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Fall 22: surgical > wound healing > Flashcards

wound healing Flashcards

1
Q

skin protects against

A

UV
mechanical stress
chemicals
thermal insult
dehydration
pathogens

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2
Q

skin is used to sense

A

touch
pressure
heat

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3
Q

layers of skin

A

epidermis
dermis
hypodermis

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4
Q

the epidermis is ___ in origin

A

ectodermal

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5
Q

what cells make up the epidermis?

A

keratinocytes, langerhan cells and melanocytes

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6
Q

the thickness of the epidermis is inversely proportional to ___

A

hair covering

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7
Q

___ gives the epidermis a semi-permeable/protective barrier

A

keratin

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8
Q

which layer of the skin is avascular

A

epidermis

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9
Q

hair follicles, nails and sweat glands are in what part of the skin?

A

epidermis
invaginations of the epidermis into the dermis

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10
Q

dermis is composed largely of ___

A

dense irregular and loose connective tissue
collagen and elastic fiber
GAGs

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11
Q

what type of cells are found in the dermis

A

fibroblasts
adipocytes
vasculature and lymphatics
nerve endings
mast cells and histiocytes

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12
Q

hypodermis is made of ___ muscle

A

panniculus carnosus

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13
Q

where do you find the stratum adiposum subcutis

A

hypodermis

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14
Q

what are the 3 interconnected levels of cutaneous circulation

A

subdermal (subcutaneous plexus)- deep
cutaneous- middle
subpapillary- superficial

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15
Q

what is different between the blood supply for skin of a dog vs a primate

A

dermis supplied by parallel musculocutaneous arteries and veins

hypodermis supplied by direct cutaneous artery and vein

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16
Q

direct cutaneous artery and vein is found

A

superficial and deep to panniculus muscle and in the hypodermis of cats and dogs

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17
Q

the direct cutaneous artery and vein supply

A

the deep or subdermal plexus
superficial or deep to panniculus muscle

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18
Q

cutaneous plexus is found ___

A

in the dermis
formed from branches of the deep (subdermal plexus)
gives rise to the superficial plexus

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19
Q
A
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20
Q

___ is the major vascular network in skin of dogs and cats

A

deep/subdermal plexus

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21
Q

___ extends capillary loops to nourish the epidermis

A

superficial plexus

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22
Q

During dissection, to elevate the skin and preserve cutaneous vasculature, you must go between the ____ and the ___

A

subdermal plexus/ panniculus m.

underlying skeletal muscle

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23
Q

3 stages of healing

A

inflammation/debridement
repair / proliferation
maturation/ remodeling

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24
Q

Immediately after injury, ___ fills the wound and cleans the wound surface

A

hemorrhage

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25
blood clot/ scab formation provides a ___, ___ wound edges and provides the substrate for ___
hemostatic plus, immediate barrier to infection and fluid loss stabilizes wound edges early reorganization of the wound (scaffold)
26
vascular phase initially starts with ___ then followed by ___ with recruitment of plasma and leukocytes
vasoconstriction vasodilation
27
cellular/debridement phase starts ___ after injury
6ish hours
28
what cells in the cellular phase
lymphocytes and PMNs monocytes/macrophages platelets mast cell and eosinophils
29
___ come during the inflammatory phase and concentrate at the site of injury to remove cellular debris and bacteria
lymphocytes and PMNs
30
what do macrophages do
eat cell debris secrete chemoattractants and growth factors and cytokines (PDGF, VEGF)
31
___ induces vasoconstriction, platelet and neutrophil aggregation
Thromboxane A2
32
___ influence angiogenesis and fibroblast activity
mast cells
33
eosinophils mediate ___ and ___
angiogenesis and epithelial migration
34
___ is considered the lag phase of wound repair
initial (inflammation/debridement)
35
rapid increase in wound strength from collagen happens in the ____
first 3-5 days
36
3 main events of repair/proliferative phase
granulation tissue formation wound contraction epithelialization
37
granulation tissues appears ___ at a rate of ___
3-5 days post injury 0.4-1 mm per day
38
granulation tissue will help healing by ___
protect the wound, provide a barrier to infection and act as a scaffold for epithelial migration
39
fibroblast produce ECM in a process called ___
fibroplasia
40
fibroblasts come from ___
local and distant sites (can be from bone marrow→ myeloid cells)
41
fibroblasts migrate along ___
fibrin strands
42
___ produce ECM and cytokines and growth factors
fibroblasts
43
fibrin, fibronectin and hyaluronic acid will facilitate aggregation and orientation of___ and ___
collagen growth of capillary buds (neovascularization)
44
what type of collagen is laid down first?
type III, then replaced by type I
45
greatest accumulation of collagen occurs when in healing?
7-14 days post injury
46
which growth factor is important for angiogenesis initially?
bFGF (first 3 days) VEGF more important 4-7 days
47
which growth factor is important for angiogenesis at 4-7 days
VEGF bFGF - 1-3 days
48
___, ___ and ___ are important mediators for angiogensis
growth factors and cytokines (bFGF, VEGF) low O2 high lactate
49
initially capillary loops are open but become ___
closed arcades
50
wound contraction happens ___ post injury
full thicken skin advanced (no new skin formed) 5-9 days post injury tension and shape determine how well it can move
51
how does wound contraction happen
fibroblasts grab onto collagen and pull- consolidate collagen in the wound center myofibroblast grab onto skin and contract pulling the skin with them
52
___ requires new skin synthesis by keratinocytes
wound epithelialization
53
Within 24 hours of wounding, ____ from the wound margins begin to cover the wound
keratinocytes (wound epithelization)
54
what stage of wound healing requires more O2
wound epithelization energy dependent and positively related to oxygen tension
55
wound epithelization is faster or slower under moist wound healing conditions
slower
56
wound epithelization advances from ____ structures in partial thickness wound
adnexal contains stem cells that speed up healing
57
what happens during maturation and remodelling phase
scab sloughs maturation of collagen fibers remodellling
58
a wound will reach ___ % of its original strength
70-80
59
cats or dogs heal faster?
dogs - will have more granulation tissue, greater wound epithelialization and wound contraction
60
ponies or horses heal better?
ponies horses lead to proud flesh (EGT- exuberant granulation tissue)
61
contracture
contraction that results in problem closes off opening or can't move
62
5 wound assessment type of ___ ___of wound degree of ___ tissue ___ ___ of wound
type of trauma age of wound degree of contamination tissue viability location of wound
63
a clean wound
controlled aseptic environment surgical incision
64
clean contaminated wound
contaminated area entered but no spillage example: enterotomy
65
contaminated wound
most common road rash, traumatic wound acute inflammation with NO pus
66
dirty wound
pus, abscess, delayed treatment of traumatic wound
67
Contaminated wounds must be converted into ___ prior to closure (if immediate closure is not possible, open wound management will be necessary)
clean wounds -> surgical incision
68
___ will remove foreign debris and contaminants with large volume of warm fluids
lavage- hydrodynamic debridement
69
___ are used for lavage
balanced electrolyte solution sterile saline chlorhexidine (0.05%) povidone- idodine (0.1-1%)
70
___ is accomplished by maintaining a moist wound environment
autolytic wound debridement
71
3 types of autolytic wound debridement
hydrophilic occlusive semiocclusive exudate or wound fluid that contains enzymes and growth factors remain in contact with the wound
72
when a wound is too moist
maceration
73
___ are chemical enzymes that slough necrotic tissue
enzymatic wound debridement can be nonselective
74
mechanical debridement
wet to dry outdated dries and rips off bad tissue
75
___ combines mechanical and autolytic debridement
hypertonic saline bandage for moderate/high exudate, infected or necrotic wounds
76
maggot therapy
biosurgical debridement removes necrotic tissue
77
systemic antimicrobials should be used ___
High risk of bacteremia or sepsis * Prophylactic or therapeutic * Prolonged use contraindicated
78
topical antimicrobials will enhance __ and may delay ___ formation
epithelization granulation tissue
79
vacc bandage also called
negative pressure wound therapy
80
what do NPWT help with
negative pressure wound therapy (vacc bandage) Decreases edema * Decreases bacterial colonization * Increases granulation tissue * Increases local blood flow * Enhanced epithelial migration * Accelerates wound closure
81
when not to use a NPWT
negative pressure wound therapy Malignancy in wound – Untreated osteomyelitis – Non-enteric or unexplored fistula – Necrotic tissue with eschar present – Exposed blood vessels or organs
82
4 types of moisture balancing dressings
calcium alginate- high exudate polyurethane foam- moderate to high exudate hydrocolloids- low to moderate hydrogels- low to none
83
primary closure happens with in ___
24 hours
84
delayed primary closure happens within ___
2-5 days before granulation tissue
85
secondary closure happens within
>5 days, after granulation tissue
86
second intention healing
wound the healed on its own
87
Epidermis (ectodermal origin) Composed of several layers of cells called___ that are undergoing a process of differentiation.
keratinocytes
88
The dermis is composed of ___, reticular (precollagen), and elastic fibers surrounded by a mucopolysaccharide ground substance (hyaluronic acid and chondroitin sulfate.
collagen
89
In dogs and cats, the hypodermis is made up of two distinct layers of fat (stratum adiposum subcutis) and ___
muscle (panniculus carnosus muscle).
90
This ___ is composed of the cutaneous trunci, platysma, sphincter coli superficialis, sphincter colli profundus, preputialis, and supramammarius muscles.
panniculus muscle
91
cutaneous circulation
Subdermal or subcutaneous plexus (Deep)-the major vascular network to the skin. In regions of skin where a panniculus muscle is present, the subdermal plexus lies both superficial and deep to it. cutaneous (middle) plexus. subpapillary (superficial) plexus which supplies the superficial dermis and extends capillary loops to nourish the epidermis (these loops are poorly developed in the dog and cats in comparison to primates and pigs).
92
In areas of the body where the panniculus is present, the surgeon must ___ to preserve the vital subdermal plexus.
undermine the fascial plane beneath the cutaneous musculature

Fall 22: surgical (16 decks)

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