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822: Integumentary > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

What are the 3 phases of wound healing?

A

1) inflammation
2) proliferation
3) maturation and remodeling

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2
Q

The inflammatory phase consists of 2 responses, what are they?

A

1) vascular

2) cellular

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3
Q

Immediately following injury, the body responds in 3 ways to try and control blood loss. What are they?

A

1) injured blood vessel walls allow transudate to leak out of the vessels and into the interstitial space causing edema
2) local blood vessels reflexively constrict for several minutes after injury to further reduce blood loss
3) platelets aggregate at the site of injury and are activated by contact with damaged endothelial cells lining vessel walls and exposed collagen

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4
Q

The exposed collagen activates the platelets to release what 3 chemical mediators? What does each do?

A
  • Cytokines: signal proteins
  • Growth factors: control cell growth, differentiation, and metabolism
  • Chemotactic agents: attract cells for wound repair to the area
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5
Q

Within __ minutes of the initial vasoconstriction that occurs following injury blood vessels begin to vasodilate pushing more fluid into the interstitial space and allowing more growth factors and inflammatory cells to reach the injured area.

A

30

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6
Q

This mixture of fluid, proteins, and WBCs within the interstitial space is now called what?

A

exudate

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7
Q

The histamine that is released during the vascular response of the inflammatory phase acts to do what?

A

increase vessel wall permeability allowing for short term vasodilation

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8
Q

The prostaglandins that are released during the vascular response of the inflammatory phase acts to do what?

A

provide a more Long-term vasodilation

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9
Q

What are the 5 cardinal signs of inflammation?

A
  • Swelling
  • Redness
  • Warmth
  • Pain
  • Decreased function
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10
Q

What is the Latin word for swelling?

A

tumor

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11
Q

What is the Latin word for redness?

A

rubor

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12
Q

What is the Latin word for warmth?

A

calor

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13
Q

What is the Latin word for pain?

A

dolor

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14
Q

What is the Latin word for decreased function?

A

functio laesa

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15
Q

Increased vessel wall leakiness causes a decrease in local blood volume which slows the flow of circulating WBCs traveling within the capillaries and arterioles. This is known as the _____ response.

A

cellular

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16
Q

What WBCs are the first to reach the site of injury?

A

Polymorphonuclear neutrophils (PMNs)

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17
Q

Describe the 3 step process by which PMNs reach the site of injury.

A

1) diapedesis
2) margination
3) chemotaxis

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18
Q

PMNs reach the site of injury within how long?

A

12-24 hours

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19
Q

Once present, PMNs secrete chemotactic agents and mediators of inflammation. What do these substances then do?

A
  • attract more inflammatory cells to the injured area
  • stimulate fibroblasts migration
  • induce new vascular growth
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20
Q

What are the next cells to arrive after PMNs?

A

circulating monocytes, or macrophages once in the interstitium

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21
Q

What role do macrophages play in wound healing?

A

They signal the extent of the injury, attracting more inflammatory cells to the area as needed

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22
Q

Mast cells also help with wound healing during the cellular response, what role do they play?

A

They produce chemical mediators that attract and activate inflammatory cells

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23
Q

In healthy individuals it is possible for the proliferative phase of healing to begin within __ hours of injury

A

48

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24
Q

The proliferative phase consists of 4 crucial events, what are they?

A

1) angiogenesis
2) granulation tissue formation
3) wound contraction
4) epithelialization

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25
Q

Define angiogenesis

A

the formation of new blood vessels

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26
Q

What cells form the new blood vessels?

A

angioblasts

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27
Q

What do matrix metalloproteases (MMPs) do during granulation tissue formation?

A

they degrade the debris formed during the inflammatory phase leaving a defect that must be filled in order for healing to progress

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28
Q

What is granulation tissue?

A

a temporary latticework of vascularized connective tissue that fills the void left behind from the MMPs

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29
Q

What cells fill the spaces between the collagen and elastic fibers in the granulation tissue forming an extracellular matrix?

A

Fibroblasts

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30
Q

What does the extracellular matrix allow for?

A

Fibroblasts and other cells to advance across the wound bed by providing a scaffolding on which they can migrate

31
Q

Surface cells receptors, called ______, help cells recognize and reversibly bind to the extracellular matrix allowing this migration

A

integrins

32
Q

What eventually replaces granulation tissue?

A

scar tissue

33
Q

Some fibroblasts within the wound bed are transformed in ______ which cause wound contraction

A

myofibroblasts

34
Q

What type of wound contracts the fastest? Slowest?

A

linear wounds

circular wounds

35
Q

Is wound contraction greater in full or partial thickness wounds? Why?

A

Full, due to the increased amount of granulation tissue formation required for deeper wounds

36
Q

What type of cells reepithelialize the wound surface?

A

keratinocytes

37
Q

Describe the process by which keratinocytes reepithelialize the wound

A

They elongate, extend pseudopods across the extracellular matrix, and then pull their parent cells with them as they advance

38
Q

What can slow the process of epitheltialization?

A

low oxygen tension and thick debris

39
Q

When examining a wound what 2 things are indicative of the proliferative phase?

A
  • small endothelial buds within the wound bed, indicating angiogenesis
  • pale pink epithelial cells at the wound edge which is evidence of epithelialization
  • wound contraction
40
Q

After the prolifertive phase the granulation tissue matrix must continue to strengthen and reorganize itself to fit the surrounding tissue which requires continued collagen synthesis. The old collagen is broken down by what?

A

collagenases

41
Q

How can you tell the differnece between a scar that is remodeling and one that is fully remodeled?

A

A rosy, pink scar is still in the remodeling phase, whereas a scar that is pale or more closely approximates the surrounding tissue color is fully remodeled

42
Q

Describe the change collagen fibers make during the remodeling phase

A

They change from immature Type III collagen to mature type I collagen and reorient along the line of stress

43
Q

Remodeling continues up to _ years following wound closure, with the greatest amount occurring when?

A

2

6-12 months

44
Q

Even once fully remodeled, scar tissue is at most only __% of the original tissue’s strength and elasticity

A

80

45
Q

What are the 3 types of wound closures?

A
  • primary
  • secondary
  • delayed
46
Q

Describe primary wound closure

A

It is the simplest and fastest type of wound closure as it occurs when the wound edges are able to be approximated with little or no granulation tissue formation

47
Q

Give an example of a primary wound closure

A

a surgical incision

48
Q

How long should a wound take to close via primary intention?

A

1-14 days

49
Q

Describe secondary wound closure

A

Requires the body to make a matrix of granulation tissue to fill the wound defect

50
Q

Describe delayed primary wound closure

A

It is a combination of primary and secondary closure that may be used in patients with large wounds that are initially infected or that fait to successfully close by secndary closure

51
Q

A wound that is closed via delayed primary closure should be closed within how many weeks?

A

1-2

52
Q

What characterizes a chronic wound?

A

Senescent cells, which are mitotically active but minimally responsive

53
Q

Chronic wounds have higher levels of MMPs and lower levels of TIMPs which leads to what?

A

degradation of the extracellular matrix

54
Q

In what type of patient can a reduced or absent inflammatory response be seen?

A
  • pts taking high doses of steroids
  • patients who are malnourished
  • patients who are elderly
  • patients with immune system disorders (HIV, AIDS, etc.)
55
Q

Cellulary, chronic inflammation is characterized by an increase in what?

A

macrophages and fibroblast proliferation

56
Q

What are the 3 common causes of chronic inflammation?

A
  • Presence of foreign body in wound bed
  • Repetitive mechanical trauma
  • Cytotoxic agents
57
Q

A wound that is _____ fails to build enough granulation tissue to fill the wound defect, resulting in a pothole-type wound. In the end what does this result in?

A

hypogranular

the epithelial cells cannot bridge the gap to achieve wound closure and repair is suspended

58
Q

What is the cause of wound epibole?

A

The epithelial tissue migrates
down sides of the wound instead of across. Edges that roll over will ultimately cease in migration secondary to contact inhibition once epithelial cells of the leading edge come in contact with other epithelial cells.

59
Q

In what type of patients do hypogranular wounds seem to occur more frequently in?

A

those with diabetes or malnutrition

60
Q

How can hypogranular wounds be managed?

A

by gently wiping the wound edges with gauze with each dressing change

61
Q

How can hypergranulation be prevented?

A

by protecting the fragile epithelital cells from trauma

62
Q

Once present, hypergranulation can be resolved in 3 ways. What are they?

A

1) pressure over the hypergranular tissue
2) silver nitrate applied to the hypergranular tissue cauterizing the tissue
3) surgical excision

63
Q

What is hypertrophic scarring due to?

A

the overproduction of immature collegen during the proliferative and maturation/remodeling phases of healing

64
Q

What do hypertrophic scars look like?

A

red, raised, fibrous lesions that stay within the confines of the original wound

65
Q

What type of wounds are more likely to result in hypertrophic scarring?

A

in wounds that cross lines of tension in the skin or in wounds with prolonged inflammatory phase, such as large or infected wounds

66
Q

Hypertrophic lesions are often associated with what?

A

contractures, because of the random overproduction of collagen

67
Q

How can hypertrophic scars be managed?

A
  • compression garments worn 23 hours per day
  • silicone gel sheets over the scarred areas
  • scar mobilization to alter the scar tissue
  • repeated steroid injections to modify the scar
  • topical agents
  • surgery
68
Q

How do keloid scars differ from hypertrophic scars?

A

Keloids extend beyond the confines of the original wound and rarely regress independently

69
Q

What are keloids associated with?

A
  • laceration
  • tattoo
  • surgery
  • ear piercing
  • burns
70
Q

What do keloids look like?

A

nodular masses of collagen randomly arranges in swirls or clusters of collagen fibers

71
Q

How are keloid scars managed?

A

steroid injections with or without surgical excision

72
Q

What is a contracture?

A

a pathological shortening of scar tissue resulting in deformity

73
Q

When are contractures most likely to form?

A

in wounds crossing a joint

74
Q

What is dehiscence?

A

the separation of wound margins due to insufficient collagen production or tensile strength

822: Integumentary (16 decks)

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