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Surgical principles > Wound healing > Flashcards

Wound healing Flashcards

1
Q

What are the 4 main stages in wound healing?

A

1) coagulation
2) inflammation
3) new tissue formation / proliferation
4) remodelling / maturation

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2
Q

What are the main cells seen during inflammation?

A

platelets
macrophages
neutrophils

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3
Q

What are 4 jobs of macrophages during inflammation?

A

1) remove wound debris and degrade matrix
2) cell recruitment and activation
3) angiogenesis
4) matrix synthesis regulation

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4
Q

Main cells types needed for tissue formation?

A 
macrophages
lymphocytes
fibroblasts
epithelial cells
endothelial cells
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5
Q

What are the 8 stages of new tissue formation?

A

1) single keratinocyte layer migrates under the fibrin clot to re-surface the wound (angiogenesis, ECM production, dissolve non-viable tissue)
2) Differentiation and stratification of neo-dermis
3) Fibrin clot secrets factors to promote re-epithelialisation
4) Angiogenesis stimulated by keratinocytes and macrophages
5) Fibroblasts at wound edge promote angiogenesis and synthesis and deposit ECM
6) Fibroblasts become myofibroblasts and express contractile proteins
7) Myofibroblasts contract pulling wound together
8) Now have granulation tissue (takes 3-5 d)

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6
Q

What is proud flesh?

A

Normal exuberant granulation tissue in horses

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7
Q

How long can the remodelling phase last?

A

over a year

dont get any appendages grow on it (hair etc)

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8
Q

What are Esmarch’s principles of wound management?

A
  • non-introduction of anything harmful
  • tissue rest
  • wound drainage
  • avoidance of venous stasis
  • cleanliness
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9
Q

What are 6 reasons for swelling at the incision site?

A

1) acute haemorrhage and haematoma
2) swelling and oedema
3) seroma
4) acute infection
5) abscess
6) diehescence of underlying body wall

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10
Q

How can haemorrhage be classified?

A

primary
delayed primary
secondary

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11
Q

What can haematoma do to a wound?

A 
physical separation of wound edges
prevention of adherence of flaps and grafts
barrier to leucocyte migration
growth medium for bacteria
pain
deformity
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12
Q

What can swelling and oedema do to a wound? How to treat it?

A

dehiscence
reduce vascularity

  • massage, support dressing, remove constricting sutures
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13
Q

What is a seroma?

A

Collection of serum and tissue fluid in dead space

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14
Q

How can a seroma affect a wound?

A

tissue serparation
tension on sutures
intereferes with blood supply and WBC migration

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15
Q

What can cause a seroma?

A 
inflammation
lymphatic injury
poor haemostasis
traumatic surgery
implants
movement
dead space
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16
Q

2 main categories of dehisccence?

A

excessive force on incision

poor wound holding strength

17
Q

6 groups of things that can delay/complicate wound healing

A

1) swelling at incision site
2) dehiscence
3) wound infection
4) tissue necrosis / sequestration
5) scarring / contracture / adhestions
6) draining tracts

18
Q

Problem with excess scarring and how to avoid it?

A
  • may limit movement over joints and cause closure of orifices
  • avoid by atraumatic surgery, control of infection, early wound closure
19
Q

What is the problem with wound contracture? how can it be prevented?

A

loss of function of a body part due to excessive scarring

prevent by early wound closure

20
Q

When do adhesions occur? and what are they caused by?

A

when equilibrium between normal fibrin depostion and fibrinolysis is disrupted
caused by ischaemia, haemorrhage, foreign body, infection

21
Q

how can adhesions be prevented?

A

atraumatic handling
keeping tissues moist
asepsis

22
Q

What is a sinus draining tract?

A

Blind ending tract that extends from an epithelial surface

23
Q

What is a fistula?

A

communicating tract extending from one epithelial surface to another

24
Q

What can draining tracts be due to?

A 
necrotic tissue
resistant bacteria / fungi
underlying osteomyelitis or sequestrum
foreign bodies
neoplasia
25
Q

what do you do with draining tracts?

A

excise or lavaged with open/closed management

26
Q

What can cause problems in granulation tissue formation?

A

necrotic / devitalised tissue
wound infection
movement
near bone

27
Q

What can cause failure of wound contraction?

A 
peripheral countertension (no lose skin)
restrictive fibrosis (excess scar)
28
Q

What can cause failure of epithelialisation?

A 
necrotic tissue
wound infection
fibrotic scar tissue
poor quality granulation tissue
repeated trauma
bandages abrading the wound
tissue desication
movement
29
Q

What is an indolent pocket wound?

A

granulation tissue with pliable skin surrounding it but the skin is elevated and doesnt adhere to the margins

30
Q

How can you manage indolent pocket wounds?

A 
no infection
excise scar border
suture wound
anchor wound edges to granulation tissue
manage dead space with drains
use skin flaps / omentalisation

Surgical principles (9 decks)

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