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Biomechanics > Stages of Tissue Injury & Repair PPT > Flashcards

Stages of Tissue Injury & Repair PPT Flashcards

1
Q

Define Inflammation.

A

Fundamental reaction of the body tissues to protect, localize, and fight either an acute or chronic irritant or injury, as well as prepare the area for healing and repair

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2
Q

What is the purpose of inflammation?

A

protective mechanism to rid the body of the irritant and to promote repair and healing of the damaged tissues

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3
Q

What are some causes of inflammation (list as many as possible, 9)?

A
  1. trauma (sprain, strain, contusion)
  2. chemical agents (poisons, stings)
  3. pathogenic organisms (infections)
  4. foreign bodies (splinters, sutures)
  5. hypoxia & ischemia
  6. irradiation
  7. autoimmune responses
  8. immune reaction (hypersensitivity)
  9. thermal extremes of heat/cold (burns)
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4
Q

What are the 5 cardinal signs/symptoms of acute/chronic inflammation?

A 
heat (local) - calor
redness - rubor
swelling - tumor
pain - dolar
loss of function - functio laesa (loss of motion or use)
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5
Q

True/False: Every injury is accompanied by some degree of tissue damage. The seriousness of the injury will be determined by the type of tissue involved and the extent of the tissue damage.

A

True

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6
Q

What are the 3 phases of tissue injury & repair?

A
  1. acute inflammatory
  2. repair
  3. remodeling
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7
Q

What is the purpose of Phase 1 (5)?

A

Primarily involves inflammatory process

  • defend against foreign substances & infection
  • dispose of dead & dying tissue
  • immobilize injured area
  • compartmentalize area of damage
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8
Q

What are 3 physiological events in acute inflammation?

A

neurologic
hemodynamic (changes in vascular flow & permeability)
cellular

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9
Q

How long does phase 1 last?

A

few hours - 2-3 days

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10
Q

Are the cardinal signs of inflammation present in phase 1?

A

Yes

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11
Q

True/False: In phase 1 of the healing process, events are different depending on the cause of inflammation

A

FALSE! In phase 2, the events are the same regardless of the cause of inflammation, but the magnitude of events depends upon severity of injury & immune status

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12
Q

What are some neurologic events that occur during phase 1?

A
  1. initial vasoconstriction (transitory & reflexive, lasts up to 30 sec)
  2. gradual vasodilation (relaxation of reflexive spasm, causes ‘bleeding’ to start)
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13
Q

What are 5 hemodynamic events that occur during phase 1?

A
  1. Vasoconstriction
  2. Vasodilation… hyperemia
  3. Slowing of blood flow… stasis
  4. margination of leukocytes
  5. Permeability changes
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14
Q

What causes vasoconstriction during phase 1?

A

From chemical mediators: NE - blood vessels, serotonin - platelets

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15
Q

What causes vasodilation/hyperemia during phase 1?

A

Relaxation of reflex vasospasm, chemical mediators: histamine & prostaglandin

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16
Q

What happens during phase 1 due to blood stasis?

A

blood pooling… clotting

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17
Q

What is characteristic about margination of leukocytes during phase 1?

A

Neutrophilic migration

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18
Q

What causes permeability changes & where do they take place during phase 1?

A

Chemical mediators: histamines, leukotrienes
Cappillaries/Small venules from widening of endothelial cells, fluids leak -> transudate/exudate cause edma -> plasma exudate coagulates into network of fibrin to start tissue repair

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19
Q

What are 3 cellular events that take place during phase 1?

A

Mast cells, circulating leukocytes, monocytes/macrophages

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20
Q

What do mast cells do during phase 1?

A

Already present in CT, damage to CT leads to activation & degranulation, release histamine (increased vasodilation & permeability), release heparin (anticoagulant)

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21
Q

What do circulating leukocytes do during phase 1?

A

Basophils - release anti-coagulants
Neutrophils - phagocytosis of bacteria, release chem mediators, magnifies inflammation greater than required in musculoskel. injury

22
Q

What do monocytes/macrophages do during phase 1?

A

Arrive 5 hrs post injury

Remove dead tissue debris, clean up tissue

23
Q

How many chemicals are involved in acute inflammation? What are some sources

A

180+

Damaged cells, inflammatory cells, platelets, plasma, etc

24
Q

What does serotonin do?

A

Powerful vasoconstrictor

25
Q

What does herparin do?

A

Temp. prevents blood coagulation

26
Q

What does histamine do?

A

1st, strong vasodilator, increases permeability

27
Q

What do bradykinins do?

A

increase permeability & pain, esp. w/prostaglandins

28
Q

What do prostaglandins do?

A

Released from phospholipids, cause arachadonic acid cascade

29
Q

What is the purpose of phase 2?

A

Regenerate/repair lost/damaged tissue

30
Q

How does musculoskeletal tissue repair?

A

w/ CT & scar formation - usually efficient, sometimes hypertrophic scarring/keloid formation

31
Q

How does musculoskeletal tissue repair differ from other tissues?

A

some tissues regenerate native cells (skin, bone, lymph, liver, kidney)

32
Q

What are 4 physiological events involved in phase 2?

A

Granulation tissue formation
Fibroplasia
Scar formation & contraction
Wound contraction

33
Q

What is the time frame of phase 2?

A

Begins w/in 24 hours, may last 48 hours - 6 weeks

34
Q

What is the hallmark of phase 2?

A

Synthesis & deposition of collagen

35
Q

What do M0 do during phase 2?

A

remove cell debris, erythocytes, and fibrin clot

36
Q

What does granulation tissue do during phase 2 & what are its characteristics (2)?

A

Form a gel-like matrix of collagen, hyaluronic acid, & fibronectin

  • highly vascular and contains lymphatic cells to prevent edema formation
  • forms mesh-like framework for scar formation
37
Q

When does fibroplasia in phase 2 begin?

A

hours after injury

38
Q

How does the process of fibroplasia in phase 2 take place?

A
  1. Fibroblasts synthesize collage & GAG
  2. Initiates collagen synthesis & deposit
    2a. integrity of wound depends on this
    2b. collagen laid down at random
    2c. collagen not fully oriented in direction of tensile strength
    2d. initially it is type III collagen (inferior) which is later replaced by type I collagen
  3. myofibroblasts proliferate & migrate into wound
39
Q

When does would contraction of phase 2 occur & how much does it decrease the wound?

A

Begins once scar has formed via myofibroblasts (4 days after injury, can take 6 mo - 1 yr)
Reduces wound size 5-10% over 6 weeks

40
Q

What is the purpose of phase 3?

A
  1. reorganization of the collagen fibers laid down during Phase 2
  2. collagen is remodeled to increase ability of damaged tissue to withstand stress
41
Q

What is characteristic about the remodeling phase?

A

collagen is re-orientated into direction of line with forces acting on the tissue

42
Q

What are forces that can remodel tissue?

A

stretching, exercise, muscle contraction, manipulation, mobilization, transverse friction massage

43
Q

What is the window that collagen can be remodeled in?

A

8-10 weeks

44
Q

What is the chance of reinjury?

A

It is increased, because scar that’s left is 80% as strong as original tissue

45
Q

What is the time frame for phase 3?

A

Repair & matrix formation begins in 2-4 weeks, may last from 3 weeks - 12 months+

46
Q

What are some intrinsic factors that delay healing (7)?

A
  1. age
  2. chronic disease
  3. blood supply (circulatory disease)
  4. nutrition
  5. neuropathy
  6. nature of injured tissue
  7. degree of damage
47
Q

What are some extrinsic factors that delay healing (5)?

A
  1. degree of immobilization
  2. immune suppression
  3. infection
  4. irradiation
  5. psychophysiologic stress
48
Q

What are some iatrogenic factors that delay healing (2)?

A
  1. medications

2. ischemia

49
Q

What is the healing potential of cartilage?

A

limited potential due to poor vascular supply

50
Q

What is the healing potential of ligaments?

A

slower to heal due to less vascular supply, gradually form scar, may take 1 yr

51
Q

What is the healing potential of skeletal muscle?

A

heals w/collagen scar @ same rate as other vascular tissues

52
Q

What is the healing potential of nerve?

A

peripheral nerves have fair potential depending on degree of damage (CNS heal poorly)

Biomechanics (5 decks)

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