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Surgical Wound Healing Flashcards

1
Q
  • Involves epidermis and dermis w/o total penetration of dermis
  • minimized scarring
  • most surgical wounds healed by this
A

Primary Intention

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2
Q
  • wound allowed to granulate
  • process slowed by drainage from infection
  • leaves big scar
A

Secondary Intention

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3
Q
  • delayed primary closure
  • wound cleaned, debrided, and observed 4-5 days prior to closure
  • wound purposely left open
A

Tertiary intention

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4
Q

What hormone is decreased in response to injury?

A

TSH

-everything else is increased

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5
Q

What happens in the early phase of metabolic response to injury?

A
  • dec body cell mass
  • VASOCONSTRICTION -to conserve volume
  • change in energy source
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6
Q

What are the stages of tissue healing?

A
  1. inflammation
  2. repair/fibroblastic
  3. remodeling
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7
Q

what factors are involved in the vascular and inflammatory phase?

A
  • subendothelial factor VII
  • hageman fator xii
  • platelet derived growth factor
  • histamine
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8
Q

what process is critical for a wound to be considered ‘healed’?

A

re-epithelization phase

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9
Q

what is the initial event of re-epithelization

A

-migration of undamaged epidermal cells from the wound edges

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10
Q

what is important for the migration of undamaged epidermal cells from wound margins?

A

water content because cells seek level of critical humidity

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11
Q

why do ulcers have a HPK rim?

A

there is increase in epithelial proliferation at wound margins

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12
Q

What is this?

  • crosslinks with fibrin to provide matrix for cell adhesion and migration
  • promotes phagocytosis
  • forms scaffolding for collagen deposition
A

-Fibronectin

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13
Q

What is granulation tissue made up of?

A
  • inflammatory cells
  • fibroblasts
  • new vasculature in hydrated matrix of glycoproteins
  • collagen
  • GAGs
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14
Q

What factors are involved in fibroplasia and matrix formation?

A

EGF-epidermal growth factor
MDGF-macrophage derived
PDGF-platelet derived

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15
Q

what are the processes of fibroplasia and matrix formation?

A
  • differentiation of myofibroblast
  • fibronectin crosslinks
  • migration of myofibroblast
  • type 3 collagen fibers on scaffold
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16
Q

what contracts in wound contraction?

A

-myofibroblasts and the attached surrounding tissue “fibronexus”

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17
Q

What is a fibronexus?

A

-intimate association between the membrane of myofibroblasts, intracellular actin and extracelluar fibronectin

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18
Q

What factors are involved in neovascularization?

A
  • Fibronectin

- macrophage derived angiogenic factor

19
Q

What is the initial event of neovascularization?

A

directed migration of endothelial cells

20
Q

What is the process of neovascularization

A
  • fragmentation of venule basement membrane
  • endothelial cells develop pseudopodia
  • pseudopodia protrude through the disrupted BM
  • entire cell migrates into the perivascular space

-these are stimulated by hypoxic conditions

21
Q

What factors are involved in matrix and collagen remodeling?

A

iron, copper, vitamin c

22
Q

Processes of matrix and collagen remodelling?

A

Fibroblasts->procollagen->collagen

  • collagen crosslinking
  • fibronectin disappears
  • water reabsorbed to allow collagen fibers to lie closer together
  • Type 3 collagen replaced by type 1 collagen
23
Q

Why is it important to manage your deadspace?

A

because it can fill with bacteria and cause hematoma formation

24
Q

what is the consequence of ischemic tissue?

A

-decreases: cell proliferation, resistance to infection, and collagen production

25
What deficiency causes this? | -slow re-epithlization, decreased collagen synthesis, increased infection
vitamin a
26
What deficiency causes this? | -unstable collagen produced
vitamin c | -essential co-factor for collagen synthesis
27
which vitamin deficiency coincides with deficiency of clotting factors 2,7,9,10 and increased chance of hematoma
vitamin k
28
what deficiency causes this? - impaired immune responses, decreased protein and collagen synthesis, interference with vitamin a transport - dna/rna polymerases
zinc
29
What type of sutures are these? - poly amide (nylon) - poly ester (dacron) - poly propylene (prolene)
synthetic non-absorbables silk linen is a natural non-absorbable
30
what type of sutures are these? - poly glactin (vicryl) - poly glycolic acid (dexon) - polyglyconate
synthetic absorbable -catgut is natural absorbale
31
what are the characteristics of absorbable sutures?
- subq tissue - eliminate dead space - minimize tension on wound edges - may spit if placed too superficially
32
-type of suture- - absorbable braided synthetic - homopolymer of glycolic acid - hydrolytically absorbed - good tensile str, excellent knot security - 2 week duration, 65% of tensile str remains
Polyglycolic acid -Dexon
33
-type of suture- - synthetic heteropolymer - braided, multifilament, coated - hydrolytically absorbed - stronger than dexon - can be impregnated with antibiotic triclosan
Polyglactin -vicryl
34
-Type of suture- - absorbable synthetic - monofilament; glycolic acid and trimethylene carbonate - 75% of original str at 2 weeks
Polyglyconate -maxon
35
characteristics of non-absorbable sutures
used on skin - deep suture to provide prolonged mechanical support - should be tight enough to approximate not strangulate tissues
36
-type of suture- - monofilament, dyed or undyed - isotactic crystalline stereoisomer of polypropylene - BLUE
- polypropylene | - prolene
37
which suture has lots of memory and lots of knot slippage
Nylon
38
which suture technique is used for longer wounds? - very strong - easier to evert edges - less time consuming - easier to strangulate skin edges
Horizontal mattress
39
Which suture is good for deep wounds? - aids in reapproximation of deep tissue - pretty good for keeping tension off skin edges - harder to evert skin edges
Vertical mattress
40
Which suture is used to take tension off the skin edges and provide deeper and wider support to the healing incision -hard to evert skin edges
retention sutures
41
which suture technique leaves a pretty to absent scar if done correctly and has a high rate of dehiscnece if not done properly?
subcuticular suturing
42
what is the treatment for hypertrophic scars?
cortisone injections - decreases the level of collagenase inhibitors and increase collagen degradation - kenalog 40 directly into the scar
43
when do you remove dorsal, medial, or lateral sutures? and when do you removed plantar sutures?
14 days 21 days

Surgery (9 decks)

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