Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Absite > Wound > Flashcards

Wound Flashcards

1
Q

What are the phases of wound healing?

A
  1. Inflammation (day 1-10) 2. Proliferative (day 5-3 weeks) 3. Remodeling (3 weeks - 1 year)

Peripheral nerves regenerate 1 mm/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What occurs during the inflammation phase of wound healing?

A

PMN, macrophage, TNF-alpha, IL-1, PDGF

Macrophages are essential for wound healing (release of GF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What occurs during the proliferative phase of wound healing?

A

Fibroblasts deposit collagen, neovascularization, granulation tissue, formation of Type III collagen which is then replaced by Type I, epithelialization (1-2 mm/day), PDGF, FGF, EGF

Fibronectin - release by fibroblasts are chemotactic for macrophages

Provisional matrix – mostly fibronectin and hyaluronic acid

Fibroblasts – replace fibronectin-fibrin with collagen

Platelet plug – platelet and fibrin

PDGF, FGF, EGF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What occurs during the remodeling phase of wound healing?

A

Decreased vascularity, net amount of collagen does not change, cross-linking of collagen, mostly Type I collagen present over Type III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the order of cell arrival in wound healing?

A

Platelet, PMN (0-2 days), macrophages (3-4 days), lymphocytes, fibroblasts (5 days and on)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most important factor in healing open wounds with secondary intention?

A

Epithelial integrity - Most important factor in healing open wounds with secondary intention
- Migration from hair follicles #1 site, wound edges, sweat glands
- Dependent on granulation tissues in wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most important factor in healing closed wounds?

A

Tensile strength - Most important factor in healing closed wound → Primary intention. Depends on collagen deposition and cross linking

D-penicillamine inhibits collagen cross-linking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the weakest point for SB anastomosis?

A

3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the suture removal timeline?

A

All facial lacerations can be primarily closed if < 24 hours. Use non-absorbable suture, interrupted fashion. Allows drainage

All other lacerations can be primarily closed if < 18 hours
Suture removal- Face: 4 - 7 days.
Other area 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the role of myofibroblasts in wound healing?

A

Myofibroblasts are smooth muscle cell fibroblasts that communicate through gap junctions and are involved in wound contraction and healing by secondary intention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of collagen and their locations?

A

I – MC type of collagen. Skin, bone, and tendons,
II – Cartilage
III - increased in wound healing, also in blood vessels (Associated with ANEURYSMS)
IV – Basement membrane, lens of eye
V – found in cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is required for collagen synthesis and hydroxylation?

A

Alpha-ketoglutarate, vitamin C, oxygen, and iron are required for collagen synthesis and hydroxylation (prolyl hydroxylase) and cross linking of proline residue in collagen
Proline very important for cross linking: Improved wound tensile strength
Zinc needed for wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the predominant type of collagen during remodeling?

A

Type I predominant type during remodeling
By 3 weeks all of Type III Collagen is replaced by type I and maximum collagen accumulation is reached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the maximum tensile strength of a wound reached?

A

By 8 weeks, the wound reaches maximum tensile strength which is 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is essential for wound healing in terms of oxygen measurement?

A

Transcutaneous oxygen measurement should be > 25 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What diseases are associated with abnormal wound healing?

A

Osteogenesis imperfecta - Type I collagen defect
Ehlers-Danlos – Collagen disorder
Marfan’s – fibrillin defect (connective tissue protein)
Epidermolysis bullosa - excessive fibroblasts Tx: phenytoin
Pyoderma gangrenosum - tx steroids, gets better with colectomy in UC. Associated with hidradenitis

17
Q

What are the risk factors for wound dehiscence?

A

Deep wound infection (most significant), poor nutrition, COPD, diabetes, coughers

18
Q

What are the components of scars?

A

Scars – Contain a lot of proteoglycans, hyaluronic acid, and water
- Scar revision – wait for one year to allow maturation
- Infants heal with little or no scarring

Scar revision should wait for one year to allow maturation; infants heal with little or no scarring.

19
Q

What is the effect of denervation and chemotherapy on wound healing?

A

Denervation has no effect on wound healing; chemotherapy has no effect on wound healing after 14 days.

20
Q

What is the role of wound vac in wound healing?

A

Wound vac increases wound contraction, promotes granulation, increases blood flow, and removes edema.

Contraindication to wound vac – Infected wounds, ischemic wounds, malignancy. Fistula is not a CI

21
Q

What are the key factors in wound healing?

A

PDGF (chemotactic for inflammatory cells, smooth muscle cells, and fibroblasts), fibroblast growth factor (FGF), epidermal growth factor (EGF), TGF-beta (immunosuppressive)

PDGF: key factor in wound healing. chemotactic for inflammatory cells, smooth mm cells, and fibroblasts. Angiogenesis, epithelialization

Platelet activating factor, PAF: released from endothelium when platelet binds collagen
- Activates platelets, chemotactic to inflammatory cells, increases adhesion molecule expression
- NO Angiogenesis here

Fibroblast growth factor: chemotactic for fibroblasts, angiogenesis, epithelialization

Epidermal growth factor: chemotactic for fibroblasts, angiogenesis, epithelialization

TGF-beta: immunosuppressive
TGF-beta = growth factor – responsible for granulation tissue formation, matrix formation and remodeling

22
Q

What are the components of platelet granules?

A

Alpha granule
- Platelet factor 4 – aggregation
- Factor V and VIII
- vWF
- Fibrinogen
- Beta-thrombomodulin – binds thrombin
- PDGF
- TGF-B – modulates above responses

Dense granules – contain adenosine, serotonin, calcium

Platelet aggregation factors – TXA2, thrombin, platelet factor 4

23
Q

What is the role of selectins and integrins in wound healing?

A

Selectin – E selectin on endothelial cells bind P selectin (platelet), and L selectin (leukocyte) - involved in rolling adhesion of platelets to initiate platelet plug

Beta-2 integrin – found on leukocytes and platelets. Involved in anchoring adhesion and migration. They bind ICAM and VCAM

ICAM – Found on endothelial cells. Involved in anchoring adhesion and transendothelial migration. Bind Beta 2 integrin

24
Q

What is the function of CD4 helper cells?

A

CD4 helper – interacts with MHC class II and releases:
- IL2 release: activates cytotoxic T (CD8) and natural killer cells

  • Interferon gamma: activates macrophages
  • IL 4 release: increases B cell ab production
25
Q

What is the best suture technique for wound closure?

A

A slowly absorbable 2-0 monofilament suture (PDS) with 0.5 cm bite and 0.5 cm distance apart using 4:1 suture to wound length is best.

26
Q

Ulcers

A

Diabetic foot ulcers - Usually at charcot’s joint (2nd MTP) and HEEL 2/2 to neuropathy

Leg ulcers – 90% from venous insufficiency tx Compression and wrap

27
Q

Cartilage

A

Contains no blood vessels. Get nutrients and oxygen from diffusion

28
Q

Natural killer cell

A

Attacks cells with missing MHC expression. Doesn’t use or need MHC complex

29
Q

MHC 1/2

A

MHC I – self antigen. Cytotoxic T cells (CD8) recognize and attack non-self MHC I

MHC II – found on APC. CD4 interacts with it.

30
Q

1ary/ 2ary lymphoid organs

A

Primary lymphoid organs – liver, bone, thymus

Secondary lymphoid organs – spleen and LN

31
Q

Reopening a wound

A

Accelerated wound healing - reopening a wound, results in quicker healing the 2nd time (since healing cells already present)

32
Q

Sutures

A

Absorbable sutures: broken down by the body via enzymatic reactions or hydrolysis. Used for deep tissues and tissues that heal rapidly- small bowel anastomosis, suturing in the urinary or biliary tracts, or tying off small vessels near the skin.

Vicryl rapide = 42 days
Vicryl = 60 days
Monocryl = ~100 days
PDS = ~200 days

Non-absorbable sutures: provide long-term tissue support, remaining walled-off by the body’s inflammatory processes (until removed manually if required). Used include for tissues that heal slowly- fascia or tendons, closure of abdominal wall, or vascular anastomoses.

33
Q

Fascial dehiscence and characteristics of fluid draining from surgical wound

A

Fascial dehiscence and evisceration (extrusion of abdominal viscera out of wound)= surgical emergency

salmon-color fluid concerning for peritoneal fluid

Risks for wound dehiscense/ incisional hernia: wound infection, obesity, COPD, cardiovascular disease, immunosupression, age, malnutrition, renal failure

34
Q

Calciphylaxis

A

-Associated with ESRD on hemodialysis; skin ischemia and necrosis manife

Absite (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions