The Integumentary System (wound Healing) Flashcards

1
Q

Describe the basic anatomy and physiology of the skin

A

Epidermis - outermost layer, regenerates every 4-6 weeks. Protective barrier
Dermis - support and transport of nutrients to the epidermis, contains blood and lymph vessels, sweat, oil glands and hair follicles. Made of collagen, fibroblasts, elastin.
Hypodermis - subcutaneous adipose fatty tissue

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2
Q

What are the functions of the skin?

A
Protection
Sensation
Thermoregulation
Metabolism
Synthesis of vitamin d
Secretion and excretion
Cosmetic
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3
Q

Define a wound

A

An injury or discontinuity in the epithelium and or the connective tissue which results in a breakdown of protective function.

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4
Q

What are common wounds in perinatal women?

A

Tears to genital tract or episiotomy
Abrasions to nipples
Caesarean section wound

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5
Q

What are the 4 phases of wound healing?

A

Haemostasis
Inflammatory phase
Proliferation phase
maturation phase

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6
Q

Give detail about haemostasis

A

Occurs immediately
Vasoconstriction
Platelets clot
Scab formation

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7
Q

Give detail about the inflammatory phase

A

Days 1-5
Clot and wound tissue release pro inflammatory cytokines and growth factors
Histamine is released
Vasodilation
Increased permeability of capillary walls
Open blood supply cleanses wound

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8
Q

Give detail about the reconstructive phase

A

Growth factors induce cellular migration, division and proliferation
Vascular endothelial cells form new blood vessel network
Fibroblasts enlarge and migrate
Fibronectin and collagen form provisional matrix, new collagen laid down, granulation tissue rebuilds viable tissue
Myofibroblasts grip the matrix edges and contract the wound
Epithelial cells proliferate over moist surface resurfacing the wound site to cover new tissue

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9
Q

Give deal on the maturation phase

A

21-365 days
When wound is closed
Collagen fibres enlarge and reorientate along lines of tension in the wound
Cellular activity reduced, redundant cells undergo apoptosis
Number of blood vessels in wound area regresses
Maximum tensile strength is reached from approx 3 months
Scar only achieves 70-80% of normal strength

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10
Q

What is meant my healing by primary intention?

A

Surgically incised, clean margins, aseptic
Close proximity of wound margins, edges swiftly approximated by surgical ligatures
Uncomplicated healing, minimal granulation tissue
Rapid in growth of wound healing cells
Rapid skin regeneration
Edges soundly united in 14 days, dense scar tissue by one month
Neat hairline scar

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11
Q

What is meant by healing by secondary intention?

A

Significant epithelial damage and loss
Dead space-open gaping wound with large clot
Irregular margins, unclean, contaminated
Larger scab, granulates from bottom to surface of wound site
Protracted healing process increase potential for infection
Wound edges not brought together, healing by contraction
Larger amount of scar tissue

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12
Q

What is meant by healing by tertiary intention?

A

Surgical incision
Wound edges not reapproximated initially, left open for a few days to permit drainage of oedema, blood, contamination
Wound debrided and devitalised tissue removed
Late surgical closure
Increased granulation
Wide scar

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13
Q

What local factors can affect wound healing

A
Size of wound
Skin tension
Poor surgical technique
Vascular supply
Venous drainage
Location
Poorly applied dressing
Presence of infection
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14
Q

What systematic factors can effect wound healing?

A
Cold or excessive heat
Age
Degree of immobility
Obesity
Stress
Smoking
Alcohol use
Malnutrition 
Diabetes
Anaemia
Shock
Vitamin deficiency
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15
Q

What are the signs of infection?

A
Feelings of malaise
Temperature
Fluid drainage (excess)
Continual or increased pain
Redness and swelling
Offensive odour
Hot incision site
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