The Integumentary System (wound Healing) Flashcards
Describe the basic anatomy and physiology of the skin
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
What are the functions of the skin?
Protection Sensation Thermoregulation Metabolism Synthesis of vitamin d Secretion and excretion Cosmetic
Define a wound
An injury or discontinuity in the epithelium and or the connective tissue which results in a breakdown of protective function.
What are common wounds in perinatal women?
Tears to genital tract or episiotomy
Abrasions to nipples
Caesarean section wound
What are the 4 phases of wound healing?
Haemostasis
Inflammatory phase
Proliferation phase
maturation phase
Give detail about haemostasis
Occurs immediately
Vasoconstriction
Platelets clot
Scab formation
Give detail about the inflammatory phase
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
Give detail about the reconstructive phase
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
Give deal on the maturation phase
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
What is meant my healing by primary intention?
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
What is meant by healing by secondary intention?
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
What is meant by healing by tertiary intention?
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
What local factors can affect wound healing
Size of wound Skin tension Poor surgical technique Vascular supply Venous drainage Location Poorly applied dressing Presence of infection
What systematic factors can effect wound healing?
Cold or excessive heat Age Degree of immobility Obesity Stress Smoking Alcohol use Malnutrition Diabetes Anaemia Shock Vitamin deficiency
What are the signs of infection?
Feelings of malaise Temperature Fluid drainage (excess) Continual or increased pain Redness and swelling Offensive odour Hot incision site
