Wound Healing Flashcards
intermediate phase: when and what (3)
4-30 days
epithelialization (24-48h after for incisional wounds)
angiogenesis
fibroblast migration & proliferation
early phase? how many days?
0-5 days
inflammatory. PMNs migrate to area first 48-72h
macrophages migrate 72h after injury, stimulate fibroblasts & collagen production
when is the late phase and what is it (4)
3 weeks- 2 years
matrix deposition for collagen
collagen synthesis
thickening of collagen fibers- increased tensile strength
wound contraction (continues for 12-15 days)
collagen synthesis timeline
begins 3-5 days after injury
rapid rate up to 4-5 weeks, then declines
when does the collagen content peak in a healing wound
4 weeks
when does the wound reach 80% of eventual strength? 90%?
6 weeks
6 mo.
when and what is the final phase of wound healing
30 days - 2 years
scar remodeling & maturation
becomes avascular and acellular
most common method of wound closure?
primary intention
how does a wound close by secondary intention
contraction & epithelialization
which wounds are usually closed by secondary intention? (3)
full thickness wounds
contaminated
infected
which wounds are closed by tertiary intention
obvious infection or contamination
how do you close an abrasion
rarely closed
closing a puncture?
secondary intention
closing a laceration?
6-8h after wound or ASAP
how long to leave a dressing in place on a clean wound
48h
how do you pack a contaminated wound
how often do you change the dressing
packed open to promote hemostasis and drainage
changed every 8-12h
what kind of wounds do you leave open (several)
bite wounds, >8h since wound (non-face), necrotic tissue, foreign material, high velocity injuries, inflamed/infected, crushed/ischemic tissue, steroid use
treatment of traumatic wounds (3)
cleanse
anesthetize
debridement
where to avoid anesthetics w/ epinephrine? (5)
ears fingers toes nose peen
biggest source of wound infection?
patient
C. diff prevention?
handwashing with soap and water, not alcohol or gels
methods for treating chronic wounds (5)
debridement cleaning dressing changes negative pressure devices hyperbaric O2
examples of chronic wounds (3)
diabetic foot ulcers
venous stasis ulcers
open wounds
risk factors for pressure ulcers (4)
neurologically impaired pts
bedridden
paralyzed
critically ill
nonblanching erythematous intact skin, pressure sore
grade 1
pressure sore- partial-thickness skin loss, can appear as a blister or abrasion
stage 2
pressure sore- full thickness skin loss w/ necrosis of subcutaneous tissue that can extend to fascia
grade 3
pressure sore- full thickness skin loss w/ necrosis. can involve muscle, bone, and tendon
grade 4
treatment of sebaceous cyst (2)
incision & drainage
excision of entire capsule
soft, fatty, subcutaneous mass
lipoma
soft, smooth borders, encapsulated, freely moving mass
non-infected sebaceous cyst
erythematous, tender, fluctuant cutaneous nodule
infected sebaceous cyst
fluctuant, tender, erythematous lesion. local LAD, fever, chills
abscess
abscess treatment (3)
incision & drainage for pain relief
open with #11, evacuate contents, irrigate, & pack open
may need to anesthetize & go to the OR for large abscesses
small midline pits or abscesses on/off midline near coccyx or sacrum
pilonidal disease
fever, wound crepitance, gray or dusky skin
necrotizing fasciitis
fever, perineal & scrotal pain, indurated tissue
Fournier’s Gangrene
risk factors for Fournier’s Gangrene (5)
urethral strictures perirectal abscess poor hygiene DM CA
