Wound Healing

Question 1

Define wound

Answer 1

Loss of integrity of skin tissue

Question 2

What can cause chronic wounds?

Answer 2

Disruption in normal healing process
- aetiology go wound
- location
- tissue type

Slowed/incomplete healing

Question 3

What are the 3 phases of wound healing?

Answer 3

Inflammatory phase (0-48 hours)
Proliferation phase (48hours - 6 weeks)
Maturation and remodelling phase (3 weeks - 1/2 years)

Question 4

Clinical signs of inflammatory phase

Answer 4

Rubor
Calor
Dolor
Tumor

Question 5

Phat are the 3 main phases of the inflammatory phase?

Answer 5

Wound cleaning (phagocytosis)
Chemoattraction
Structural framework development (temporary matrix)

Question 6

Clinical signs of the proliferative phase

Answer 6

No inflammatory signs
Reduced swelling
Reduced wound size (contraction)
Itch

Question 7

Describe the concepts in the proliferative phase

Answer 7

Net collagen synthesis
Increased wound tension strength
- epidermal cells proliferate and move to wound eggs to granulation tissue - closes wound
- wound contraction via forces within myofibroblasts
Scar formation
- apoptosis of immune cells, fibroblasts, endothelial cells
- remaining fibroblasts for laying down collagen

Question 8

What happens in the maturation and remodelling phase?

Answer 8

Reorganisation of collagen

Question 9

What factors can affect the duration of the maturation and remodelling phase?

Answer 9

Age
Wound type (burns take a long time to heal)
Body location
Duration of inflammatory phase

Question 10

What can affect wound healing?

Answer 10

Size of wound
Blood supply to area
Presence of foreign bodies or microorganisms
Age and health of patient
Nutritional status
Drugs

Question 11

What is primary intention?

Answer 11

Immediate closure of wound edges when no loss of tissue has occurred
Rapid epithelial cover, faster healing, better cosmetic result
Eg. Surgical incision

Question 12

What is secondary intention?

Answer 12

Spontaneous healing of wound without direct closure (intentionally left open)
Granulation, slow epithelial cover, wound contraction, compromised cosmetic result
Eg. Excessive trauma, difficult wound closure, tissue loss

Question 13

What is tertiary intention?

Answer 13

Initially left open after removal of all non-viable tissue
Wound edges brought together a few days later
- when wound appears clean and well vascularised
- before granulation tissue is visible
Eg. Traumatic injury, dirty surgery, delayed primary intention of surgical wounds

Question 14

How does cryotherapy cause cell death?

Answer 14

Ice crystal formation
Osmotic differences -> cell disruption
Ischaemic damage
Immunologic stimulation

Question 15

Cryotherapy indications

Answer 15

Actinic keratosis
Viral warts
Seborrhoeic wart
Molluscum contagiousum
Myxoid cyst
Bowen’s disease
Superficial BCC

Question 16

Cryotherapy contraindications

Answer 16

Pigmented lesions
Malignant lesions (needs histology, I’ll-defined borders)
Cold urticaria
Lesion of uncertain diagnosis

Question 17

Efudix indications (5-Flurouracil)

Answer 17

Superficial BCCs
Multiple actinic keratoses
Bowen’s disease

Question 18

What is photodynamic therapy?

Answer 18

Activation of topical porphyrin cream to destroy cancer or pre-cancer

Question 19

Photodynamic therapy indications

Answer 19

Actinic keratosis
Bowen’s disease
Superficial BCC
Multiple or large lesions

Question 20

Photodynamic therapy contraindications

Answer 20

Pigmented lesions
Malignant lesions (requires histology)
Patients unable to tolerate pain

Question 21

What is curettage and cautery?

Answer 21

Scraping off lesion and applying heat to skin surface for haemostasis

Question 22

Curettage and cautery indications

Answer 22

Pyogenic granuloma
Cutaneous horn/actinic keratosis
Large seborrhoeic wart
Small Nodular BCCs

Question 23

Curettage and cautery contraindications

Answer 23

Pigmented lesions
BCCs (morphoeic, infiltrating, Ill-defined)
BCCs on sites with high recurrence rate (nose, nasolabial fold, eye area, ear, scalp)
Most SCCs

Question 24

What is a shave excision?

Answer 24

Lesion raised by local anaesthetic, lesion is shaved off and heat is applied to skin surface for haemostasis

Question 25

Shave excision indications

Answer 25

Chondrodermatitis nodularis helix is
Benign naevi

Question 26

Shave excision contraindications

Answer 26

Keratoacanthoma vs SCC
Melanomas
Don’t shave potential cancers

Question 27

Excision biopsy indications;

Answer 27

Suspected tumours
Pigmented lesions

Question 28

Excision biopsy contraindications

Answer 28

No (valid) consent
INR too high or under preparation with anti platelets/anticoagulants (deeper cut, more vasculature, higher bleeding risk)
Pacemaker check (bipolar current used to close vessels, lidocaine anaesthetic can be a cardiac depressant and reduce heart rate)

Question 29

What is Moh’s surgery?

Answer 29

Micrographic surgery
Removing lesions, examining under microscope and continue to excise until all lesion removed

Question 30

Moh’s surgery indications

Answer 30

Recurrent
High risk zone
Aggressive growth
>2cm off face
>0.5cm on face
Incomplete excision
Ill-defined borders