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Integumentary > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

acute wounds

A

traumatic or surgical wounds that move through the healing process at a predictable rate from insult > closure

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2
Q

chronic wounds

A

wounds that do not progress through the predictable stages of wound healing

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3
Q

Wound Healing Phases

A
  1. Coagulation
  2. Inflammatory
  3. Proliferative
  4. Remodeling
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4
Q

remodeling time frame

A

3 wks - 2 yrs

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5
Q

Coagulation time frame

A

immediate

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6
Q

inflammatory time frame

A

immediate to 2-5 days

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7
Q

when does hemostasis begin and how long does it last

A

begins when the injury occurs and lasts only a few hours

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8
Q

proliferative time frame

A

2 days - 3 wks

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9
Q

What happens in the coagulation phase

A
  • platelet aggregate
  • clot formation
  • vasoconstriction
  • cytokines
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10
Q

cytokines

A

growth factors/chemical messengers brought to the site of injury

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11
Q

what influences cellular growth and development

A

platelet- derived growth factor

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12
Q

how is the barrier to bacteria and bleeding controlled at the site of injury

A

platelet aggregate and fibrin and plasma fibronectin cross-link to create a scaffold for cells to attach

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13
Q

what is the focus of the inflammatory phase

A

clean up the debris

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14
Q

what is the role of mast cells in the inflammatory phase

A

produce histamine > vasodilation > leakage of plasma, neutrophils and cytokines to the injury site

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15
Q

what is the role of macrophages in the inflammatory phase

A
  • phagocytosis

- release of growth factors and fibroblast

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16
Q

what does the release of fibroblasts and growth factors do during the inflammatory

A

stimulates angiogenesis, CT synthesis

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17
Q

what is the role of neutrophils during the inflammatory phase

A

1st line of defense

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18
Q

what is the primary component of pus

A

neutrophils (WBC)

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19
Q

what is the phase of healing when most chronic wounds stop progressing

A

inflammatory phase

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20
Q

clinical presentation of the inflammatory phase

A
  • edema
  • induration
  • heat
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21
Q

what are the key players in the inflammatory phase

A
  • Mast cells
  • Macrophages
  • Neutrophils
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22
Q

what creates the provisional ECM

A

created by fibrin and plasma fibronectin

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23
Q

the provisional ECM provides

A

scaffolding to direct cells into the injury to create new ECCM

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24
Q

what do fibroblast secrete

A

new ECM

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25
new ECM allows nutrients
to diffuse into cells and hold the cellular structure together
26
the new ECM provides the skin with
- elasticity - tensile strength - compressibility
27
Matrix Metalloproteinases (MMPs)
breakdown proteins comprising the ECM of tissues
28
the role of MMP during inflammation
removes damaged ECM and bacteria
29
the role of MMP during proliferation
- degrades basement membrane for angiogenesis | - migration of epidermal cells
30
the role of MMP during remodeling
- contraction of scar ECM | - remodeling of scar ECM
31
what does the MMP do in non healing wounds
MMPs > off target destruction of proteins that are essential for healing
32
what do MMP do in normal wound healing
- activate inflammatory cells | - wound cells
33
what is required for MMP activity
metal ion (Zinc)
34
transforming growth factor
- ECM formation | - reduce scar
35
platelet derived growth factor
- ECM formation | - angiogenesis
36
fibroblast growth factor
- angiogenesis | - keratinocyte proliferation and migration
37
insulin-like growth factor
- keratinocyte and fibroblast proliferation | - collagen synthesis
38
epidermal growth factor
- keratinocyte proliferation and migration | - ECM formation
39
connective tissue growth factor
collagen synthesis
40
what happens during the proliferative phase
- Granulation tissue - angiogenesis - epithelialization - contraction
41
what is granulation tissue? what does it do
- fibroblast lay bed of collagen matrix | - fills injury site
42
how does angiogenesis occur
- basement membrane degraded by proteases | - capillary sprouting
43
epithelialization
keratinocytes cross moist surfaces to cover surface of the wound
44
explain how epithelialization occur
- leap frog from wound edge or dermal appendages | - use the fibronectin cross-linked with fibrin to crawl across
45
explain the contraction during proliferative phase
wound edges pull together to reduce defect - myofibroblasts migrate to edges along fibronectin crosslinks and pull on ECM - fibroblasts fill in with collagen matrix
46
what happens during the remodeling phase
- new collagen forms which increases tensile strengths wounds - scar tissue is only 80% as strong as original tissue
47
during proliferative phase type III collagen is replaced with what
type I collagen
48
Reasons the wound "DIDN'T HEAL"
``` Diabetes Infection Drugs Nutrition Tissue necrosis Hypoxia Excessive tension Another wound Low temp ```
49
how does diabetes impair wound healing
diminished sensation and arterial inflow
50
how does infection impair wound healing
infection potentiates collagen lysis
51
what kind of drugs impair wound healing
steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis
52
what nutritional deficiencies impair wound healing
protein-calorie malnutrition | - vitamins A, C, and zinc
53
how does tissue necrosis impair wound healing
ischemia (oxygen starvation)
54
what causes hypoxia impairing wound healing
local vasoconstriction
55
low temperature and impaired wound healing
reduction of 2-3 deg F from normal core body temp slows wound healing at distal sites
56
DOMINATE to heal wounds
``` Debridement Offloading Moisture, Meds, Mental Infection, Inflammation Nutrition Arterial Technical Advances Edema, Education ```
57
how many calories are needed during the healing process
2400/day
58
why is protein important for wound healing
collagen development
59
how much protein is needed for wound healing
2-3 servings/day
60
why is vitamin A important for wound healing
increasing the inflammatory response in wounds stimulating collagen synthesis
61
how much Vitamin A is needed during wound healing
1 serving/day
62
why is vitamin C important for wound healing
- increased immune activity - collagen synthesis - angiogenesis
63
how much vitamin C is needed for wound healing
1 servings/day
64
why is zinc important for wound healing
- protein and collagen synthesis | - tissue growth and healing
65
how much zinc is needed during wound healing
15-20 mg/day
66
primary intention wound healing
- wound edges approximated and held together with staples, sutures, etc - healing occurs from epithelialization and CT
67
secondary intention wound healing
- wound edges are not approximated - healing occurs with granulation tissue, contraction of wound edge, epithelialization - mm, tendons, ligs do not regenerate
68
tertiary intention (delayed primary intention) wound healing
wound is left open initially granulation is allowed to give depth, then wound edges are approximated

Integumentary (10 decks)

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