Wound Healing Flashcards
What are the three phases of wound healing?
Inflammatory/substrate
Proliferative
Maturation/remodeling
What is primary wound healing?
Healing by primary intention- Tissue is anatomically re-approximated
What are the advantages of primary wound healing?
Ease in wound care
Faster return of function
Better cosmetic results
What are the disadvantages if primary wound healing?
Risk of wound infection
What is secondary wound healing?
Wound is left open and granulation tissue forms and there is an eventual coverage of the defect by wound contraction
What are the advantages of secondary wound healing?
Infection is virtually impossible
What are the disadvantages of secondary wound healing?
Complicated wound care
Bad cosmetic outcome
When should secondary wound healing be used?
When there is a highly-contaminated wound
What is tertiary wound healing?
Wound is left open
Closed about 5 days of wound care
Abundant granulation tissue
Rarely done
What cells are found during the inflammatory phase of wound healing?
PMNs, platelets, macrophages
How does the wound appear during the inflammatory phase of wound healing?
Edematous and erythematous
How long does the inflammatory phase of wound healing take?
Approx 4 days
When does the proliferative phase of wound healing take place?
Only once wound is covered in epithelium
What is produced during the proliferative phase?
Collagen
How does the wound appear during the proliferative phase?
Raised, red, and hard scar
What is the maturation phase of wound healing?
Maturation of collagen by intermolecular cross-linking
How does the wound appear during the maturation phase?
It flattens, becomes less prominent, and more pale and supple.
What is a clean wound?
A new wound
What is an avulsion wound?
Skin violated by shearing force with a flap or total skin loss
What are the five classifications of wounds?
Clean Avulsion Abrasion Puncture Crush
Under what circumstances should you not close a contaminated wound?
If high bacteria inoculum as in human bites or farm injury.
If it has been >4 hours since injury
If it is a crush injury
What classifies an infected wound?
Contamination >10^5 organisms per gram of tissue
Should systemic abx be used for contaminated wounds?
Not helpful unless cellulitis or signs of sepsis, but might use topical abx
What factors inhibit wound healing?
Hypoxia/ischemia Wound infection Edema Pressure Fecal soiling
What vitamin aides in collagen formation
C
What vitamin helps clotting?
K
What Vitamin helps the inflammatory response, collage, and macrophags?
A
What mineral helps protein synthesis?
Mg
What mineral is a cofactor for RNA and DNA synthesis?
Zinc
What factors of wound healing does hyperglycemia inhibit?
collagen formation, fibroblast and endothelial cell proliferation in the wound
How do steroids affect wound healing?
Blunt inflammatory response
Decrease vit A in wound
Alter deposition and remodeling of collagen
How does chronic illness affect wound healing?
Predispose to infection and malnutrition
In which phase are chronic wounds stalled?
Inflammatory phase
Stage I pressure ulcer
Unblanchable erythema
Stage II pressure ulcer
Partial thickness skin loss
Stage III pressure ulcer
Full thickness skin loss
Stage IV pressure ulcer
Full thickness skin loss with involved supporting structures
How do you characterize a wound?
Size, depth, extend of undermining
Necrotic or viable surface?
Amount/characteristic of exudate
Status of periwound tissues
What are the most common chronic wounds in the adult?
Venous stasis ulcer
What are other symptoms of venous stasis?
Leg discomfort, vericose veins, hyperpigmentation
Where are venous stasis ulcers most commonly found?
Anterior medial malleolus
How are venous stasis ulcers treated?
Compression Elevation Debridement (+/-) Abx (+/-) Vein Ligation
What are arterial insufficiency ulcers caused by?
Atherosclerosis
Where do arterial insufficiency ulcers usually appear?
Toes but can be anywhere on the foot, ankle, or leg
What are other features of an arterial insufficiency ulcer?
Dry or wet gangrene, cool skin, limb loss
What are the 5 p’s of arterial insufficiency ulcers?
Pain, pallor, pulselessness, paresthesias, paralysis
How are arterial insufficiency ulcers treated?
Revascularization, amputation
What three features are common in diabetic neuropathic ulcers?
Hyperglycemia, Arterial disease, a site of increased weight bearing
How are diabetic neuropathic ulcers treated?
Control infection Debridement Special shoes Arterial revascularization wound care amputation
What are the three most important factors in formation of the ideal scar?
- Accurate alignment of sharply incised tissue parallel to the natural lines of resting skin tension
- Closure of wound without tension on epidermis
- Primary healing without complications
What is a hypertrophic scar?
Widening or unsightly scar that does not extend beyond the original boundaries of the wound
How is a hypertrophic scar treated?
Can be excised if initial closure was unusual
steroid injection
What is a keloid?
An abnormal scar that grows beyond the boundaries of original skin injury
How are keloids treated?
Excision + injected steroids
What type of organism is found in an infected surgical incision of the skin and subQ tissue?
Gram +
How is cellulitis treated?
Oral abx
How is a superficial abscess that is above fascia of the wound bed treated?
Re-opening of the wound with or without abx
What type of organisms are in a deep incisional surgical site infection?
Polymicrobial
How is a deep incisional surgical site infection treated?
Open the wound with or without debridement, abx
How is a surgical site infection of the organs or intracavitary space treated?
Drainage, IV abx
What is a clean-case?
Elective, non-traumatic surgery, primarily closed, no acute inflammation, no break in technique, no entry of respiratory, GI, biliary, or GU tracts
What is a clean-contaminated case?
An elective opening of the respiratory, GI, biliary, or GU tract with minimal spillage, not contacting infected urine or bile, minor technique break
What is a contaminated case?
Non-purulent inflammation, gross spillage from GI tract, entrance into biliary or GU tract with infected bile/urine, major break in technique, penetrating trauma <4 hrs old, chronic open wounds to be grafted or covered
What is a dirty case?
Purulent inflammation, preoperative perforation of resp, GI, biliary or GU tract, penetrating trauma >4 hours old
When are perioperative abx used?
1 hr before incision
Continue postop for no more than 24 hrs or not at all
Dirty cases require prolonged abx
No abx in clean cases unless:
a prosthetic is used
Which types of surgeries require pre-op antibiotics?
clean-contaminated, contaminated, and dirty cases
