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Musckuloskeletal > Wound healing > Flashcards

Wound healing Flashcards

1
Q

Epidermis- one of two major layers

A

thin outer layer

  • regenerates every 4 to 6 weeks,
  • acts as a barrier
  • temp. control
  • sensations
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2
Q

Dermis

A
  • Blood vessels (removes waste via capillaries
  • Hair follicles
  • Lymphatic vessels (removes waste via lymphatic gates)
  • sweat glands
  • Nerves
  • proteins
  • fibroblast, collage, and elastic fibers.
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3
Q

strength of skin

A
  • Collagen gives strength to the skin
  • Collagen bundles anchor to subcutaneous tissue
  • Collagen is normally organized and aligned in a smooth collagen matrix

connection decreases as we age.

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4
Q

Wound healing

A

inflammation healing response to vascularized tissue.

-ultimate goal of response is to eliminate the pathological or physical insult, replace the damaged tissue, promote regeneration and restore function.

-body doesn’t know how to focus on just one thing.
inflammation is the first stage of wound healing.

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5
Q

Primary intention healing

A

sutured together- best healing type for a wound- will heal the fastest and the cleanest with the least amount of scaring.

steri-strips or surgical adhesive.

wound bed is closed and covered with skin.

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6
Q

Secondary intention healing

A

Heals from the bottom up. Was not closed surgically- pressure sores, blisters on our heals, edges are not brought together. Left to fill in.

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7
Q

Tertiary intention healing

A

There was a delay in closure- fisherman cuts hand, cat bites, human bites (have a lot bacteria), don’t want to close right away. need to be pumped with antibiotics and leave open to make sure they do not close the site with bacteria inside. Come back later and close it up after safe to do so.

combination of primary and secondary healing

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8
Q

Tensile strength

A

Strength of tissue

  • load applied per unit of cross section area
  • measured in newtons of force
  • how much force the tissue can take before breaking/rupture
  • fibrin contributes to its strength.
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9
Q

Tensile strength continued

A
  • Skin achieves peak tensile strength by 60 days post injury in a healthy individual (8 weeks)
  • This scar tissue has decreased vascularity
  • Scar tissue strength is 70 to 80% of normal.

-At 4 weeks we can do scar massage (sometimes even sooner, wont be any fluid coming from it.

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10
Q

tensile strength timeline

A

4 weeks- 40% to 50%
6 weeks- 60%
8 weeks- 70% to 80%

at 4 weeks can come out of splint for some activities/motions to do active motion for 50% tensile strength

At 6 weeks- person can usually come out of splint. For a shoulder they have to wait until it is 60% tensile strength- MOST ADLs but no power griping (nothing heavier than toothbrush or spoon)

At 8 weeks- MAGIC NUMBER- we can start doing stuff such as strengthening a little bit, can do most of their ADLs with resistance, putty and stuff can be worked with.

For shoulder- strengthening doesn’t start until about 10 to 12 weeks.

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11
Q

Stages/phases of wound healing

A

Hemostasis -(sometimes considered a separate phase). Vasoconstriction followed by vasodilation- we start bleeding and body focuses to stop bleeding.

1) Inflammatory phase
2) Proliferative, fibroblastic stage, latent or reparative phase
3) Maturation, remodeling phase.

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12
Q

inflammatory stage

A

Usually lasts 3 to 5 days. Typically don’t use hot packs- it is already hot, red, and inflamed. We may elevate and massage the injury site.

-IN this stage, leukocytes migrate into the wound, followed by monocytes which convert to macrophages to clean up the area. Clotting occurs to stop bleeding.

0-6 days

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13
Q

Fibroblastic stage

A

Reparative stage- collagen is being laid down- collagen matrix is being formed and the wound is closing. A lot of scar tissue formation.

-This stage is characterized by wound contraction, scar synthesis, blood vessel proliferation and epithelialization. Collagen is being laid down at a rapid rate.

  • This is where our most effective work is done.
  • From day 7 to day 21
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14
Q

Maturation stage

A

After 3 years

  • In this stage the collage matric is remodeled and the tissue changes over time. when things are being smoothed out.
  • 21 days- 2 years
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15
Q

Epithelialization

A

When the skin seals shut. Closure of the skin. When all of the collage has been laid out.

Fibroblasts synthesizes and secretes collagen.

-Collagen closes or seals the opening in the skin.

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16
Q

Partial thickness wound

A

Tissue injury that extends partially through the dermis.

  • Heals by epithelialization
  • IF painful it is secondary to exposure of nerve endings.

Ex: Skin tears, Abrasions, Tape burns, non-bloody blisters

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17
Q

Full thickness wound

A
  • Tissue destruction extending through the dermis to involving subcutaneous tissue.
  • Healing process: Granulation, contraction, and epithelialization.
  • Appearance can be snowy white, gray, or brown,
  • Firm leathery texture

All scars want to be shorter which can cause problems with movement and like to stick to things under and around them.

Ex: Donor sites for grafting, venous ulcers-blood flow issues, surgical wounds

18
Q

Tidy

A

what doctor did under sterile conditions

19
Q

red wound

A

uninfected, granulation tissue, revascularization. wound is beefy red, without infection
-Granulation tissue is dark pink or red.

Tx focus is on protection and wound closure.

Whiteness is not okay- too much moisture in dressing that is wrapped around the hand. Or may have some vascular issues. Wound will head from the bottom up.

20
Q

Yellow wound

A

Drainage, slough, delayed epithelization

Usually some drainage and will have a dressing on it. Slough is a yucky yellow stuff that has to come off.

  • odor in wound is a sign of infection.
  • requires debridement.
  • fever and streaking redness are signs of infection.
21
Q

Black wound

A

Eschar, necrotic tissue.
tissue is either dead or eschar- a build up of protein. Typically done by doctor.

Healing cannot progress.

  • requires meticulous and timely debridement to decrease the risk of infection and promote healing by facilitating normal cellular response.
  • requires surgery
22
Q

Cellulitis

A

Inflammation of cellular or connective tissue.

Pearl: inflammation may be diminished or absent in immunosuppressed patients.

May present differently in others.

23
Q

Cellulitis advancing

A

Cellulitis that is visibly spreading in the area of the wound.

  • Inflammation of subcutaneous tissue with local redness, warmth and pain. Tender red streaks may be seen.
  • circle to see if spreading.

Spider bites are very common for causing cellulitis

*antibiotics are necessary- its an infection.

massages can spread cellulitis.

24
Q

Wound care

A
  • clean wound immediately with mild diluted soap and water, saline or purified water. Do not use peroxide or iodine. These are too harsh and can damage tissue.
  • Do apply pressure to stop bleeding ASAP. Maintain pressure for 5 minutes (allow for coagulation)
  • Keep wounds covered and moist. Wounds were found to heal twice as fast with a little moisture vs being dry.

Comorbidities- affect the healing process.

25
Q

long cue tips

A

avoid touching with hands- helps keep distance when cleaning suture lines and pin sites. If any type of coagulation of blood we want that away so the suture line is nice and clean. Use to scrub the area very gently. Then put some form of an ointment on it. We do not use neomyosin (Neosporin)- because it is an irritant and some people are allergic to it which can affect wound healing and make them more susceptible to infection.

26
Q

Xeroform

A

usually used right in surgery or right after surgery- to prevent the sutures from sticking to the dressing. Between the suture and the gauze. It is a fiber that has petroleum in it and has an antibiotic agent in it as well. Lay on top of the dressing. Whatever goes right on top of incision is called our primary dressing. Usually used when there is drainage (more moist). As soon as drainage stops they switch to adaptic.

27
Q

Adaptic

A

allows the site to breath and is to prevent the sutures from sticking to the primary dressing.

28
Q

gauze

A

either us a one in or a two inch for the wrist and the hand. Secondary dressing is the gauze and gauze wraps. Put the tape on that and not on the skin.

29
Q

Primary dressing

A

silver inside of it which is a very good antibacterial substance to prevent infection.

30
Q

Topicals

A

Vaseline is the current preferred ointment

Polysporin or a triple antibiotic contains zinc and Bacitracin

31
Q

milk of magnesia

A

can help limit response to silk tape when applied before.

32
Q

Aquacel

A

Used for moisture

33
Q

Silvadene

A

Used on burns

34
Q

Hydrogel

A

Used for moisture.

35
Q

Debridement

A

the removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

You must have orders to perform sharp debridement- doctors do this.

36
Q

Goals of treatment

A 
Prevent infection,
Prevent rupturing of sutures,
Promote healing,
Scar management,
Patient education,
Desensitization- scars are sensitive- cubital tunnel scar (very sensitive- putting on clothes touches it a lot). Decrimainze carpal tunnel.
37
Q

Scars

A

all scars contract or shorten,
Scar can adhere to surrounding,
Scar can become thick,
scar can be sensitive and painful.

38
Q

Scar tissue/adheasions

A

Hypertrophic scar,

Keloid,

Adhesions to surround tissue,

Limited mobility,

Pain

39
Q

Adhesions

A

Can result around a primary injury to tissue as a result of prolonged swelling and inflammation.

Not only limit motion in extremities but can also limit motion in tendons, nerves, vessels, and other soft tissues.
— Effects gliding and sliding.

Fibrosis is a type of scar.
swelling in an area longer than it should be can turn into a scar.
Hypertrophic scars- are raised scars but stays in the scar bed.
Keloid scar- comes up and raises but it also widens outside of the wound bed.

40
Q

prevent scars

A

Keloiding is hard to prevent- things that the doctor can do.

Scar management- keep them from infection and facilitate wound healing through patient education.

Heat, paraffin, fluidotherapy, ultrasound- helps make the tissue more supple and more mobile

41
Q

silicone gel sheeting

A

Cic-care- cost over 80 bucks. keeps body heat close to the skin. can keep nice neutral heat.

Mederma- Can help the appearance of scars- made with onions.

42
Q

scars and ROM

A

restrict motions due to scars adhering to tendons and affecting ability to glide and mood.

Musckuloskeletal (14 decks)

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