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Surgery > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

Big Factors of wound healing?

A
  • nutrition
  • diabetes
  • smoking
  • PAD
  • Venous insufficiency
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2
Q

What are the 4 stages of wound healing?

A
  1. hemostasis/coagulation
  2. inflammation (1st PMNs arrive and then macrophages)
  3. migration/proliferation
    - angiogenesis
    - epithelization
    - contraction
    - fibroplasia
  4. remodeling
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3
Q

What is involved in the coagulation stage?

A
  • vessel rupture: platelet aggregation, coagulation
  • platelets degranulate: release cytokines and growth factors:
    PDGF
    TGF-B1
    IGF-1
    PAF
    PDEGF
    Fibronectin
    Serotonin
  • fibrin clot formation
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4
Q

What is involved in inflammation stage?

A
  • attraction/activation of infiltrating cells
  • neutrophils:
    bacteria and matrix phagocytosis, not essential unless wound contaminated
  • macrophages:
    debridement/matrix turnover, major source of stimulatory signals, impt for wound healing
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5
Q

What are the diff roles of macrophages in wound healing?

A
  • phagocytosis, antimicrobial fxn
  • wound debridement
  • cell recruitment and activation
  • angiogenesis
  • matrix synthesis regulation
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6
Q

What is involved in angiogenesis stage (migration/proliferation)?

A

formation of vessels:

  • begin as endothelial cell buds
  • progress toward wound space, following O2 gradient
  • immature vessels differentiate into capillaries, arterioles, and venules
  • macrophages and keratinocytes provide angiogenic stimuli
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7
Q

What is involved in epithelization stage (migration/proliferation)?

A
  • epidermal covering (keratinocytes) reconstituted from wound margin and hair follicle remnants
  • keratinocytes migrate across wound
  • during and after migration, differentiation and stratification of neodermis occur
  • epithelization aided by moist environment
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8
Q

Diff roles of keratinocytes in wound healing?

A
  • migration/proliferation
  • ECM (extracellular matrix) production
  • growth factor/cytokine production
  • angiogenesis
  • protease release
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9
Q

What is involved in fibroplasia (migration/proliferation) stage?

A

fibroblasts:

  • migrate into wound site and replicate
  • dominant cell type at wound edge
  • synthesize and deposit collagen and proteoglycans
  • matrix deposition dependent on O2 and substrate availability as well as growth factors
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10
Q

Role of fibroblasts in wound healing?

A
  • migration/proliferation
  • ECM production
  • growth factor/cytokine production
  • angiogenesis
  • protease release
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11
Q

What is involved in the remodeling stage?

A
  • changes in matrix composition over time

- lead to extracellular matrix and then collagen and lastly a scar

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12
Q

Cell types involved in coagulation process?

A
  • platelets
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13
Q

Cell types involved in inflammatory process?

A
  • platelets
  • macrophages
  • neutrophils
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14
Q

Cell types involved in migratory/proliferative process?

A
  • macrophages
  • lymphocytes
  • fibroblasts
  • epithelial cells
  • endothelial cells
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15
Q

Cell types involved in remodeling process?

A
  • fibroblasts
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16
Q

Healing is retarded by what factors?

A
  • ischemia
  • dry wound enviro
  • infection
  • fbs
  • anti-inflammatory therapy (don’t use NSAIDs)
  • nutritional deficiency
17
Q

What are local factors that affect wound healing?

A
  • mechanical injury
  • infection
  • edema
  • ischemia/necrotic tissue
  • topical agents
  • ionizing radiation
  • low O2 tension
  • fbs
18
Q

What is impt info to know about your pt?

A
  • age
  • nutritional status
  • circulation
  • diabetes
  • smoking (vasoconstriction, alters collagen metabolism, response to bacteria)
  • steroids (decreases inflammatory process)
  • support system
19
Q

What are essential nutrients involved in wound healing?

A
  • calories
  • carbs
  • proteins
  • fats
  • vitamin A
  • vitamin C
  • zinc
  • water
20
Q

Eval of pt w/ a healing wound?

A
  • hx
  • physical exam including pulses
  • other injuries, comorbidities
  • if wound not healing: A1C, check for other neuropathies (B12 def)
21
Q

What are Halsted’s principles?

A
  • gentle handling of tissues
  • careful hemostasis
  • aseptic technique
  • avoidance of tension
  • sharp dissection
  • obliteration of dead space
22
Q

Diff intentions of wound healing?

A
  • primary intention: just epidermis and dermis involved - wound edges brought together by staples, sutures, tape, minimize scarring
  • secondary intention: wound allowed to granulate, pack w/ gauze or have drainage system, slow healing time, higher risk of infection, daily wound care
  • third intention: initially cleaned, debrided, left open early and closed later on, use tissue grafts
23
Q

What is primary intention healing?

A
  • wound is closed w/ stitches or staples
  • covered w/ sterile dressing
  • may drain a small amt of blood or serosanguinous fluid
  • generally kept protected from getting wet w/ plastic coer for 2-10 days depending on site, if allowed to get wet - shower only
  • monitor for erythema, swelling, warmth and drainage
  • note: wound is intact, no erythema or drainage, dressing is dry, wound redressed
24
Q

What is secondray intention healing?

A
  • epidermis and dermis not closed, sometimes other layers not closed allowed to granulate in
  • usually if there has been contamination, an infected wound, peritonitis
  • has to be packed daily to q other day w/ saline moistened gauze or sponges and covered w/ sterile dressing
25
Q

Pros of the wound vac?

A
  • decreases edema
  • enhances granulation and vascularity
  • lower bacterial counts
  • excellent results
26
Q

What is surgical site infection (SSI)? How common is this?

A
  • refers to infection at incision site, but also infections that extend to adjacent deeper structures
  • among surgical pts SSIs MC nosocomial infection (accounting for 38% of nosocomial infections)
  • death is directly related to SSI in over 75% pts w/ SSI who die in postop period
27
Q

Common etiologies of SSIs?

A
  • most are acquired at time of surgery
  • MC source direct inoculation of pt flora (S. aureus and coag neg staph)
  • when a viscus is opened pathogens reflect flora from viscus and are usualy polymicrobial
  • more MRSA and candida are being isolated
  • exogenous sources can occur from operating room personnel carrying Group A strep
28
Q

Pt related RFs for SSIs?

A
  • DM
  • obesity
  • cigarette smoking
  • systemic corticosteroids or other immunosuppressive drugs
  • malnutrition
  • pre-op nasal carriage or colonization w/ S. aureus
  • presence of remote focus of infection
  • duration of preop hospitalization
  • preop severity of illness of pt
29
Q

What are the most impt factors for prevention of SSIs?

A
  • general health of pt
  • meticulous operative techniques
  • timely admin of pre-op abx:
    given w/in 60 min prior to surgical incision
    cefazolin 1-2 g IV preferred for most procedures, for bowel procedures: cefoxitin or ampicillin/sulbactam, vanco if PCN allergic
30
Q

Abx prophylaxis for colorectal surgery?

A
  • can be oral, IV or both
  • oral is equal to IV
  • oral regimen is neomycin and erythromycin w/ bowel prep
  • IV regimens:
    cefoxitin or cefotetan
    cefazolin + metronidazole
31
Q

Hair removal correlation w/ SSI?

A
  • most studies have shown increased risk of SSI in pts undergoing pre-op hair removal, one study showed the highest w/ shaving, then clipping and the least w/ depilatory
  • lowest rate of SSI were reported when hair was removed just prior to surgical incision

Surgery (19 decks)

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