Wound Care Flashcards
What are the stages of wound healing (3)
Inflammatory phase
Proliferative phase
Remodeling phase
Inflammatory phase
- time frame
- what occurs
- cells involved
days 1-4
- initial vasoconstriction followed by vasodilation
- neutrophils and macrophages are recruited
Proliferative phase
- time frame
- what occurs
- tensile strength at 14 days
days 3-21
- collagen synthesis provides tensile strength of wound
- at 14 days, tensile strength of wound equals that of suture
remodeling phase
-time frame
days 21 up to one year
At what stage of healing do chronic wounds stop progressing
at the proliferative phase
What is santyl
collagenase- an enzymatic debrider that digests collagen in necrotic tissue
What is Regranex
PDGF-1
Where is Regranex made
Puerto Rico
What is a normal value for serum albumin
3.4-5.0 g/dL
What is a low serum albumin level associated with (5)
- decreased wound healing
- edema
- impaired cellular immunity
- decreased collagen synthesis
- decreased fibroblast proliferation
What minimum ABI is necessary for wound healing
.35 for non-diabetic
.45 for diabetic patient
How does negative pressure wound therapy assist wound closure
negative pressure wound therapy applies mechanical shear stress to the wound site. This is believed to promote granulation by decreasing bacterial bioburden, reducing edema, and inducing capillary budding
How does hyperbaric oxygen therapy assist wound closure
Hyperbaric oxygen therapy increases the partial pressure of O2 in arterial circulation, which increases diffusion of O2 at the wound site. This is believed to increase growth factors promoting angiogenesis and collagen synthesis.
What is integra
bilayer graft composed of bovine tendon collagen with chondroitin 6- sulfate and a silicone layer to control moisture loss
What is oasis
extracellular graft matrix derived from porcine, small intestine submucosa
What is apligraf
bilayer graft derived from neonatal foreskin with dermal and epidermal layers
What is graft jacket
extracellular graft matrix derived from human tissue with intact vascular channels
What is tissue mend
acellular collagen matrix derived from fetal bovine dermis
Inflammatory Phase: 3 parts
- Vascular
- Hemostatic
- Cellular
Inflammatory Phase Vascular component
1) Vasoconstriction of the blood vessels. Fibrin promotes hemostasis and provides scaffolding for the ingrowth of cells at a later stage.
2) Vascular permeability: achieved through histamine (vasodilator)
Serotonin and kinins also increase the permeability
Neutrophils: when they get there, peak numbers, function
- Arrive at the wound in 6 hours
- Peak numbers occur at 1-2 days
- Responsible for wound debridement with the release of callagenolytic and fibrinolytic enzymes. Neutrophiles also ingest bacteria
Lymphocytes: peak numbers. Most important roles.
How they attract and activate macrophages
- Reach peak numbers in 6 days
- most important role is in the synthesis of lymphokines
- Migration Inhibition factor (MIF): attracts macrophages to the wound
- Macrophage Activation Factor (MAF): activates the macrophage
Macrophages:
Reasons why they are the most important cell for wound healing (4)
1) only cells able to tolerate low O2 tension at the wound edge
2) Appear in the wound during first 5 days and have a long life span
3) Wound healing severely limited by their absence
4) Process and presents antigens to the lymphocytes
- Cells that produce collagen
- When does collagen synthesis begin
- What is fibronectin and what does it do (3)
- Migratory fibroblasts (mesenchymal cells) produce collagen
- Collagen synthesis begins on the 5th day and lasts for 2-4 weeks
- Fibronectin (produced by fibroblasts)
- – Coats macrophages to aid in opsonization and phagocytosis
- – Found on surface of fibroblasts where it aids in the adhesion of these cells to the ECM
- –Fibronectin corss lings with collagen and glycosaminoglycans
