Tissue Healing - Skin

Question 1

Phases of Healing

Answer 1

1. Hemostasis and Degredation
2. Inflammatory
3. Proliferation and Migration
4. Remodeling and Maturation

Timeline: Months to Years

Question 2

Hemostasis

Answer 2

Blood coagulation
- Aggregation of platelets and Fibrin release chemical messengers including growth factors

Question 3

Inflammatory Phase

Answer 3

• Elastase and Collaganase breakdown area so new growth can occur
• Cardinal Signs

Question 4

Proliferation Phase

Answer 4

• “Rebuild”
• Growth factors stimluate prliferation and migration of epithelial cells, fibroblasts, and vascular endothelial cells
• Creation of new blood vessels
• Avoid disturbing granulation tissues
• Reepithelialization = skin cells from nearby slowly grow and form over area of granulation

Question 5

Maturation

Answer 5

• Reduction of fibroblasts and capillaries through apoptosis
• Collagen fibers arm formed, broken down, rearranged to withstand stress (70-80% tensile strength to original; Risk for re-injury)
• Last for almost two years

Question 6

Wound Healing Time Course

Answer 6

• Immediate: Platelets
• Neutrophils in small amounts immediate but slowly grow over time
• Machrophages come later and consume cells

Question 7

Contracture

Answer 7

Abnormal loss of skin area limiting movement due to excess tightness.
-Scare formation (Myofibrolasts) pulls edges of the skin together creating tight skin

Question 8

Keloid

Answer 8

-Predominantyl type 3 collagen (immature scar) than type 1

Question 9

Hypertrophic

Answer 9

-Collagen 3

Question 10

What type of wound healing would occur? Regen or Repair
-Wound with both epidermis and dermis

Answer 10

Repair because basement membrane is damaged. Proteoglycans and collagen is damaged in basement membrane.

Question 11

How many type of would healing are there?

Answer 11

3: Primary, Secondary, Teritary

Question 12

Venous Insufficency

Answer 12

• Type of skin wound
• Valves don’t work properly (back flow) mostly in lower extremity
• Common around medial malleolous

Question 13

Lipodermatosclerosis

Answer 13

-Thicker skin and discolorization; tight skin
- Often LE

Question 14

Hemosiderin

Answer 14

-Dark Skin
- Often LE

Question 15

Arterial Insufficency

Answer 15

• Intermittent Claudication (Ischemia results in pain every 6th step, as ischemia gets worse pain every 3rd step)
• Hair loss (No blood supply = no nutrients)
• Pain w/activity (ischemia)

Question 16

Arterial Ulcer

Answer 16

Location: Lower leg, feet
Pulse: absent or decreased
Temp: Cool (No blood to warm it)

Question 17

Neurpathic Wounds

Answer 17

Neuropathy: Sensroy, motor and autonomic
Causes: Diabetes (diabetic wounds)
Others: Improper foot care, mechanical - shear and friction
Changes:
- Sensory: Numbness, tingling, pain
- Motor: Weakness, spasms, atrophy
- Autonomic: Impaired thermoregulation, no sweating to dry skin

Commonly will be actively bleeding with no pain.

Question 18

Pressure Ulcer

Answer 18

Cause: unrelieved pressure -> ischemic hypoxia
Risk factors: repetitive stress, shear forces, prolonged pressure, nutrition, maceration, advanced age, impaired mobility, cognitive impairement

Question 19

Pressure Ulcer Stages

Answer 19

Stage 1: Non-blachable erythema of intact skin
Stage 2: Partial-thickness skin loss with exposed dermis (skin, dermis)
Stage 3: Full thickness skin loss (skin, dermis, fat)
Stage 4: Full thickness skin loss and tissue loss (skin, dermis, fat, muscle)

Question 20

Pressure Injury

Answer 20

Unstageable Full thickness: Obscured full thickness skin and tissue loss (Black)
- Tunneling (tunnel) and undermining (hole) can occur
- If skin is black = unstageable

Question 21

What does Wound VAC do?

Answer 21

Helps with bringing Macrophages and Neutrophils to Wound through Negative Pressure