Wound Healing

Question 1

Wound healing

Answer 1

Requires adequate blood flow for supply line/nutrients as building blocks in repair process
Sufficient ingestion/absorption/metabolic distribution of micro/macronutrients

Imbalance due to inadequate supply/excessive demand = inability to heal wounds

Question 2

Epidemiology

Answer 2

Protein-energy malnutrition
Hospital patients
Elderly/pressure ulcers
Patients with diabetes
Addicts - drugs/alcohol
Burn victims
Trauma (war, sports, etc)

Question 3

Stages of healing

Answer 3

Hemostasis: MINUTES, blood released to wound, fibrinogen –> fibrin (starts clotting)
Inflammation: DAYS, white blood cells travel to site to fight infection (vasodilation: widening of blood vessels)
Proliferation: WEEKS, tissue perfusion/scar formation/collagen and granulation
Contraction: WEEKS, wound shrinks by recruiting adjacent tissue and pulling into the wound
Remodeling: MONTHS/YEARS, scar is transformed into mature healed wound, tensile strength approaching undamaged tissue, 3 years for scar to completely heal

Question 4

Effect of stress

Answer 4

Large burns/critically ill/traumatic injury –> modification in digestion/absorption/metabolism

Hypermetabolism: body eats itself to meet the demands of injury (protein catabolism), needs nutritional intervention

Question 5

Nutrients in wound healing

Answer 5

Proteins: needed for white blood cell formation/collagen synthesis
Fats (Omega 3 fatty acids): aid inflammatory response and enhance immune system
Vitamin C: free radical scavenger, increases defense against infection
Vitamin A: enhances rate of collagen synthesis
Vitamin E: free radical scavenger
Vitamin K: clotting
Zinc: cell mitosis/cell proliferation in wound repair
Iron: enhances bactericidal activity of white blood cells, hemoglobin transport oxygen to wound

Question 6

Contributing conditions

Answer 6

Obesity: infection
Diabetes: infection, wound repair issues
Cancer; inflammatory response/wound repair (radiation, chemo)

Question 7

Diabtes

Answer 7

Elevated blood sugar levels: arteries less pliable, blood vessels narrow
Influences origin of wounds/wound healing

Question 8

Poor circulation

Answer 8

Narrowed blood vessels –> decreased blood flow/oxygen to wound
Elevated blood sugar level decreases function of RBC that carry nutrients to tissue
Lowers efficiency of WBC to fight infection, wound heals more slowly
Infection risks because immune cells don’t function properly (diabetes)

Question 9

Diabetic Neuropathy

Answer 9

Nerve damage can occur and result in loss of sensation in limbs
Cannot feel a developing blister/infection
Severity progresses
Complications with healing

Question 10

Untreated infections

Answer 10

–> gangrene, sepsis, bone infections

Diabetes = #1 reason for limb amputation in US