Wound Healing and Asepsis Flashcards
The breakdown of living tissue by the action of microorganisms and is usually accompanied by inflammation
Sepsis
The attempt to keep patients, personnel, objects, surgical wounds free of microbial contamination
Asepsis
Substance applied to living tissue to prevent multiplication of micro-flora
Antiseptic
Substance applied to inanimate object to prevent multiplication of micro-flora
Disinfectant
- Surgeon’s hand/arm surgical scrub procedure
- Surgical field prep with betadine or chlorhexidine
- Sterlie drape/gown/gloves
Sterile technique for operating room
When is the clean technique used
Intraoral office based procedure
- heat
- mechanical dislodgement
- Radiation
Physical methods of general sterilization/disinfection
- Antiseptics
- Disinfectants
- Ethylene oxide gas
Chemical methods of general sterilization/disinfection
- Hair back
- Eye protection
- Mask
- Scrub of white coat
- Wash hands
- Open instruments
- Glove
Surgical staff prep
Under Rule#1 what are the only surfaces the gloved hands can touch
- Opened instruments
2. Covered operatory
What is Rule #2
Glove can’t touch anything else besides the patient’s mouth or anything in Rule #1
What is Rule #3
When gloves touch anything else they are considered contaminated and have to be changed
- Compromised blood flow
- Crushing
- Desiccation
- Incision
- Irradiation
- Overcooling
- Overheating
Physical causes of tissue damage
- Agents w/ unphysiologic pH
- Agents w/unphysiologic tonicity
- Proteases
- Vasoconstrictors
- Thrombogenic agents
Chemical causes of tissue damage
Stage 1 of Wound Healing
Inflammatory Stage
Stage 1a of Wound Healing
Vascular Phase
Stage 1b of Wound Healing
Cellular Phse
Stage 2 of Wound Healing
Fibroplastic Stage
Stage 2a of Wound healing
Migratory Phase
Stage 2b of Wound Healing
Proliferative Phase
Stage 3 of Wound Healing
Remodeling
Stage 3a of Wound healing
Wound maturation
Starts at injury and lasts 3-5 days
Inflammatory stage
- Vasoconstriction/Coagulation
- Vasodilation
- Fibrin causes lymphatic obstruction
Vascular phase of the inflammation stage
- Histamine/Prostaglandins cause leukocyte to migrate and plasma leaks into interstitial tissues
- Results in edema
Vasodilation during Vascular Phase of Inflammation Stage of Wound Healing
- Fibrin does not improve wound strength
2. Results in EDEMA
Fibrin causing lymphatic obstruction during Vascular Phase of Inflammation Stage of Wound Healing
- Tissue trauma produces C3a and C5a
- C3a/C5a are chemotactic for Neutrophils
- Neutrophils release lysosomal enzymes (Degranulation)
- Macrophages phagocytize foreign and necrotic material
- B Cells produce antibodies
- T cells Help/Kill/Suppress
Cellular Phase of Inflammatory Stage
C3a and C5a are chemotactic for
Neutrophils
When neutrophils stick to blood vessel walls
Margination
When neutrophils migrate through vessel walls
Diapedesis
These destroy bacteria, foreign material, and digest necrotic tissue
Proteases, which are the lysosomal enzymes released by neutrophils
- Erythema/Redness
- Edema/Swelling
- Warmth
- Pain
- Loss of function
Signs of Inflammation
- Proliferation/Migration
2. Contact inhibition
Steps of Epithelialization
- Edge of epithelium advances over wound bed until contact with other epithelial cells
- Cell w/o cell-to-cell contact release chemical mediators that regulate cell growth
Proliferation/Migration stage of Epithelialization
- Chemical mediator release stops
2. Cell proliferation stops
Contact inhibition of epithelialization
- Wound fills with clotted blood, inflammatory cells, and plasma
- Epithelium migrates into wound
- Mesenchymal cells transform into fibroblasts
Beginning of wound healing during inflammatory stage
- Starts 3-4 days after injury
- Epithelial Migration continues
- Leukocytes remove necrotic material
- Capillary in-growth
- Fibroblasts migrate into wound
- If wound is placed under early tension (no suture) the edges pull apart and increase scarring
Migratory Phase of the Fibroplastic Stage of Wound healing