Wound Healing Flashcards
What are the three phases of wound healing?
Inflammation
Proliferation
Maturation/Remodeling
What is the goal of the Vascular Response during the Inflammation phase of healing?
What steps are done to achieve this goal?
Control bleeding and fight infectious diseases
- transudate leaks out of vessel walls: local edema
- local blood vessels reflexively constrict
- platelets aggregate to wall in wound bed
- localized redness and edema
cardinal signs are edema, redness, warmth, pain and decreased function
What is the cellular response of the inflammation phase of healing?
When cells become “leaky” and release PMNs which is the front line of defense and kills bacteria, cleans the wounds and degrades debris using MMPs
What is the role of macrophages and mast cells?
Macrophages kill pathogens and direct the repair process
Mast cells: produce histamine and secrete enzymes to accelerate riddance of damaged cells
What is angiogenesis?
formation of new blood vessels
What are the steps of the proliferation phase of wound healing?
- Angiogenesis
- formation of granular tissue (an extracellular matrix laid down by fibroblasts)
- wound contraction
- epithelialization (keratinocytes and epidermal appendages multiply and migrate across wound bed)
What stage of wound healing is characterized by rapid collagen synthesis and may last for up to 2 years?
Maturation phase
When would you expect to see the greatest change in healing of a wound during the maturation phase?
How strong will the tissue in a scar be compared to when it was healthy skin tissue? How else will the scar tissue be different from skin tissue?
in the first 6-12 months
80% of full tissue strength and it will no longer be able to sweat due to loss of glands and it will be less sensitive to touch and temperature
What are the general factors that affect wound healing?
- mechanism of injury
- time since onset (acute vs chronic)
- location
- wound dimensions
- temperature
- wound hydration
- necrotic tissue
- infection
What local factors affect wound healing?
- circulation and sympathetic nervous system responses to cold, fear, and pain
- sensation (decreased knowledge of pain and if there is any additional trauma to the area)
- mechanical stress (friction, shear, weight bearing, pressure, etc.)
What systemic factors affect wound healing?
- Age (normal physiological changes such as slowed immune response, decreased pain perception, and decreased collagen synthesis)
- nutrition (carbs for energy and protein for cellular repair/regeneration)
- comorbidities (esp. those affecting )2 perfusion)
- Medications (steroids, chemotherapy, etc.)
- behavioral risk taking (smoking, etc.)
What are examples of inappropriate wound care that a clinician could administer that would affect wound healing?
- prolonged or inappropriate use of antiseptics
- wrong dressing selection
- failure to detect/treat infection
- inappropriate irrigation, debridement, compression, etc.
- poor wound exploration
- poor temperature management
What are examples of appropriate wound care that a clinician could administer that would affect wound healing?
-initial use of antiseptic to kill everything
-maintenance care when wound healing is not priority
use of iodine to encourage/maintain non-viable tissue desiccation
What is primary wound closure?
- wound edges are approximated without/little formation of granulation tissue
- not typically seen by PTs unless preparing for delayed primary closure
What is secondary wound closure?
- wound edges unable to be approximated
- granulation tissue fills in wound bed
- PTs more likely to be involved
