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D2: 622 Oral Surgery > Wound Healing and Asepsis > Flashcards

Wound Healing and Asepsis Flashcards

1
Q

The breakdown of living tissue by the action of microorganisms and is usually accompanied by inflammation

A

Sepsis

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2
Q

The attempt to keep patients, personnel, objects, surgical wounds free of microbial contamination

A

Asepsis

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3
Q

Substance applied to living tissue to prevent multiplication of micro-flora

A

Antiseptic

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4
Q

Substance applied to inanimate object to prevent multiplication of micro-flora

A

Disinfectant

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5
Q
  1. Surgeon’s hand/arm surgical scrub procedure
  2. Surgical field prep with betadine or chlorhexidine
  3. Sterlie drape/gown/gloves
A

Sterile technique for operating room

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6
Q

When is the clean technique used

A

Intraoral office based procedure

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7
Q
  1. heat
  2. mechanical dislodgement
  3. Radiation
A

Physical methods of general sterilization/disinfection

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8
Q
  1. Antiseptics
  2. Disinfectants
  3. Ethylene oxide gas
A

Chemical methods of general sterilization/disinfection

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9
Q
  1. Hair back
  2. Eye protection
  3. Mask
  4. Scrub of white coat
  5. Wash hands
  6. Open instruments
  7. Glove
A

Surgical staff prep

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10
Q

Under Rule#1 what are the only surfaces the gloved hands can touch

A
  1. Opened instruments

2. Covered operatory

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11
Q

What is Rule #2

A

Glove can’t touch anything else besides the patient’s mouth or anything in Rule #1

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12
Q

What is Rule #3

A

When gloves touch anything else they are considered contaminated and have to be changed

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13
Q
  1. Compromised blood flow
  2. Crushing
  3. Desiccation
  4. Incision
  5. Irradiation
  6. Overcooling
  7. Overheating
A

Physical causes of tissue damage

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14
Q
  1. Agents w/ unphysiologic pH
  2. Agents w/unphysiologic tonicity
  3. Proteases
  4. Vasoconstrictors
  5. Thrombogenic agents
A

Chemical causes of tissue damage

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15
Q

Stage 1 of Wound Healing

A

Inflammatory Stage

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16
Q

Stage 1a of Wound Healing

A

Vascular Phase

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17
Q

Stage 1b of Wound Healing

A

Cellular Phse

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18
Q

Stage 2 of Wound Healing

A

Fibroplastic Stage

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19
Q

Stage 2a of Wound healing

A

Migratory Phase

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20
Q

Stage 2b of Wound Healing

A

Proliferative Phase

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21
Q

Stage 3 of Wound Healing

A

Remodeling

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22
Q

Stage 3a of Wound healing

A

Wound maturation

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23
Q

Starts at injury and lasts 3-5 days

A

Inflammatory stage

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24
Q
  1. Vasoconstriction/Coagulation
  2. Vasodilation
  3. Fibrin causes lymphatic obstruction
A

Vascular phase of the inflammation stage

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25
Q
  1. Histamine/Prostaglandins cause leukocyte to migrate and plasma leaks into interstitial tissues
  2. Results in edema
A

Vasodilation during Vascular Phase of Inflammation Stage of Wound Healing

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26
Q
  1. Fibrin does not improve wound strength

2. Results in EDEMA

A

Fibrin causing lymphatic obstruction during Vascular Phase of Inflammation Stage of Wound Healing

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27
Q
  1. Tissue trauma produces C3a and C5a
  2. C3a/C5a are chemotactic for Neutrophils
  3. Neutrophils release lysosomal enzymes (Degranulation)
  4. Macrophages phagocytize foreign and necrotic material
  5. B Cells produce antibodies
  6. T cells Help/Kill/Suppress
A

Cellular Phase of Inflammatory Stage

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28
Q

C3a and C5a are chemotactic for

A

Neutrophils

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29
Q

When neutrophils stick to blood vessel walls

A

Margination

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30
Q

When neutrophils migrate through vessel walls

A

Diapedesis

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31
Q

These destroy bacteria, foreign material, and digest necrotic tissue

A

Proteases, which are the lysosomal enzymes released by neutrophils

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32
Q
  1. Erythema/Redness
  2. Edema/Swelling
  3. Warmth
  4. Pain
  5. Loss of function
A

Signs of Inflammation

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33
Q
  1. Proliferation/Migration

2. Contact inhibition

A

Steps of Epithelialization

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34
Q
  1. Edge of epithelium advances over wound bed until contact with other epithelial cells
  2. Cell w/o cell-to-cell contact release chemical mediators that regulate cell growth
A

Proliferation/Migration stage of Epithelialization

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35
Q
  1. Chemical mediator release stops

2. Cell proliferation stops

A

Contact inhibition of epithelialization

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36
Q
  1. Wound fills with clotted blood, inflammatory cells, and plasma
  2. Epithelium migrates into wound
  3. Mesenchymal cells transform into fibroblasts
A

Beginning of wound healing during inflammatory stage

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37
Q
  1. Starts 3-4 days after injury
  2. Epithelial Migration continues
  3. Leukocytes remove necrotic material
  4. Capillary in-growth
  5. Fibroblasts migrate into wound
  6. If wound is placed under early tension (no suture) the edges pull apart and increase scarring
A

Migratory Phase of the Fibroplastic Stage of Wound healing

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38
Q
  1. Epithelial thickness increases
  2. Collagen fibers are laid down in a haphazard pattern
  3. Capillaries connect to increase vascularity
  4. 2-3 week long; increases wound to 75% of uninjured tissue
A

Proliferative Phase of Fibroplastic Stage

39
Q

Mucopolysaccharides

A

Ground substance present in the proliferative phase of fibroplastic stage

40
Q

Tropocollagen

A

Forms crosslinks to make collagen….this process is found in the proliferative phase of the fibroplastic stage of wound healing

41
Q
  1. Epithelial Stratification
  2. Collagen remodeling
  3. Fibroblasts disappear
  4. Vascular integrity
  5. No new elastin in tissue = loss of flexibility
  6. Wound contraction
A

Remodeling Stage

42
Q
  1. Foreign Material
  2. Necrotic Tissue
  3. Ischemia
  4. Tension (meaning anything holding wound edges apart)
A

Factors that Impair Wound healing

43
Q
  1. Bacteria (Infection)

2. Debris (Shelters bacteria from host response

A

Foreign Material as a factor of impaired wound healing

44
Q
  1. Barrier to in-growth of reparative cells
  2. Shelters bacteria from host defenses
  3. Frequently includes blood (hematoma) which is a nutrient source for bactera
A

Necrotic tissue

45
Q
  1. Leads to further necrosis
  2. Decreases delivery of antibodies, WBCs, antibiotics (increased risk of infection)
  3. Decreases delivery of oxygen and nutrients
46
Q
  1. Tight/incorrect sutures
  2. Improperly designed flaps (small base to height ratio)
  3. Excessive external pressure to the wound
  4. Excessive internal pressure (hematoma)
  5. Systemic hypotension
  6. Peripheral vascular disease
  7. Anemia
A

Causes of Ischemia

47
Q
  1. Tight sutures –> strangulation –> Ischemia
  2. Early suture removal
  3. Sutures left in place too long
A

Sources of tension

48
Q
  1. Edges of wound placed together in pre-injury anatomic position
  2. Minimal re-epithelialization, collagen deposition, contracture
  3. Associated with????_________
A

Healing by primary intention

Laceration/Incision
Reduced & Stablilized bone fracture
Anatomic nerve anastomoses

49
Q
  1. Gap between tissue edges, bone fractures, nerve endings
  2. Epithelial migration, collagen deposition, increased contracture
  3. Associated with???__________
A

Healing by secondary intention

Extraction socket
Unreduced bone fractures
Ulcer
Avulsive injury

50
Q
  1. Corical bone
  2. Periodontal Ligament
  3. Rim of gingival epithelium
  4. Blood clot
A

Contents of the extraction socket

51
Q
  1. WBCs remove bacteria and debris/bone fragments
  2. Fibroplasia (Fibroblasts & Capillaries)
  3. Epithelium migrates down walls until contact inhibition
  4. Osteoclasts accumulate along crestal bone
A

First week after extraction

52
Q
  1. Osteoid deposition along alveolar bone lining
  2. Cortical bone lining resorbed (in 4-6 months)
  3. Trabecular bone fills socket
  4. Epithelium displaced on top of socket as bone fills
A

2nd, 3rd, 4th Weeks of Healing after extraction

53
Q
  1. Osteoclasts
  2. Osteoblasts
  3. Primary Intention
  4. Secondary Intention
  5. Factors
A

Factors in Bone Healing

54
Q

Come from a Monocyte precursor cell

Resorb necrotic bone and bone to be remodeled

A

Osteoclasts

55
Q

Circulating multipotent mesenchymal cells
Lay down osteoid
Periosteum
Endosteum

A

Osteoblasts

56
Q
  1. Greenstick fracture
  2. Anatomically reduced fracture
  3. Ossification
A

Bone Healing via Primary Intention

57
Q

This primary intention fracture is not completely seperated

A

Green stick

58
Q

This primary intention fracture has been stabilized by surgery

A

Anatomically reduced fracture

59
Q

This occurs across the fracture site with minimal fibrous tissue

A

Ossification

60
Q

Free ends of bone more than 1 mm apart

Fibroplastic stage:
Excess collagen formation around free ends
Results in a callus

A

Secondary Intention

61
Q
  1. Osteoclasts remove old bone
  2. Osteoblasts lay down new bone
  3. Cortical bone laid down along blood vessels
A

Remodeling stage of bone healing

62
Q
  1. Vascularity

2. Immobility

A

Factors affecting bone healing

63
Q
  1. Supplies oxygen for proper healing

2. Compromised: low oxygen levels

A

Consequences of good and bad vascularity on bone healing

64
Q
  1. Cartilage formation

2. Fibrous tissue formation

A

Results of poor vascularity on bone healing

65
Q
  1. Bone forms perpendicular to lines of tension: functional matrix theory
  2. Excess mobility form excess tension results in decreased vascularity
A

Consequences of movement v. immobility on bone healing

66
Q

An INERT FOREIGN MATERIAL placed through an EPITHELIAL BARRIER develops a BIOLOGIC BOND to surrounding bone, which resists EPITHELIAL MIGRATION along the surface of the material

A

Implant Osseointegration

67
Q
  1. Bone heals to implant
  2. Tissue reaction
  3. Alveolar soft tissue heals to implant
  4. Guided-Tissue Regeneration
A

Process of Implant Osseointegration

68
Q
  1. Short distance between bone/implant
  2. Viable bone
  3. No movement
  4. Implant Surface
A

Factors that would help bone to heal to implants

69
Q

how can distance from bone to implant be minimized?

A

Through excellent site preparation

70
Q

How can you maximize the viable bone retained?

A

limit heat production when drilling hole

71
Q

What is it important that you keep the implant surface free from

A

Bacteria
Oil
Glove powder

72
Q
  1. Surrounding damaged bone remodeled by osteoclast/osteoblast activity
  2. Osteocytes secrete glycosaminoglycans to coat the titanium oxide implant surface
  3. Osteoblasts deposit OSTEOID over the proteoglycan layer
A

Tissue reaction between bone and titanium oxide implant

73
Q
  1. Woven membrane placed around implant

2. Pore Size

A

Factors in Guided-Tissue Regeneration

74
Q

How does a woven membrane help osseointegration

A

It inhibits fibrous tissue ingrowth

75
Q

How does the right pore size help guided tissue regeneration?

A
  1. Allows oxygen and nutrients in but keeps fibroblasts out
76
Q
  1. Epithelium secretes ground substance to coat implant

2. Hemidesmosomal-Basal Lamina system forms

A

How alveolar soft tissue heals to the implant

77
Q
  1. Neuropraxia
  2. Axonotmesis
  3. Neurotmesis
A

Seddon Classification of Nerve Injury

78
Q
  1. Contusion from trauma
  2. Inflammation
  3. Ischemia
  4. Spontaneous recovery within a few days/weeks
A

Neurapraxia

79
Q

What is neurapraxia?

A

Epineural sheath and axons maintain continuity after injury

80
Q
  1. Crushing injury
  2. Excess traction
  3. Axonal regeneration within 2-6 months possible
A

Axonotmesis

81
Q

What is Axonotmesis

A

When the epineurial sheath is intact but the axons are disrupted

82
Q
  1. Fractures
  2. Iatrogenic transection
  3. Poor prognosis unless re-anastomosed/reapproximated
A

Neurotmesis

83
Q

What is a neurotmesis

A

A nerve injury where the nerve has been completely severed

84
Q
  1. Degeneration phase

2. Regeneration phase

A

Phases of Nerve Healing

85
Q

Altered sensation

A

Paresthesia

86
Q

Dysesthesia

A

Painful sensation

87
Q

Hyperesthesia

A

Excessive sensation

88
Q

Hypoesthesia

A

Decreased sensation

89
Q

When does segmental demyelination occur typically?

A

After a neuropraxia injury

90
Q

Myelin sheath dissolved into segments

A

segmental demyelination

91
Q
  1. Segmental Demyelination

2. Wallerian Demyelination

A

Results of the degeneration phase of nerve healing

92
Q

What type of demyelination results in the myelin sheath/axon distal from injury disintegrating?

93
Q
  1. Begins immediately after injury
  2. New growth cone down Schwann cell tube
  3. 1 mm-1.5 mm per day
  4. New myelin sheath forms
  5. Continues until area of innervation reached OR FIBROUS TISSUE OBSTRUCTS GROWTH
  6. PARESTHESIA/DYSESTHESIA before normal feeling returns
  7. If obstructed, a TRAUMATIC NEUROMA may form (painful)
A

Regeneration Phase of Nerve Healing

D2: 622 Oral Surgery (7 decks)

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