wound healing

Question 1

superficial wounds: skin tears

Answer 1

confined to layers of epidermis and dermis

will heal by re-epithelialization

Question 2

wounds extending past the dermis heal by:

Answer 2

scar formation

Question 3

3 types of wound healing:

Answer 3

primary intention
secondary intention
tertiary intention

Question 4

primary intention:

Answer 4

wounds that have been surgically closed or approximated with sutures or staples

Question 5

secondary intention:

Answer 5

wounds that have been left open and allowed to heal through scar tissue formation

Question 6

tertiary intention:

Answer 6

delayed primary closure

occurs when wound is intentionally left open for a period of time and then closed surgically at a later date

often necessary in cases where there is a wound infection that needs to be treated before surgical closure

Question 7

wounds that fall into category of healing by secondary intention:

Answer 7

pressure
venous
arterial
diabetic
neuropathic

Question 8

trajectory of wound healing:

Answer 8

process of how wounds extending beyond the dermis heal once there is tissue damage

visualized as:
1) hemostasis
2) inflammation
3) proliferation
4) remodeling

4 phases are over-lapping = each phase must be completed in order for the wound to close

Question 9

wound healing relies on:

Answer 9

sequential cascade of cellular and biomechanical events

if trajectory is interrupted at any point, the wound will not close

Question 10

hemostasis:

Answer 10

body’s immediate response to any type of tissue injury

vasoconstriction occurs and platelets aggregate in injured area to initiate blood coagulation

result = formation of fibrin clot = seals of injured vessels so blood loss is controlled

calcium and vitamin K = important in clot formation

after clot forms = it contracts = starts to pull wound edges in

Question 11

failure to clot: factors

Answer 11

medications (anti-coagulants)

recent lab reports (low platelet counts)

Question 12

inflammatory:

Answer 12

occurs once bleeding is controlled

can last up to 4 days

focus = establish a clean wound bed

neutrophils, macrophages, and lymphocytes enter wound bed and begin phagocytosis of bacteria and damaged tissue

increased erythema, induration, heat, and pain

Question 13

things that delay/impair inflammatory process:

Answer 13

steroid medication
diabetes mellitus
HIV
chemotherapy
necrotic tissue in wound bed
foreign bodies (sutures/staples)
wound infection
advanced age
repeated pressure or trauma

Question 14

impaired immune reponses =

Answer 14

mask traditional signs of infection and inflammation

until these factors are treated or removed, they will continue to delay healing

Question 15

proliferation:

Answer 15

growth of granulation tissue filling in the wound cavity

neoangiogenesis = development of new capillaries

once wound has started filling in = edges begin to contract = wound begins to epithelialize

new epithelial cells branch from edges of wound by joining with small islands of epithelialized tissue in wound bed until it resurfaced the entire wound

starts 4th day of tissue damage and lasts up to 21 days

Question 16

poor nutrition:

Answer 16

can prolong proliferation phase of healing

growth of new granulation tissue and blood vessels is delayed

wounds healed without optimal nutrition = weak = likely to break down again

Question 17

remodelling/maturation:

Answer 17

last and longest phase of wound healing

starts after wound closure - lasts up to 2 years

additional collagen is laid down in the wound and reorganized to increase tensile strength

edges of wound contract/draw together = decreasing size of defect

restructuring and realigning of tissue = increase its tensile strength

changes color of scar from dusty red to pale pink or white

Question 18

closed vs healed

Answer 18

when epithelialization is completed the wound is considered closed rather than healed

closed wound is still weak and vulnerable to re-injury

even when remodeling is completed and wound is considered healed - scar tissue is only about 80% as strong as original skin

healed wound is always at higher risk of injury

Question 19

timeline for trajectory of wound healing:

Answer 19

hemostasis: immediate
inflammation: 0-4
proliferation: 4-21
remodeling: 21- 2 years

Question 20

A venous ulcer has been present for four weeks. Mrs.Applewood has had vascular testing to indicate there is enough arterial blood supply to support wound healing. She eats well, is active, and does not smoke.

This wound is in the ____ phase of wound healing as there is presence of necrotic tissue

Answer 20

inflammatory

Question 21

A venous ulcer has been present for four weeks. Mrs.Applewood has had vascular testing to indicate there is enough arterial blood supply to support wound healing. She eats well, is active, and does not smoke.

It is healing by:

Answer 21

secondary intention

Question 22

A venous ulcer has been present for four weeks. Mrs.Applewood has had vascular testing to indicate there is enough arterial blood supply to support wound healing. She eats well, is active, and does not smoke.

Increased pain and erythema are signs of wound infection. Will the wound progress to the next phase of wound healing while there is infection present?

Answer 22

No

Question 23

A stage 4 pressure ulcer (went to bone) over a coccyx. Without conservative wound management, it took 10 weeks to close to this present state.

This wound is completely closed and is in the ___ phase of wound healing trajectory.

Answer 23

remodeling/maturation

Question 24

A stage 4 pressure ulcer (went to bone) over a coccyx. Without conservative wound management, it took 10 weeks to close to this present state.

True or false: We still protect this area after is has closed over with epithelial tissue as extra collagen is deposited in the affected area during this phase.

Answer 24

True

collagen deposition helps increase tensile strength of tissue, however the resulting scar will never be as strong as the undamaged skin prior to injury

area = at higher risk of re-injury

Question 25

A stage 4 pressure ulcer (went to bone) over a coccyx. Without conservative wound management, it took 10 weeks to close to this present state.

True or false: In this final phase, vascularity of the tissue is decreased and there is contracture of the scar.

Answer 25

True

decreased vascularity leads to a color change in the scar from dusky red to pale pink or white

contraction decreases the overall size of the scar

Question 26

When the wound was open and needed dressing changes, part of the care plan was to ensure the patient did not lie on his back for any great period of time and instead alternated lying side to side. Though the wound has now closed over, the health care team decides to keep this plan in place. They slowly increase the time spent on his back but closely monitor it for any new areas of tissue damage.

A few days later, you notice tissue damage has occurred to this same area. The wound presents with yellow necrotic tissue, erythema and increased pain. This wound is now in the ___ phase.

Answer 26

inflammatory