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Surgery I > Wound healing > Flashcards

Wound healing Flashcards

1
Q

Term: Closed wound

A

Contusion or crushing injury

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2
Q

Term: Open wound

A

Abrasions + Avulsions + Incisions + Lacerations

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3
Q

Term: Clean wound

A

Surgically created under aseptic conditions

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4
Q

Term: Clean-contaminated

A

Surgical wound into respiratory + alimentary + urogenital tract

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5
Q

Term: Contaminated

A

Open, acute, accidental or surgical wounds with a major break in sterility

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6
Q

Term: Crush wound

A

Result of body part being subject to high degree of force

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7
Q

Term: Contusion

A

A blod to the skin which blood vessels are damaged and rupture

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8
Q

Term: Abrasion

A

Damage to the epidermis and portions of the dermis by blunt trauma or shearing forces

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9
Q

Term: Avulsion

A

Loss of skin by tearing of tissue from attachments

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10
Q

Term: Incision

A

Sharp object that has minimal adjacent tissue damage

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11
Q

Term: Laceration

A

Irregular wound created by tearing of the tissue

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12
Q

Term: Puncture

A

Penetrative injury with minimal skin damage + variable underlying tissue damage

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13
Q

What are the four stages of wound healing?

A

Inflammatory
Debridement
Repair
Maturation

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14
Q

What kind of response is the inflammatory phase of healing?

A

Protective tissue response

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15
Q

What four big things occur during the inflammatory phase of healing?

A

Vascular constriction for 5 to 10 min
Vascular dilation
Extrinsic pathway activation by thomboplastin
Platelet aggregation + clot formation

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16
Q

What is the inflammatory phase causes vasoconstriction?

A

Catcholamine
Serotonin
Bradykinin
Histamine

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17
Q

What is occurring with in the inflammatory tissue in that inflammatory phase?

A

Localized when fibrin + plasma exudate plug the lymphatics

Clot dries –> scab forms

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18
Q

How long is the inflammatory phase?

A

3 to 5 days

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19
Q

What is the debridement phase characterized by?

A

Exudate

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20
Q

What is in the exudate in the debridement phase?

A

WBC’s + Necrotic tissue + Wound fluid

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21
Q

At what point do neutrophils show up to the injury?

A

6 hours post insult

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22
Q

At what point do monocytes show up to the injury?

A

12 hours post insult

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23
Q

What cell type is essential for wound healing?

A

Monocytes

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24
Q

How long does it take monocytes to become macrophages at the injury site?

A

24 to 48 hours

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25
Q

What four functions do macrophages provide at the injury site once they are activate?

A

Secrete collagenases + GF
Recruit mesenchymal cells
Stimulate angiogenesis
Modulate matrix production

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26
Q

At what point post-injury does the repair phase occur?

A

3 to 5 days

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27
Q

What occurs during the repair phase?

A

Fibroblasts migrate to the wound
Followed by angiogenesis
Type 3 collagen is deposited

28
Q

What time point post injury is the max amount of collagen present?

A

2 to 3 weeks

29
Q

What happens to the type 3 collagen in the wound

A

converts to type 1

30
Q

What structurally makes up granulation tissue?

A

Capillaries + FIbroblasts + Fibrous tissue

31
Q

What occurs at the maturation phase?

A

Wound strength is at its maximum

32
Q

What % of original tissue strength is regained?

A

80%

33
Q

What happens in the maturation phase?

A

Granulation tissue loses some of its cellularity

34
Q

When is the most rapid increase in the strength of the wound during healing?

A

During days 7 to 14

35
Q

What is moist wound healing?

A

Occlusive bandage to facillitate healing
Low oxygen tension within wound
Increase local temperature to site of wound

36
Q

What are the advantages to moist wound healing

A 
Optimal environment for healing 
Hastens debridement + granulation formation 
Limits infection 
Less scars and no scabs 
Less painful
37
Q

How much does epithelialization increase by with moist wound healing?

A

twice as fast

38
Q

What is the disadvantage of moist wound healing?

A

Bacterial COLONIZATION of wound surface + foliculitis + maceration of wound border

39
Q

What Four big things affect wound healing?

A

Age + Serum protein level + Disease + Obestit

40
Q

What level of serum protein do we start to see healing issues?

A

Below 1.5 to 2 g/dl

41
Q

What diseases cause a decrease in a patients ability to heal?

A

Hepatic disease
Hyperadrenocorticism
Diabetes mellitus

42
Q

What is different about the way cats heal?

A

Cutaneous wounds close slower
Slower by second intention
Produce less granulation tissue
Heal more by contraction of wound edges

43
Q

What are some underlying tissue types that DO NOT support granulation tissue?

A

Periosetum + Tendon + Nerve sheath

44
Q

What are common external factors applied to patient to help/harm with wound healing?

A

Radiation therapy
Corticosteroids
Chemotherapy
Hyperbaric oxygen therapy

45
Q

What does radiation therapy do to wound healing?

A

Inhibits all stages of wound healing by affecting angiogenesis

46
Q

What does corticosteroids do to wound healing?

A

Depress all stages of wound healing and increase change of infection

47
Q

What are the fundamentals of wound management

A 
Stabilize patient 
Cover wound till you can address it 
Clip and clean area 
Debride dead or necrotic tissue 
Lavage wound 
Perform appropriate wound closure
48
Q

What are the tips for a good surgical debridement?

A

Start superfically and progress deeper
Sharp dissection techniques
Debribe muscle till it bleeds
Remove any and all contaminated fat

49
Q

What is autolytic debridement?

A

Creation of moist wound environment to facilliate increase endogenous enzymes

50
Q

Which is more prefered surgical or autolytic debridement?

A

Autoylytic

51
Q

Which is faster surgical or autolytic debridement?

A

Surgical

52
Q

What do you use on a wet bandage?

A

Hypertonic saline

53
Q

What is bandage debridement?

A

Place ment of dressings that are allowed to dry on the wound

54
Q

When is bandage debridement most effective?

A

Early stages of wound healing
– or –
Infected wounds

55
Q

What is the down side to bandage debridement?

A

Very painful, can damage surrounding healthy tissue

56
Q

What is the advantage of enzymatic debridement?

A

Poor anesthetic canadiates

57
Q

What are the disadvantages of enzymatic debridement?

A

Must reamin contact for adequate time to acheive result

Local tissue irritation

58
Q

What is biosurgical debridement?

A

Maggot therapy

59
Q

When is primary wound closure appropriate?

A

Clean or clean contaminated wounds that have been converted to clean wounds

60
Q

When is primary wound closure recommended?

A

Wounds that require immediate closure

61
Q

What is an important consideration when it comes to primary closure?

A

Close without a lot of tension

62
Q

When does delayed primary closure occur?

A

2 to 5 days post injury

63
Q

When is delayed primary closure appropriate?

A

Clean contaminated + Contaminated wounds with questionable health (Edema + skin tension)

64
Q

What is an important consideration of delayed primary closure?

A

Debride tissue and lavage wound before closure

65
Q

When is secondary intention healing appropriate?

A

Wounds unsuitable for closure

Large skin defects or extensive tissue devitalization

66
Q

How does healing occur with secondary intention healing?

A

Via granulation tissue + wound contraction + epithelialization

Surgery I (17 decks)

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