Types of Wounds (Test 1 Lecture 2) Flashcards by Kaleb Zier

What are the 4 phases of normal healing?

Hemostasis (Coagulation)
Inflammation
Proliferation
Remodeling

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How far must an injury into the skin go to cause bleeding?

Through the epidermis and BMZ

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Which phase initiates the activation of platelets to help stop bleeding?

Hemostasis

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What do blood clots consist of?

Fibrin
Aggregated platelets
Blood cells

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Whats the purpose of a clot?

Seals disrupted vessels to control blood loss
Provide temporary bacterial barrier
Provide a reservoir of growth factors
Provides an interim matrix that serves as scaffolding for migrating cells

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What is the process of breaking down a clot called?

Fibrinolysis

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What is the purpose of the inflammatory phase?

To control infection and establish a clean wound bed

Breaks down devitalized tissue
White blood cells eliminate excess bacteria

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When does vasoconstriction subside and vessels dilate and cell permeability increases?

Inflammatory Phase

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How do leukocytes get to the area of the wound?

Chemoattraction by damaged cells and platelets attract the leukocytes

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What are the 3 processes of the inflammatory phase?

Vascular Stage
Exudate Stage
Reparative/Proliferative Stage

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What happens during the vascular stage of the inflammatory phase?

Cellular filtration pressures and permeability of cells increases leading to:
Local Edema
Warmth
Erythema
Discomfort/Pain

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What happens during the Exudate stage of the inflammatory phase?

Fluid passes through the walls of vessels into adjacent tissues/spaces to help deposit fibrins and leukocytes

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What are the first cells to arrive in a new wound?

Neutrophils

-present within minutes and can dominate area for 2-3 days

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What is the primary function of neutrophils?

Remove bacteria and foreign debris via phagocytosis

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After neutrophils what is the next type of cells to get to the wound and what is their purpose?

Macrophages

-responsible for finishing bacteria and breaking down damaged tissue

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When does true wound healing start?

Reparative stage of the Inflammatory phase

What are the processes that occur during the proliferative phase?

Granulation
Angiogenesis
Wound Contraction
Epithelialization

What happens during granulation and when does it begin?

Fibroblasts and capillary buds develop at edges of the wound and advance to the center.
Starts 3-4 days post injury (as inflammatory phase subsides)

What are some factors that can affect granulation?

Perfusion Status
Oxygen Levels
Nutritional Status
Glucose Level

What is new extra-cellular matrix formed by collagen fiber deposition and new capillary loops known as?

Angiogenesis

What are the 2 mechanisms that angiogenesis can occur?

Production of new vessels by local endothelia cells

- Recruitment of circulating see progenitor cells

How does the wound contraction part of the proliferative phase work?

Myofibroblasts exert tractional forces on the new ECM. Force pulls edges of wound together so the granulation tissue and new epithelial cells don’t have to travel as far

What happens during epithelialization and when does it occur?

Basal cells from edges of wound migrate inward from the wound edges.
Happens at the same time as contraction (day 21)

What does epithelialization use as a support structure?

Uses ECM and granulation bed

What happens during contact inhibition and when does it occur?

Ceases migration of epithelial cells across a wound bed | -occurs when epithelial cells moving across a wound bed come in contact with other epithelial cells

What type of environment is best for epithelialization?

Moist environment

How can you tell the difference between granulation and epithelialization?

Granulation looks wet and shiny, while epithelialization looks less reflective

How strong is skin when it is first formed?

15% as strong as original tissue | Will become 80% as strong as original

What happens during the remodeling phase?

Completes wound healing | Constant cycle of collagen formation and lysis in the scar

What type of collagen is it converted to during the remodeling phase?

From type 3 to type 1

What are the types of wound closure?

Primary - Surgical (stitches, stables, duck tape, blah blah) Secondary closure - Normal phases of wound healing Tertiary - Wound that is healing naturally then needs reopened to clean out infection (kept open until infection is cleared then closed surgically)

What are some characteristics of primary closure?

Heals quickly Minimal scar tissue Healing can be slowed by infection, trauma, or secondary breakdown

What are some examples of secondary closure?

Pressure ulcers and dehisced surgical incisions

What can help with secondary closure?

Skin grafts, substitutes, skin flaps, or other surgical interventions

What are the different types of exudate?

Serous - Thin and liquidy (pussy, straw colored) Purulent - Snot colored, thick mucous, smells (sign of infection) Fibrinous - Cloudy, filled with fibrin, not adherent (can wipe it off) Hemorrhagic - Not just blood (thinner then blood, full of serous fluid)

What are the types of exudate that involve a combination?

Sanguineous - Reddish, thin, and watery (occurs with trauma to blood vessels) Serosanguineous - Clear, pink, think, watery (normal drainage in wound healing Seropurulent - Yellowish and cloudy (sign of infection Hemopurulent - Dark red and viscous (contains bacteria, inflammatory cells, tissue that is dead or dying)

What factors may inhibit wound healing?

``` Level/presence of infection Size of wound Location Type of wound Amount of available blood Co-morbidites Nutrition ```

How do you define the depth of the wound?

Partial thickness - partial loss of dermal tissue (epidermis and superficial dermis) Full-Thickness - involves total loss of dermal tissue (can involve deeper tissue, muscle, subQ, Bone)

What causes a chronic wound?

Vascular compromise Chronic inflammation Repetitive trauma to injured tissue