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DPT 773 - Integumentary > Wound Healing Physiology > Flashcards

Wound Healing Physiology Flashcards

1
Q

Acute wound vs. Chronic Wound

A

Acute wound progresses through normal stages of healing and achieves closure in a timely manner.

  • Within 2 weeks

Chronic wound fails to progress through normal stages of healing within the expected time frame.

  • Within 30 days
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2
Q

What are the three types of wounds based on depth of tissue involvement?

A

- Superficial: Effects epidermis only

  • Abrasions, sunburn or flash burn without blistering.

- Partial-thickness: Effects epidermis and extends into the dermis, heals primarily by re-epithelialization from wound edges and dermal appendages

  • Includes blisters which disrupt the basement membrane that separates the epidermis from the dermis

- Full-thickness wounds: Extends through the epidermis and dermis into the subcutaneous layer or deeper.

  • Full thickness and subdermal burns
  • Stage 3 & 4 pressure ulcers
  • Wagner grade 2-5 neuropathic ulcers

- Deep wound: ?

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3
Q

What is a superficial wound?

A

A wound affecting only the epidermis, such as abrasions or sunburns.

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4
Q

What is a partial-thickness wound?

A

A wound extending into the dermis, healing primarily by re-epithelialization.

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5
Q

What is a full-thickness wound?

A

A wound that extends through the dermis into the subcutaneous layer or deeper.

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6
Q

What is primary intention wound closure?

A
  • Wound edges are approximated and closed
  • Typically healing in 1-14 days
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7
Q

What is secondary intention wound closure?

A

The wound heals by forming granulation tissue, followed by epithelialization.

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8
Q

What is tertiary intention wound closure?

A

Delayed primary closure, allowing initial healing followed by suturing after infection resolution.

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9
Q

What are the four phases of wound healing?

A
  • Hemostasis
  • Inflammation
  • Proliferation
  • Remodeling
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10
Q

Hemostasis

  • What happens?
  • What role do platelets play in wound healing?
A
  • Hemostasis: Vasoconstriction, platelet aggregation, and clot formation occur immediately after injury.
  • Platelets release growth factors and cytokines, initiating the healing process.
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11
Q

When does the inflammatory phase start?

A

The inflammatory phase starts at the time of injury and lasts 3-7 days.

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12
Q

What are the cardinal signs of inflammation?

A
  • swelling
  • redness
  • warmth
  • pain
  • decreased function
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13
Q

What cells are primarily involved in the inflammatory phase?

A
  • platelets
  • neutrophils
  • macrophages
  • fibroblasts
  • mast cells
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14
Q

What is the role of neutrophils in wound healing?

A
  • They cleanse the wound of microorganisms and debris, initiating the immune response.
  • Neutrophils levels peak at 24 to 48 hours after injury (acute response) to clean wound site for tissue restoration.
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15
Q

What is the goal of the proliferative phase?

A

To fill the wound defect with new tissue and restore skin integrity.

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16
Q

What is angiogenesis?

A

The formation of new blood vessels, occurring during the proliferative phase.

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17
Q

What cells produce granulation tissue?

A

Fibroblasts produce granulation tissue by synthesizing collagen.

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18
Q

What is wound contraction?

A

Reduction of wound size due to myofibroblasts pulling the edges together.

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19
Q

When does re-epithelialization occur?

A

It starts immediately after trauma and continues until the wound is resurfaced.

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20
Q

What is the remodeling phase?

A

The phase where collagen is reorganized, lasting up to 2 years post-injury.

21
Q

What is the maximum tensile strength achieved during remodeling?

A

Scar tissue achieves 70-80% of the original tissue’s tensile strength.

22
Q

What are polymorphonuclear leukocytes (PMNs)?

A

A group of white blood cells involved in the inflammatory phase, including:

  • neutrophils:
  • eosinophils: motile phagocytes that have a distinctive anti-parasitic function.
  • basophils: release histamine, promoting vasodilation and increased blood flow.
  • macrophages: clean debris, release growth factors, and transition the wound to the proliferative phase.
23
Q

What is the function of basophils?

A

Basophils release histamine, promoting vasodilation and increased blood flow.

24
Q

What are fibroblasts?

A

Cells that synthesize collagen and extracellular matrix components during the proliferative phase.

25
Q

What role do keratinocytes play in wound healing?

A

Keratinocytes migrate from wound edges to re-epithelialize the wound.

26
Q

What is granulation tissue?

A

New connective tissue with capillaries that forms during the proliferative phase.

27
Q

What is matrix metalloprotease (MMP) function?

A

MMPs degrade extracellular matrix to allow cell migration, but excess can prolong inflammation.

28
Q

What are tissue inhibitors of metalloproteases (TIMPs)?

A

Proteins that regulate MMP activity, balancing collagen synthesis and degradation.

29
Q

What is autolytic debridement?

A

The process where macrophages release collagenases to clear necrotic tissue.

30
Q

What is epithelialization?

A

The formation of a new epithelial layer over the wound.

31
Q

What is hypogranulation?

A

Insufficient granulation tissue formation, resulting in an unfilled wound defect.

32
Q

What is hypergranulation?

A

Excessive granulation tissue that extends above the wound edges.

33
Q

What are hypertrophic scars?

A

Raised, red scars caused by excessive collagen deposition within the wound border.

34
Q

What are keloids?

A

Overgrowth of scar tissue that extends beyond the original wound border.

35
Q

What is a contracture?

A

Rigid scar tissue that limits joint range of motion.

36
Q

What is dehiscence?

A

Rupture of a wound along a surgical incision.

37
Q

What factors contribute to chronic inflammation?

A
  • foreign bodies
  • repetitive trauma, and
  • cytotoxic agents can prolong inflammation.
38
Q

What is epibole?

A

Rolled wound edges that prevent epithelial migration and wound closure.

39
Q

How does prednisone affect wound healing?

A

It inhibits inflammation, granulation, contraction, and collagen production.

40
Q

What is the impact of immune suppression on healing?

A

Impaired immune function can delay or prevent wound healing.

41
Q

How does bioburden affect wound healing?

A

Presence of necrotic tissue and bacteria can prolong inflammation and prevent closure.

42
Q

What role do cytokines play in wound healing?

A

Cytokines mediate cell communication and can be pro- or anti-inflammatory.

43
Q

What is arrested epithelialization?

A

The halting of epithelial migration, often due to rolled wound edges or infection.

44
Q

What are senescent cells?

A

Cells that have stopped dividing and contribute to delayed wound healing.

45
Q

What is the goal of wound healing by tertiary intention?

A

To manage infection before final wound closure by suturing.

46
Q

What is wound closure in the remodeling phase?

A

Final reorganization of collagen to strengthen the wound.

47
Q

What is the role of integrins in wound contraction?

A

Integrins facilitate the contractile activity of fibroblasts and myofibroblasts.

48
Q

What is heparin’s role in the inflammatory phase?

A

Heparin stimulates endothelial cell migration and promotes capillary formation.

DPT 773 - Integumentary (20 decks)

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