Wound Healing

Question 1

Scars limited to boundaries

Answer 1

Hypertrophic scars

Question 2

Causes of hypertrophic scars vs keloids

Answer 2

Prolonged inflammatory phase of healing causes hypertrophic scars

Growth factors play a role in keloid formation

Question 3

Demographics and natural history of keloids

Answer 3

Autosomal dominant inheritance
common earlobes and areas tension
do not resolve with time

Question 4

Histology of keloids

Answer 4

Increased collagen type 3 and increased vascularity

Question 5

Treatment of keloids

Answer 5

Excision followed by corticosteroid injection locally
severe cases radiotherapy after Excision
recurrence is common

Question 6

Treatment for hypertrophic scars

Answer 6

Multiple corticosteroid injection
silicone sheathing
pressure for 6 months

Question 7

For wound closure where are deep sutures placed

Answer 7

And collagen rich layers like fascia and dermis

Question 8

For wound closure why should Crush injury of the epidermis and the dermis be avoided

Answer 8

This reduces the amount of necrotic tissue and wound edges and reduces inflammation this is achieved through the use of fine forceps and skin hooks

Question 9

Which phase is especially longer in open wounds

Answer 9

The proliferative phase

Question 10

Indication for a skin graft in open wounds

Answer 10

When healing is not completed by the third week

the graft can be partial thickness or for thickness

• there must be adequate granulation and no infection

Question 11

How does removing dead tissue help and topical wound management

Answer 11

Removing this barrier decreases inflammation, removes ordor, reduces secretions and improves final scar and reduces the risk of infection

Question 12

Active debridement converts…

Answer 12

A chronic wound to an acute wound

Question 13

Other methods of debridement

Answer 13

Enzymatic. 
Chemical debridement. 
Osmotic debridement. 
Autolytic debridement. 
Biosurgical debridement for maggots
Physical/Mechanical debridement

Question 14

Description of a wound infection

Answer 14

106 colony forming units per G per tissue

Question 15

How many bacteria types must be present in order to significantly impair wound healing

Answer 15

4 or more types

Question 16

The reconstructive ladder

Answer 16

Allow wound to heal. 
Direct tissue closure. 
Skin graft. 
Local tissue transfer. 
Regional tissue transfer. 
Free tissue transfer

Question 17

What is the difference between a flap and a graft

Answer 17

A flap brings its own blood supply

Question 18

Skin graft indications

Answer 18

Lack of adjacent tissue for coverage.
Uncertainty of tumor clearance.
Morbidity or risk with more complicated treatment options.
Patient factors