
- usually happens with venous insufficiency ulcers

34
Q

What are some characteristics of scar tissue?

A
  • insensate
  • hairless
  • unable to sweat
35
Q

What are the pillars of wound healing?

A
  • moist environment to heal quickly
  • don’t want scab to form
36
Q

What is primary closure, heal time, and characteristics?

A

Primary Intention
- simplest and quickest
- clean wound, edges approximated (sutures, stables, etc.)
- surgical wounds
- paper cuts, small cutaneous wounds
- 1-14 days to heal
- epithelialization can start within 24 hours

37
Q

What is secondary closure, heal time, and some characteristics?

A

Secondary Intention
- granulation matrix MUST be built
- signs of progression through stages of healing noted w/in acute wounds w/in 14 days - 30 days for chronic
- increased time & scarring
- round wounds that usually need to heal from the inside out

38
Q

How can PT help the healing process of secondary intention wounds?

A
  • heals via phases of healing
  • help clean & dress the help wound heal itself
39
Q

What is delayed primary closer, healing time, and some characteristics?

A

Tertiary Intention
- Primary and secondary closure
- dirty wound left open for cleaning
- closed by surgeon
- PT prepares wound for closure
- skin graft, sutures after being left open
- should close within 1-2 weeks of suturing

wound bed needs to be ready to accept graft with granulation tissue and vascularization

40
Q

What are chronic wounds?

A
  • a wound, induced by varying causes, whose progression through the phases of healing is prolonged or arrested for any reason
  • little or no progress w/in 2-6 weeks
41
Q

What type of cells are present in chronic wounds?

A
  • senescent cells: capable of mitotic activity but barley do so
  • higher MMP (matrix metalloproteases) levels: cleans up debris during infla stage but leaves bigger hole to fil
  • lower TIMP (tissue inhibitors of MMP) levels: cant control the MMP
  • higher inflammatory cytokines
  • lack of response to growth factor
  • arrest of current of injury: loss of negative charge in wound bed
42
Q

What are some reasons for chronic wound healing?

A
  • absence of inflammation
  • chronic inflammation
  • hypogranulation/non-advancing wound edge
  • Dehiscence
  • hypertrophic scarring/keloid
  • contractures
43
Q

What is the absence of inflammation and what medical conditions inhibit inflammation?

A
  • the cleaning and soliciting of cells needed for repair does not occur
  • increased corticosteroid use for COPD
  • HIV or AIDs
  • Malnourished
  • elderly
44
Q

What is chronic inflammation and how does it hinder wound healing?

A
  • persistent signs of inflammation
  • prevents movement into the proliferation phase
  • begins to “clean up” and kill healthy tissues
  • chronic macrophages and cytokines are present in the wound
45
Q

Why is hypogranulation/non-advancing wound edge not good for wound healing?

A
  • cant fill the wound
  • epiboly formation (rounded edges on a wound that go around and not across)
  • non-advancing edges is caused by scar formation around the perimeter, repetitive trauma, wound dehydration, and local hypoxia (decreased O2)
46
Q

What is the treatment for hypogranulation and non-advancing wound edges?

A
  • treat reason for chronic wounds
  • decrease trauma (if occuring)
  • increase moisture (if dry)
  • decrease infection (if infected)
  • dress wound appropriately to prevent epiboly
47
Q

What is hypergranulation and how can PT’s treat it?

A
  • epithelial cells can’t climb hill (edges are too high)
  • decrease pressure, hypoxia, silver nitrate
  • surgery
48
Q

What is dehiscence?

A
  • separation of wound margins due to insufficient collagen production of tensile strength
  • could be from: obesity, underlying edema
49
Q

What is hypertrophic scarring/keloid and how do you treat them?

A
  • overproduction of collagen
  • at risk wounds: wounds that cross joints, burns
  • treat with surgical excisions called z-plasties (keloid)
  • compression dressing, silicone gel pads, scar mobilizations (hypertrophic scarring)
50
Q

What is the difference between a hypertrophic scar and a keloid?

A

Keloid: overproduction of collagen OUTSIDE the wound margins

Hypertrophic scar: overproduction of collagen INSDIE margins of the wound

51
Q

What are contractures?

A
  • pathologic shortening resulting in deformity

best treatment is PREVENTION

52
Q

What are 4 deterrents of wound healing?

A
  • wound characteristics
  • local factors
  • systemic factors
  • inappropriate management
53
Q

What factors about wound characteristics hinder wound healing?

A
  • causative agent of wound: surgery or trauma?
  • time since onset of wound: acute or chronic?
  • wound dimensions: larger and more round increased time to heal
  • location: less vascular, underlying bone prominence; thicker skin increases heal time
  • temperature: heals best at 30 degrees C or 86 degrees F
  • foreign matter: necrotic tissue = increased healing time
  • infection: increases healing time
  • wound hydration: moist not wet
54
Q

What happens to the skin with aging?

A

Epidermis:
- atrophies
- thickening of stratum corneum
- decreased Langerhan cells
- atrophy basal membrane

Dermis:
- decreased vascularization
- damage to collagen and elastin fibers
- decreased sympathetic nervous system input (decreased BF via decreased vasodilation)

55
Q

What is Futcher’s (Voigt’s) line?

A

sharp demarcation b/w darkly pigmented and lightly pigmented skin in the UE (usually in bicep region)

56
Q

What is Midline hypopigmentation?

A

line of hypopigmentation over the sternum

57
Q

What is Nail pigmentation?

A

diffuse nail pigmentation or linear dark bands on nail

58
Q

What are palmar changes?

A

creases may be hyperpigmented

59
Q

What are plantar changes?

A

hyperpigmented macules may vary in color and distribution

60
Q

What is Dermatosis Papulosa Nigra?

A

brown to black papules usually around the face

Integ Fall 2024 (8 decks)

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