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FoundSci II Unit 1 > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

What is wound healing?

A

Restoration of tissue architecture and function after an injury

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2
Q

What is wound healing?

A

A term used in the context of regeneration

When the original architecture and structure of an organ or anatomic part is completely restored to the way it was before injury

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3
Q

What is wound repair?

A

Eventual outcome is not anatomic restoration but a functional compromise`

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4
Q

What are labile cells? x4

A

Cells that undergo continuous, rapid, normal regeneration

  1. Bone marrow
  2. Epidermis
  3. Gastrointestinal epithelium
  4. Bronchial epithelium
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5
Q

What are stable cells?

A

High regenerative activity with injury

Liver and kidney cells

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6
Q

What are permanent cells?

A

No regeneration, scarring only

Brain
Heart muscle
Skeletal muscle

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7
Q

Which cells do not have stem cells?

A

Permanent cells

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8
Q

What occurs with injury and inflammation with tissue that is not capable of regeneration?

A

Scarring - fibrous repair only

Wound repair

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9
Q

What occurs with inflammation and injury with tissue capable of regeneration?

A

If limited injury, normal anatomy is regenerated (wound healing)

If extensive injury, partial regeneration and scarring (fibrous repair) - more like wound repair

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10
Q

What are the 3 phases of the wound healing process?

A
  1. Inflammatory phase
  2. Proliferative phase
  3. Remodeling phase
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11
Q

What are the characteristics, timeline, and effector cells of the inflammatory phase of wound healing?

A

Occurs up to 3 days after wound

Cells - platelets, neutrophils, macrophages

Clot formation, increased vessel permeability and neutrophils migrate into tissue

Macrophages clear debris 2 days later

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12
Q

What are the characteristics, timeline, and effector cells of the proliferative phase of wound healing?

A

Day 3 - weeks after wound

Cells - fibroblasts, myofibroblasts, endothelial cells, keratinocytes, macrophages

Deposition of granulation tissue and type III collagen, angiogenesis, epithelial cell proliferation, dissolution of clot, and wound contraction (myofibroblasts)

Delayed wound healing in Vitamin C and copper deficiencies

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13
Q

What are the characteristics, timeline, and effector cells of the remodeling phase of wound healing?

A

1 week - 6+ months after wound

Cells - fibroblasts

Type III collagen replaced by type I collagen, increased strength of tissue

Delayed wound healing in zinc deficiency

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14
Q

What are the differences between the proliferative and remodeling phase of wound healing?

A

Proliferative - type III collagen, granulation tissue

Remodeling - type I collagen

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15
Q

What deficiencies delay wound healing?

A

Vitamin C, copper, and zinc

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16
Q

What is the “director” of wound healing? What does the director do?

A

Macrophage

  1. Removes injured tissue and debris (phagocytosis, collagenase, elastase)
  2. Antimicrobial activity (ROS, nitric acid)
  3. Chemotaxis and proliferation of fibroblasts and keratinocytes (PDGF, TFG-beta, TNF, IL-1, KGF-7)
  4. Angiogenesis (VEGF, FGF-2, PDGF)
  5. Deposition and remodeling of ECM (TGF-beta, PDGF, TNF, OPN, IL-1, collagenase, MMPs)
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17
Q

What is the role of PDGF?

A

Secreted by activated platelets and macrophages

Induce vascular remodeling and smooth muscle cell migration

Stimulate fibroblast growth for collagen synthesis

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18
Q

What is the role of FGF?

A

Stimulates angiogenesis by promoting proliferation of endothelial cell

Stimulates proliferation of fibroblast

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19
Q

What is the role of EGF?

A

Stimulates cell growth via tyrosine kinases (EGFR/ErbB1)

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20
Q

What is the role of TGF-beta?

A

Angiogenesis, fibrosis

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21
Q

What is the role of metalloproteinases?

A

Tissue remodeling

22
Q

What is the role of VEGF?

A

Stimulate angiogenesis

23
Q

What are the steps of angiogenesis? What is the major regulatory molecule?

A
  1. Capillary budding
  2. Endothelial cell proliferation
  3. Major molecule - VEGF

Other molecules involved - PDGF, FGF, TGF-beta

24
Q

What are the steps of fibrogenesis? What is the major stimulatory molecule?

A
  1. Fibroblast activation and proliferation
  2. Collagen deposition
  3. Major molecule - TGF-beta

Other molecules involved include PDGF, FGF

25
What is seen with fibrosis?
By 3-5 days, a specialized type of tissue that is characteristic of healing becomes apparent - granulation tissue
26
What is the histological appearance of granulation tissue?
Proliferation of fibroblasts New thin-walled, delicate capillaries Fibroblasts and capillaries are in a loose ECM Scattered macrophages and some other inflammatory cells
27
How does scarring occur?
Granulation tissue progressively accumulates CT matrix, eventually resulting in dense fibrosis (scarring) which may further remodel over time
28
What is seen with early granulation tissue?
Numerous macrophages, myofibroblasts, and blood vessels
29
What is seen with late granulation tissue?
Less vascular, only scattered macrophages with more matrix and fibroblasts
30
What is granulation tissue and what can occur?
A temporary structure that matures by the process of cicatrization (collagen deposition, contraction, and devascularization) to form a scar Contraction may lead to considerable deformity (contracture) and functional impairment The more granulation tissue, the more the contraction and the greater the risk of organ impairment
31
What are the factors that influences tissue repair? x6
1. Infection 2. Diabetes 3. Steroids 4. Ischemia 5. Foreign body 6. Nutritional status
32
What are the characteristics of infection that influence tissue repair?
Delays healing
33
What are the characteristics of diabetes that influence tissue repair?
One of the most important systemic causes of abnormal wound healing
34
What are the characteristics of steroids that influence tissue repair?
Result in weakness of scar due to its inhibition of TGF-beta production and diminished fibrosis
35
What are the characteristics of ischemia that influence tissue repair?
Due to arteriosclerosis and diabetes or to obstructed venous drainage (varicose veins)
36
What are the characteristics of a foreign body that influence tissue repair?
Fragments of steel, glass, or even bone impede healing
37
What are the characteristics of nutritional status that influence tissue repair?
Protein deficiency, particularly Vitamin C deficiency, inhibits collagen synthesis and retards wound healing
38
The healing of skin wounds is said to occur by.....
First or second intention
39
What is healing by first intention?
In a closed, noninfected wound, such as a surgical incision, the margins are opposed and healing occurs directly, with a minimum of granulation tissue Epithelial regeneration (epithelization) predominates over fibrosis
40
How does healing by 2nd intention differ from healing by 1st intention?
1. Non-opposed wound margins 2. Large tissue defects have more necrotic debris, exudate and fibrin to be removed 3. More granulation tissue is formed 4. Seen in large gaping wound, infected wound or foreign body containing wound 5. Myofibroblast - wound contraction within 6 weeks
41
What is wound contraction?
Reduction in the size of a wound that is healed by 2nd intention, as a result of the action of myofibroblasts in the granulation tissue Exposed surface is reduced by gradual regeneration of the surface epithelium Complication is contracture
42
What are myofibroblasts and their properties?
Found in granulation tissue Have hybrid properties of fibroblasts and smooth muscle cells Can produce collagens and other ECM proteins Can also contract - important for contraction of wounds and prevention of dehiscence (split apart)
43
What is keloid?
Accumulation of exuberant amounts of collagen Give rise to prominent, raised scars Hereditary predisposition to keloid formation - more common in African Americans
44
What is the histological appearance of a keloid?
Dermis replaced by a meshwork of thick collagen fibers without many cells and lacking glands and hair follicles
45
What is a hypotrophic scar?
Atrophic or depresses Have a sunken and often hyperpigmented appearance due to loss of collagen and ground substance Ex. acne, pregnancy stretch marks
46
What is a hypertrophic scar?
Similar to keloid scar BUT never gets worse beyond 6 months
47
What is different between a hypertrophic scar and keloid?
A hypertrophic scar never gets worse beyond months and occurs early after injury, reaches a certain size, and regresses Following excision a keloid tends to recur, whereas a hypertrophic scar does not Keloid begins later after the event and grow over time without any tendency to subside
48
What are the characteristics of a hypertrophic scar in regards to collagen, extent of scar, myofibroblast, recurrence, and predisposition?
Increased type III collagen Parallel collagen Confined to borders of original wound Numerous myofibroblast Infrequent recurrence No predispostion
49
What are the characteristics of a keloid in regards to collagen, extent of scar, myofibroblast, recurrence, and predisposition?
LOTS of type I and III collagen Disorganized collagen Extends beyond borders of original wound with claw like projection Few myofibroblasts Frequent recurrence Increased incidence in ethnic groups with darker skin
50
What is proud flesh (exuberant granulation tissue)?
Healing wounds may generate excessive granulation tissue - abnormal cell growth and ECM production in wound healing Protrudes above the level of surrounding skin wound, preventing wound closure or hindering proper epithelization When bumped, rubbed, or traumatized - bleeds excessively Cautery or surgical resection is necessary for restoration of epithelial continuity
51
What is contracture?
An exaggeration of contraction Results in severe deformity of the wound and surrounding tissues Contractures are particularly conspicuous in the healing of serious burns Can be severe enough to compromise the movement of joints Related to extensive burns
52
Besides joint spaces, where is contracture also important?
Important in hollow viscera like urethra, esophagus, intestine where it leads to progressive stenosis with stricture formation

FoundSci II Unit 1 (9 decks)

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