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Surgery > Wound healing (Case) > Flashcards

Wound healing (Case) Flashcards

1
Q

Skin functions

A
  • maintain hydration & thermoregulation
  • defense against pathogens & chemicals
  • Vitamin D synthesis
  • Sensory (mechanoreceptors)
  • Storage (H2O, electrolytes, fat, proteins)
  • Insulation
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2
Q

Epidermis

A
  • superficial
  • cuboidal / stratified epithelium
  • avascular
  • variable thickness
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3
Q

Dermis

A
  • below the epidermis
  • collagen / elasticity
  • vascular plexus, lymphatics, nerves
  • hair follicles, glands
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4
Q

hypodermis

A
  • associated w/ dermis
  • mostly fat / connective tissue
  • contains panniculus
  • subdermal plexus and direct cutaneous artery and vein
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5
Q

Wound Healing

(test question)

A
  • Coagulation: < 5 minutes
  • Inflammation: 0-24 hours
  • Debridement: 2-5 days
  • Proliferation (repair): 4-21 days
  • Maturation: 21 days - 2 years
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6
Q

Coagulation

Primary

Clotting factors

A
  • Primary
    • platelets
    • vWF
    • subendothelial collagen
  • Clotting factors
    • intrinsic (12, 11, 9, 8)
    • extrinsic (7, 3)
    • common (10, 5, 2, 1)
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7
Q

Vessels spasming down is a …..

A

sympathetic response

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8
Q

Inflammation

A
  • Vasodilation (redness, heat)
  • Egress of leukocytes & serum (swelling)
    • fibrin plug >> protects wound bed
  • Plateslets >> cytokines (TNF, PDGF, TGF)
    • neutrophils 24-48 hours
    • Macrophages 2-5 days
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9
Q

Macrophages

A
  • necessary for wound healing
  • clean up neutrophil debris
  • mark debridement
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10
Q

Debridement

A
  • Removal of necrotic tissue & debris by macrophages (lag phase)
  • Duration
    • depends on amount of necrotic tissue
    • tissue type: collagenase, metalloproteinase, pH
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11
Q

Proliferation

A
  • Fibroblast influx
  • Epithelialization
  • Contraction
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12
Q

Fibroblast influx

A
  • max at 7-10 days
  • signaled by macs >> FGF, PDGF, TGF
  • only after adequate debridement
  • random, rapid deposition of type-1 collagen
    • rapid gain in tensile strength (log phase)
  • angiogenesis >> VEGF
    • granulation tissue formation (glistening, pink tissue)
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13
Q

Epithelialization

A
  • Begins 1-2 days, peaks at 5-7 days
  • slide and divide
  • contact inhibition
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14
Q

Contraction

A
  • 5-7 days
  • myofibroblasts >> actin & myosin
  • 1mm/day
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15
Q

Maturation

A
  • Collagen remodeling according to tensile forces
  • second lag phase
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16
Q

Wound factors

Intrinsic

A
  • hypoproteinemia
  • anemia
  • malnutrition
  • uremia
  • diabetes mellitus
  • hyperadrenocorticism
  • infection
17
Q

Wound factors

Extrinsic

A
  • Mechanism
    • shear
    • crush
    • laceration
  • foreign material
  • irradiation
  • antiseptics
18
Q

Wound classification

A

Based on time and contamination

  • Class 1: 0-6 hours; minimal contamination
    • primary closure = common
  • Class 2: 6-12 hours; moderate contamination
    • primary closure = reality
  • Class 3: > 12 hours; gross contamination
    • primary closure = don’t do it
19
Q

Wound classification

A

Based on surgical factors

  • Clean
    • surgical procedure not entering GI or respiratory tract
    • no contamination/ break in asepsis
  • Clean-contaminated
    • GI or respiratory tract entered or minor break in asepsis
    • enterotomy or lung lobectomy SSI = 10%
  • Contaminated
    • GI with gross contamination, inflammation, major break in asepsis
    • enterotomy with spillage SSI = 30%
  • Dirty
    • devitalized or necrotic tissue, gross debrus, pus
    • aged dog bite wound infected = infected
20
Q

Antimicrobials

A
  • Class 1 clean: don’t need
    • unless systemically unhealthy or foreign material
  • Class 2-3 Clean-contaminated, dirty: yes
    • broad spectrum penicillin or cephalosporin
21
Q

For lavage

A
  • we want 7-8 PSI
  • don’t use something that will kill fibroblasts
  • saline may be best
22
Q

Dry to dry bandages

A
  • Non-adherent
  • protects wound, allows moist healing
  • doesn’t harm wound bed
23
Q

Wound closures

A
  • Primary
    • immediate (< 6 hours)
  • Delayed primary
    • after 6 hours before granulation (< 2 days)
  • Late Secondary
    • after granulation tissue (>2 days)
  • Second intention
    • no surgical closure

Surgery (11 decks)

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