Surgery: Wound Care

Question 1

with a tissue injury, what are the 4 possible outcomes? KNOW

Answer 1

1. normal repair
2. regeneration
3. deficient healing
4. excessive healing

Question 2

4 phases of wound healing KNOW

Answer 2

1) . Hemostasis- blood clotting (protease activation), fibrin plug, early messengers for inflammatory stage
2) . Inflammation- inflammatory cells arrive, cytokines, neutrophils are first to arrive, macrophages
3) . Proliferation- fibroblast migration (build new tissue) and angiogenesis (collagen also becomes more important)
4) . Remodeling- collagen 1 shows up more, granulation tissue matures

Question 3

what do neutrophils do?

Answer 3

• ->activate the leukocytes

- ->Release elastase and collagenase

Question 4

what do macrophages do and why is this important for wound healing? KNOW

Answer 4

• Phagocytosis and removing devitalized matrix

* if lacking then get an increase in avascular, non bioavailable tissue for healing

Question 5

too much proliferation during wound healing causes KNOW what?

Answer 5

overactivity = scar formation

Question 6

what cells are the main players in each phase of healing? SUMMARY

Answer 6

Hemostasis: Platelets, Fibrin matrix, cytokines, GFs (FIBRONECTIN, COLLAGEN 3)
Inflammation: Neutrophils, macrophages, Cytokines, GFs, proteases
Proliferation: Fibroblasts-collagen
Remodeling: MMPs, TIMPs

Question 7

what three things stimulates angiogenesis? KNOW

Answer 7

Stimulated by hypoxia, acidosis, high lactate (during proliferative phase)

Question 8

what layer is the only layer to proliferate in healing?

Answer 8

basal layer

Question 9

wound dehiscence usually occurs during which days of wound healing? why? KNOW

Answer 9

day 5-8, because a lot of the inflammatory response is done (losing fibronectin and collagen 3)

Question 10

characteristics of the healing wound (5) KNOW

Answer 10

1) . low inflammatory cytokines
2) . low proteases, ROS
3) . intact functional matrix
4) . high mitogenic activity
5) . mitotically competent cells

Question 11

characteristics of the chronic wound (5) KNOW

Answer 11

1) . high inflammatory cytokines
2) . high proteases, ROS
3) . degraded, non-functional matrix
4) . low mitogenic activity
5) . old cells

Question 12

final pathways to wound healing failure (4)

Answer 12

1) . infection
2) . malperfusion hypoxia (PAD, smoking, coag probs)
3) . cellular failure
4) . trauma

Question 13

effusion occurs in what body space? edema occurs where?

Answer 13

effusion- potential space

edema- interstitium

Question 14

what does an alginate dressing do?

Answer 14

reduce edema (venous stasis ulcer)