Week 8 - Wound Healing

Question 1

How many years does it take for a scar to reach its steady state?

Answer 1

2 years

Question 2

What % of final strength does a wound have at 3 weeks?

Answer 2

Only 20%

Question 3

What are some factors that may delay wound healing?

Answer 3

• Infection
• Presence of foreign body
• Diabetes
• Anaemia
• Obesity
• Immobility
• Poor nutrition
• Zinc deficiency
• Age - slower healing in elderly patients
• Incontinence for sacral wounds
• Trauma, including artefact

Question 4

What drugs can delay wound healing?

Answer 4

• Oral steroids
• Anticoagulants
• Retinoids
• Immunosuppressants

Question 5

What is this and what bugs commonly cause it?

Answer 5

An infected wound

• Staph Aureus, Strep A/B orG
• Occasionally Pseudomonas

Question 6

What wound is this?

Answer 6

A necrotic wound

Question 7

What wound is this?

Answer 7

A Granulating Wound

• A red and well vascularised wound
• White/pink epithelial tissue coming in from the edges and in islands.

Question 8

What wound is this?

Answer 8

A Sloughy Wound

• A yellow/cream exudates consisting of dead cells and protein.
• Appropriate dressings will help reduce excess exudate.

Question 9

What is the difference between a keloid scar and an hypertrophic scar?

Answer 9

Keloids are thicker and extend beyond the edge of the wound.

Question 10

What is the difference between primary and secondary intention healing?

Answer 10

• Primary intention - wound is sutured closed.
• Secondary intention - heals without closure.

Question 11

Why do people get keloid scars?

Answer 11

• Genetic predisposition (family history)
• Environmental factors
• Tension on the scar site.

Question 12

What are some risk factors for keloid scars?

Answer 12

• Young age (10-30 years)
• Familyhistory
• African-American skin (15-20x more prone)

Question 13

What are some treatment options for keloid scars?

Answer 13

1. Remove the keloid lesion- surgery & radiotherapy is the gold standard.
2. Decrease symptoms and bulk.
   
   • Steroid injections
     
     • Triamcinolone 10mg/ml
     • Review at 6 weeks to decide if more needed.
   • Massage- 10 minutes per day.
   • Steroid tape.

Question 14

When investigating a leg ulcer, what should you do?

Answer 14

• Document the size, site etc.
• Doppler - if <0.8 means arterial disease.
• Swab for infection
• Consider XR or MRI scan if osteomyelitis suspeced.

Question 15

What is the treatment for arterial leg ulcers?

Answer 15

• Stop smoking
• Exercise
• Consider vascular surgery

Question 16

What is the treatment for venous leg ulcers?

Answer 16

Sustained graduated compression

Question 17

What is the treatment for skin surrounding the wound?

Answer 17

• Emollients
• Topical corticosteroids if dermatitis
• Consider patch test if the dermatitis isn’t responding to patch tests.

Question 18

Venous ulcers are the most common leg ulcers. What are some rarer causes?

Answer 18

• Rheumatoid arthritis
• Physical trauma
• Radiation
• Vasculitis
• Infection -mycobacterial, syphilis, yaws, Buruli.
• Neuropathy
• Malignancy - SCC or BCC
  
  • Evolving ulcers can develop into SCC - Marjolin’s ulcers.
• Inflammatory -pyoderma gangrenosum, necrobiosis lipoidica.