Wound Healing

Question 0

intermediate phase: when and what (3)

Answer 0

4-30 days
epithelialization (24-48h after for incisional wounds)
angiogenesis
fibroblast migration & proliferation

Question 1

early phase? how many days?

Answer 1

0-5 days
inflammatory. PMNs migrate to area first 48-72h
macrophages migrate 72h after injury, stimulate fibroblasts & collagen production

Question 2

when is the late phase and what is it (4)

Answer 2

3 weeks- 2 years
matrix deposition for collagen
collagen synthesis
thickening of collagen fibers- increased tensile strength
wound contraction (continues for 12-15 days)

Question 3

collagen synthesis timeline

Answer 3

begins 3-5 days after injury

rapid rate up to 4-5 weeks, then declines

Question 4

when does the collagen content peak in a healing wound

Answer 4

4 weeks

Question 5

when does the wound reach 80% of eventual strength? 90%?

Answer 5

6 weeks

6 mo.

Question 6

when and what is the final phase of wound healing

Answer 6

30 days - 2 years
scar remodeling & maturation
becomes avascular and acellular

Question 7

most common method of wound closure?

Answer 7

primary intention

Question 8

how does a wound close by secondary intention

Answer 8

contraction & epithelialization

Question 9

which wounds are usually closed by secondary intention? (3)

Answer 9

full thickness wounds
contaminated
infected

Question 10

which wounds are closed by tertiary intention

Answer 10

obvious infection or contamination

Question 11

how do you close an abrasion

Answer 11

rarely closed

Question 12

closing a puncture?

Answer 12

secondary intention

Question 13

closing a laceration?

Answer 13

6-8h after wound or ASAP

Question 14

how long to leave a dressing in place on a clean wound

Answer 14

48h

Question 15

how do you pack a contaminated wound

how often do you change the dressing

Answer 15

packed open to promote hemostasis and drainage

changed every 8-12h

Question 16

what kind of wounds do you leave open (several)

Answer 16

bite wounds, >8h since wound (non-face), necrotic tissue, foreign material, high velocity injuries, inflamed/infected, crushed/ischemic tissue, steroid use

Question 17

treatment of traumatic wounds (3)

Answer 17

cleanse
anesthetize
debridement

Question 18

where to avoid anesthetics w/ epinephrine? (5)

Answer 18

ears
fingers
toes
nose
peen

Question 19

biggest source of wound infection?

Answer 19

patient

Question 20

C. diff prevention?

Answer 20

handwashing with soap and water, not alcohol or gels

Question 21

methods for treating chronic wounds (5)

Answer 21

debridement
cleaning
dressing changes
negative pressure devices
hyperbaric O2

Question 22

examples of chronic wounds (3)

Answer 22

diabetic foot ulcers
venous stasis ulcers
open wounds

Question 23

risk factors for pressure ulcers (4)

Answer 23

neurologically impaired pts
bedridden
paralyzed
critically ill

Question 24

nonblanching erythematous intact skin, pressure sore

Answer 24

grade 1

Question 25

pressure sore- partial-thickness skin loss, can appear as a blister or abrasion

Answer 25

stage 2

Question 26

pressure sore- full thickness skin loss w/ necrosis of subcutaneous tissue that can extend to fascia

Answer 26

grade 3

Question 27

pressure sore- full thickness skin loss w/ necrosis. can involve muscle, bone, and tendon

Answer 27

grade 4

Question 28

treatment of sebaceous cyst (2)

Answer 28

incision & drainage

excision of entire capsule

Question 29

soft, fatty, subcutaneous mass

Answer 29

lipoma

Question 30

soft, smooth borders, encapsulated, freely moving mass

Answer 30

non-infected sebaceous cyst

Question 31

erythematous, tender, fluctuant cutaneous nodule

Answer 31

infected sebaceous cyst

Question 32

fluctuant, tender, erythematous lesion. local LAD, fever, chills

Answer 32

abscess

Question 33

abscess treatment (3)

Answer 33

incision & drainage for pain relief
open with #11, evacuate contents, irrigate, & pack open
may need to anesthetize & go to the OR for large abscesses

Question 34

small midline pits or abscesses on/off midline near coccyx or sacrum

Answer 34

pilonidal disease

Question 35

fever, wound crepitance, gray or dusky skin

Answer 35

necrotizing fasciitis

Question 36

fever, perineal & scrotal pain, indurated tissue

Answer 36

Fournier’s Gangrene

Question 37

risk factors for Fournier’s Gangrene (5)

Answer 37

urethral strictures
perirectal abscess
poor hygiene
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