WOUND HEALING Flashcards
1
Q
TGF Alpha cell origin
A
macrophages
2
Q
TGF beta cell origin
A
platelet alpha granules
Macrophages
fibroblast \ keratinocyte
3
Q
EGF
A
platelet alpha granules
4
Q
IL 1 cell origin
A
macrophage
5
Q
IL 2 cell origin
A
T. lymphocyte
6
Q
what cells or critical and what cells are not critical for wound healing
A
neutrophils NOT needed for wound healing
macrophages ARE required further wound healing
7
Q
effects smoking on wound healing
A
decreased metalloproteinase
decrease a white cell taxis
microvascular vasoconstriction
8
Q
Vitamin supplementation proven to help wound healing
A
vitamin A. 25,000 international units IV-given to counteract steroid use
9
Q
maximum dose of lidocaine
A
4.5/5 mg per kilogram without epi
7 mg per kilogram with epi
10
Q
Maximum dose of bupivacaine
A
- 5 mg per kilogram without epi
3. 5 mg per kilogram with epi
11
Q
Avastin effects on wound healing
A
prevent angiogenesis
12
Q
rapamycin effect and wound healing
A
“Seroliumus”
do not use of recent wound - prevent neointimal hyperplasia
(Used to coat cardiac)
13
Q
retention of tensile strength of catgut
A
7 days
14
Q
retention of tensile strength of chromic
A
14 days
15
Q
retention of tensile strength of polyglycolic acid
A
“Vicryl “
14-30 days
dissolve by hydrolysis
16
Q
polypropylene trade name
A
Prolene
17
Q
retention of tensile strength of polydioxanone and trade name
A
PDS
2 months
18
Q
what is Marlex mesh made out of
A
polypropylene
19
Q
Why venous ulcers found with air found
A
medial malleolus
Cockett veins communicate saphenous
20
Q
diabetic foot pathology
A
collapse of midfoot resulting Charcot foot
plantar prominence of metatarsals
21
Q
went home improved use of PDGF
A
foot ulcers
22
Q
with his best preparation of iodine for wound care
A
Cadexomer iodine
elemental iodine
“Iodosorb”
absorbs exudate from wound to promote sterile environment
One a few topical antimicrobial supported by random -controlled trials
23
Q
cell that get everything started for wound healing
A
platelets
24
Q
at what time. In wound healing are PMNs predominant cell
A
day 3
25
what type of collagen was made down in the proliferative phase of wound healing
type III
26
whitish type III collagen converted to an wound healing
converted to type I collagen
27
first choice at and management of keloid scar
silicone sheet
| Second choice inject with steroid
28
with family of local anesthetic can cause methemoglobinemia
Amides:
lidocaine
Marcaine
29
2 examples of Ester local anesthetic
procaine
| Chloral procaine
30
what is treatment of methemoglobinemia
methylene blue
31
Symptoms of methemoglobinemia
decreased oxygen saturation
32
Marcaine toxicity treated with
Intralipid
33
and in wound healing cuff all G. warehouse are metalloproteinases seen
principle pathology and AAA
| increase was smoking
34
name complications that are being monitored with system based medicine
```
PE
DVT
Central line infection
Sternal wound
Ventilator acquired pneumonia
CHF
Surgery site infection
Wrong site surgery
```
35
pathophysiology of venous ulcer
venous pressure increases to the point of decreased perfusion pressure ultimately limits arterial inflow
36
most common organisms associated with cholecystectomy wound infection
staph aureus
37
definitive diagnosis with necrotizing fasciitis
excess skin
| Intraoperatively she easily delaminated from the digital dissection excised until this stops
38
for perforated appendicitis and kids how is skin incision managed
closed!
| NOT in adults
39
The textbook management of fluctuance in postoperative wound without surrounding erythema and cellulitis
I&D only
| NO antibiotics
40
antibiotics for necrotizing pancreatitis?
NO!
| NO imipenem!
41
Xigris
TAKEN OFF THE MARKET!
Recombinant protein C
BLEEDING complication
protein C is endogenous anticoagulant and clotting cascade
42
Pathophysiology of Coumadin causing skin necrosis
inhibits protein C (endogenous anticoagulant) before the vitamin K dependent clotting factors are inhibited-paradoxical HYPER coagulable
43
Pathophysiology of factor V Leiden deficiency
Factor V Leiden is required to activate protein C causes patient to be HYPERCOAGULABLE
44
best management to avoid seroma
Close suction drain
45
number of days when peak number of fibroblasts
6
46
functional macrophage in wound
peak number of macrophages 40-96 hours post injury
Most cubital roll is activation and improvement of other cells side of times and growth factors
releases TGF beta and the VEGF , and for a growth factor, endothelial growth factor
Also involved in phagocytosis and a, angiogenesis
47
First cell to migrate into wound
PMN
48
Type I collagen
| where it is found what is function
Major component of extracellular matrix and skin
49
Type III collagen
transformed into a type I collagen with wound maturity
50
Tensile strength of completely healed wound approaches the strength uninjured tissue at what time.
Never
51
time it take for reepithelialization-complete repair of external barrier in a well approximated surgical wound
2 days! in superficial wound such as skin grafts and second-degree burns
The Unless large wound with significant epidermal and dermal defect
52
TGF beta
released by macrophages
Angiogenesis
also released by:
platelet alpha granules
fibroblast \ keratinocyte
53
Ehlers-Danlos syndrome
| Inheritance and findings
autosomal dominant most common
fibronectin and lysyl hydroxylase
laxity of skin and joints or graft possible abnormal clotting studies
54
protein abnormality and Marfan syndrome
| and clinical findings
FIBRILIN
(Also defect and collagen type III)
myopia, scoliosis, AAA, ligament laxity
Hernias
55
protein defective in osteogenesis imperfecta-describe syndrome
collagen type I (also defect in Ehlers-Danlos syndrome along with fibronectin)
SCARRING IS NORMAL
Skin hyper distensible with increased bruisability and dermal thinning
```
presentation:
Can be fatal,
Brittle bones
Osteopenia
Decreased muscle mass
Hernias
Ligament laxity
```
4 major types:
56
Acrodermatis enteropathica
pediatric condition from
Inability to absorb sufficient zinc from breast milk
fracture and faint uptake in intestine
sphincter deficiency associated with him. Granulation tissue
think is also cofactor for being a polymerization reverse transcutaneous
impaired wound healing, pustular dermatitis,
Treat with zinc orally curative for wound healing
57
With layer of intestine has greatest tensile strength
SUBMUCOSA
58
Which structures of the gastrointestinal tract lack serosa
esophagus
Rectum
Retroperitoneal portions of the colon
59
primary mechanism from which bowel anastomosis leak 5-7 days after surgery
increased collagenolysis
60
pathophysiology of bowel healing
initial watertight characteristic dependent on fibrin seal on the serosa
Decreased marginal strength in the first week due to collagenolysis that far exceeded collagen symphysis
61
Supplementation of which amino acid may improve wound healing
arginine
fibroplasia related
may enhance wound collagen deposition
62
Vascular pathology seen with Ehlers-Danlos syndrome
spontaneous arterial venous fistula
small blood vessels are friable may develop aneurysms, varicosities, arteriovenous fistulas,
63
Clinical findings suspicious for Ehlers-Danlos syndrome in child
Recurrent hernia, coagulopathy, platelet abnormality and low coagulation factor levels
64
name defects seen with Ehlers-Danlos syndrome
Defects:
type III (and I) collagen
fibronectin
lysyl hydroxylase
65
epidermolysis bullosa
3 types
Impairment of adhesion with the epidermis and basement membrane her dermis
Causes blisters and minimal trauma
Nutritional status compromised because of oral erosions and esophageal obstruction
Treatment may include esophageal dilation, gastrostomy tube
66
Which phase of healing is most affected by exogenous corticosteroids
Initial phase of so migration and angiogenesis
Reduces collagen symphysis and one strength
Most deleterious effect therefore is 3-4 days post injury
```
Inhibit inflammatory phase of wound healing:
Angiogenesis
Neutrophil migration
Macrophages migration
Fibroblastic proliferation
Release lysis normal enzymes
```
also inhibits epithelialization and contraction with increased rate of wound infection regardless of time of administration
67
Pathophysiology of vitamin C deficiency
Failure and collagen symphysis
Failure of collagen cross-linking
Vitamin C required for Prolene and glycine conversion to hydroxy Prolene and hydroxy lysine
Possible associated impairment of neutrophil function-increased wound infection
Nonsmoker without trauma needs only 60 mg a day
Trauma and the smoker may need one to 2 g of a
68
vitamin A dose IV
25,000 mg - 100,000 mg
69
how does vitamin a work to help wound healing
counteract steroids
Increases inflammatory response and wound probably related to life his Lysosomal membrane
increases macrophages that increase collagen symphysis
Direct increase of collagen production and epidermal growth factor receptors
Also helpful for diabetics tumor formation radiation
70
marjolin's ulcer
malignant transformation of chronic ulcer
Seen in any chronic wound
Over turned wound edges
71
metallic pronation to have what functioned biochemically
initiate collagen degradation
pile of collagen in AAA with smokers
72
severe cases of hidradenitis suppurativa in the groin treated how
rotational flap
