Wound Healing

Question 1

Primary cell types in the inflammatory phase

Answer 1

Neutrophils and Macrophages

Question 2

Primary cell types in the proliferative phase

Answer 2

Fibroblasts

Granulation tissue: collagen and fibroblasts

Contraction: myofibroblasts

Question 3

Primary cell type during maturation phase

Answer 3

Lymphocytes and collagen

Question 4

`describe the inflammatory phase of healing

Answer 4

This phase exhibits the cardinal signs of inflammation caused early on by neutrophils and then macrophages on days 3-5. Blood clots form during this phase and there may be more purulent exudate.

Question 5

Describe the proliferative phase of healing

Answer 5

This phase starts at day 4 with fibroblasts and is characterized by granulation tissue (collagen and fibroblasts) and epithelialization around the wound edge. Then myofibroblasts start contraction.

Question 6

Describe the Maturation Phase of healing

Answer 6

This is the final remodeling, where the skin will never regain more than 80% of original strength

Question 7

What solutions are appropriate for lavage?

Answer 7

Tap water, 0.9% saline, any IV fluid that is not hydrogen peroxide

Question 8

What are some recommended lavage additives?

Answer 8

Chlorohexidine solution 0.05% and Povidone Iodine solution 0.1-0.2%, but don’t use scrub

Question 9

__ is critical for neutrophils to kill bacteria and for collagen production

Answer 9

Oxygen

Question 10

What are the steps for initial wound treatment?

Answer 10

1. Clip and clean skin
2. Lavage
3. Debride
4. Culture

Use good biosecurity to prevent into and spread of disease or bacterial resistance

Question 11

What is the goal of lavage?

Answer 11

The most effective way to reduce bacterial numbers on the surface of the wound

Question 12

Antibiotics (topical and systemic) are most commonly used during the __ phase and not necessarily during the __ phase

Answer 12

Inflammatory phase, proliferative phase

Question 13

To obtain cultures you should know __ you got the sample and want __ or more samples.

Answer 13

When, 2-3

Question 14

When should you close a wound?

Answer 14

When there is good blood supply, no infection, sufficient skin for tension free closure, minimal health risk for anesthesia/surgery, financially and clinically beneficial and when there is a high likelihood of healing success

Question 15

Primary closure

Answer 15

First intention healing where the wound is sutured soon after injury

Question 16

Contraction and epithelialization

Answer 16

Second intention healing where the wound heals naturally without sutures and may be used for very small or very large wounds when primary closure has failed

Question 17

Secondary closure

Answer 17

This is third intention healing where the wound is closed later than 5 days after injury when granulation tissue is present. This may be used in severely infected wounds or wounds with massive tissue destruction.

Question 18

Describe the layers of building a bandage briefly

Answer 18

1. Primary layer: this is the dressing or contact layer that manipulates the wound environment
2. Secondary layer: this plays a role in absorption, stabilization and pressure +/- a splint (support)
3. Tertiary layer: provides additional protection, pressure and cosmetics

Question 19

Inflammatory Phase Dressing Options

Answer 19

The goal of dressing here is to debride and reduce bacterial contamination:

1. Wet to dry bandage
2. Honey and sugar

Question 20

Proliferative phase dressing options

Answer 20

The goal of dressings in this phase is to not disrupt the fragile new tissue and hold cells and cytokines in so we want something non adherent and occlusive:

1. Petroleum infused gauze
2. Telefax +TAB
3. Honey/Sugar
4. hydrogel (dry wounds)
5. Polyurethane foam
6. Calcium alginate (wetter wounds)

Question 21

Describe the Wet to Dry bandage

Answer 21

This bandage should only be used during the inflammatory phase and requires sedation as application and removal can be painful. It’s indicated for wounds with necrotic tissue, foreign material and viscous exudate. It works by diluting the exudate, absorbing it and is removed when dry.

Question 22

Honey and Sugar work well as dressings because they’re __ with a high ___ that draws water out causing bacterial lysis. Honey specifically has antimicrobial molecules related to ___

Answer 22

Antimicrobial, osmolarity, hydrogen peroxide

Question 23

What are the benefits of keeping a wound moist?

Answer 23

1. physiologically favors cell migration and matrix formation
2. Accelerates healing of wounds by promoting autolytic debridement
3. Reduces pain

Question 24

What is the role of wound exudate?

Answer 24

The growth factors and cytokines modulate healing. Metalloproteinases promote degradation of fibrin clot and eschar

Question 25

Hydrogels and Hydrocolloids should be used on __ wounds to provide moisture

Answer 25

Dry

Question 26

Calcium alginate is a __ wound dressing that promotes autolytic debridement and __ tissue. It requires large amounts of wound fluid to hydrate and become gel

Answer 26

Moist, granulation

Question 27

What are some less expensive alternative for dressings?

Answer 27

TELFA pad with triple antibiotic ointment and petroleum impregnated gauze

Question 28

Bandage changes become __ frequent during the proliferative phase

Answer 28

Less