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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
Q

new ECM allows nutrients

A

to diffuse into cells and hold the cellular structure together

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26
Q

the new ECM provides the skin with

A
  • elasticity
  • tensile strength
  • compressibility
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27
Q

Matrix Metalloproteinases (MMPs)

A

breakdown proteins comprising the ECM of tissues

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28
Q

the role of MMP during inflammation

A

removes damaged ECM and bacteria

29
Q

the role of MMP during proliferation

A
  • degrades basement membrane for angiogenesis

- migration of epidermal cells

30
Q

the role of MMP during remodeling

A
  • contraction of scar ECM

- remodeling of scar ECM

31
Q

what does the MMP do in non healing wounds

A

MMPs > off target destruction of proteins that are essential for healing

32
Q

what do MMP do in normal wound healing

A
  • activate inflammatory cells

- wound cells

33
Q

what is required for MMP activity

A

metal ion (Zinc)

34
Q

transforming growth factor

A
  • ECM formation

- reduce scar

35
Q

platelet derived growth factor

A
  • ECM formation

- angiogenesis

36
Q

fibroblast growth factor

A
  • angiogenesis

- keratinocyte proliferation and migration

37
Q

insulin-like growth factor

A
  • keratinocyte and fibroblast proliferation

- collagen synthesis

38
Q

epidermal growth factor

A
  • keratinocyte proliferation and migration

- ECM formation

39
Q

connective tissue growth factor

A

collagen synthesis

40
Q

what happens during the proliferative phase

A
  • Granulation tissue
  • angiogenesis
  • epithelialization
  • contraction
41
Q

what is granulation tissue? what does it do

A
  • fibroblast lay bed of collagen matrix

- fills injury site

42
Q

how does angiogenesis occur

A
  • basement membrane degraded by proteases

- capillary sprouting

43
Q

epithelialization

A

keratinocytes cross moist surfaces to cover surface of the wound

44
Q

explain how epithelialization occur

A
  • leap frog from wound edge or dermal appendages

- use the fibronectin cross-linked with fibrin to crawl across

45
Q

explain the contraction during proliferative phase

A

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
Q

what happens during the remodeling phase

A
  • new collagen forms which increases tensile strengths wounds
  • scar tissue is only 80% as strong as original tissue
47
Q

during proliferative phase type III collagen is replaced with what

A

type I collagen

48
Q

Reasons the wound “DIDN’T HEAL”

A 
Diabetes
Infection
Drugs
Nutrition
Tissue necrosis
Hypoxia
Excessive tension
Another wound
Low temp
49
Q

how does diabetes impair wound healing

A

diminished sensation and arterial inflow

50
Q

how does infection impair wound healing

A

infection potentiates collagen lysis

51
Q

what kind of drugs impair wound healing

A

steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis

52
Q

what nutritional deficiencies impair wound healing

A

protein-calorie malnutrition

- vitamins A, C, and zinc

53
Q

how does tissue necrosis impair wound healing

A

ischemia (oxygen starvation)

54
Q

what causes hypoxia impairing wound healing

A

local vasoconstriction

55
Q

low temperature and impaired wound healing

A

reduction of 2-3 deg F from normal core body temp slows wound healing at distal sites

56
Q

DOMINATE to heal wounds

A 
Debridement
Offloading
Moisture, Meds, Mental
Infection, Inflammation
Nutrition 
Arterial
Technical Advances
Edema, Education
57
Q

how many calories are needed during the healing process

A

2400/day

58
Q

why is protein important for wound healing

A

collagen development

59
Q

how much protein is needed for wound healing

A

2-3 servings/day

60
Q

why is vitamin A important for wound healing

A

increasing the inflammatory response in wounds

stimulating collagen synthesis

61
Q

how much Vitamin A is needed during wound healing

A

1 serving/day

62
Q

why is vitamin C important for wound healing

A
  • increased immune activity
  • collagen synthesis
  • angiogenesis
63
Q

how much vitamin C is needed for wound healing

A

1 servings/day

64
Q

why is zinc important for wound healing

A
  • protein and collagen synthesis

- tissue growth and healing

65
Q

how much zinc is needed during wound healing

A

15-20 mg/day

66
Q

primary intention wound healing

A
  • wound edges approximated and held together with staples, sutures, etc
  • healing occurs from epithelialization and CT
67
Q

secondary intention wound healing

A
  • wound edges are not approximated
  • healing occurs with granulation tissue, contraction of wound edge, epithelialization
  • mm, tendons, ligs do not regenerate
68
Q

tertiary intention (delayed primary intention) wound healing

A

wound is left open initially

granulation is allowed to give depth, then wound edges are approximated

Integumentary (10 decks)

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