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VETM 411: Basic Surgical Principles > Wound healing - Tesse > Flashcards

Wound healing - Tesse Flashcards

1
Q

Explain the role of skin

A
  1. structure and protection
  2. homeostasis and regulation
  3. sensation
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2
Q

What are two examples of abnormal response to skin wounding

A

ulceration, excess scar

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3
Q

what are normal responses to wounds

A

epidermal barrier restoration (epithelialization) and dermal barrier restoration (fibroblast proliferation)

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4
Q

What are the 4 stages of wound healing

A
  1. inflammation
  2. debridement
  3. repair
  4. maturation
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5
Q

What is the first stage of wound healin

A

inflammation
- early/vascular
-late/cellular

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6
Q

what is the second stage of wound healing

A

debridement

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7
Q

what is the third stage of wound healing

A

repair
- fibroplasia
- angiogenesis
-epithelialization
-contraction

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8
Q

What is the fourth stage of wound healing

A

maturation
-tissue remodelling

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9
Q

What stage of wound healing is medical intervention most effective?

A

inflammatory stage

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10
Q

how long is the inflammatory stage

A

0-3 days

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11
Q

what are the two phases of inflammatory stage

A

Vascular and cellular

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12
Q

Describe the vascular phase of the inflammatory response

A
  1. bleeding to clean wound bed
  2. immediate vasoconstriction (epinephrine response, vascular smooth muscle response)
  3. vasodilation ( 5 -10 minutes later, leakage of fibrinogen and clotting factors, cellular infiltration begins)
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13
Q

describe the cellular phase of the inflammatory response

A

-clot formation and establishment of scaffold
- fibrinogen > fibrin
- fibrin and plasmin plug lymphatics
- clot dries into a scab

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14
Q

what initiates stage 2 of wound repair

A

WBCs under scab

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15
Q

When does debridement start?

A

6 hours after wounding, peaks around day 2-3

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16
Q

What are the first responders to the scene during debridement

A

Neutrophils

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17
Q

what enzymes do neutrophils release during debridement

A

collagenase and elastase

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18
Q

what do neutrophils release to attract monocytes and fibroblasts

A

chemoattractant cytokines

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19
Q

which are essential to non-infected wounds: neutrophils or monocytes

A

monocytes

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20
Q

when do monocytes arrive?

A

12 hours in

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21
Q

what are three things that monocytes are essential for during debridement

A
  1. collagenase production
  2. phagocytic actions
  3. release growth factors and cytokines
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22
Q

Cellular infiltration begins during

A

debridement stage

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23
Q

what stage does exudate arise

A

debridement

24
Q

What calls in the mesenchymal monocytes and keratinocytes that results in epithelialization

A

macrophages

25
Q

What is “PRP”

A

platelet-rich plasma that can be injected into a patient to enhance wound healing

26
Q

when do lymphocytes come into play

A

approx 1 week after wounding. Less numerous than macrophages.

27
Q

what makes up wound exudate

A

dead cells, wbcs, tissue, protein, fluid.

28
Q

When does the repair stage begin

A

day 3-5

29
Q

what stage does proliferation of new tissue start

A

repair stage

30
Q

what are four things that happen during stage 3 of wound repair

A
  1. fibroplasia (fibroblast proliferation)
  2. angiogenesis
  3. epithelialization
  4. wound contraction by development of myofibroblasts
31
Q

When does fibroplasia begin

A

starts day 3-4, continues for 2-4 weeks

32
Q

Describe fibroplasia

A

fibroblasts migrate from surrounding tissue. Mesenchymal cells proliferate in wound and migrate along fibrin strands in clot. Fibroblasts become myofibroblasts, develop cytoskeletal contractile elements. wound fibroblasts produce type 3 collagen, type 1 pro-collagen, ECM components.

33
Q

What is the end result of fibroplasia

A

the fibrin filled wound becomes a connective tissue filled wound

34
Q

Describe angiogenesis

A

new capillaries grow into wound, attracted by tissue hypoxia.

35
Q

T/F: granulation tissue is low in blood flow, but high in innervation

A

false. it is high in blood flow, low in innervation.

36
Q

What is granulation tissue

A

healing tissue composed of newly vascularized ECM, inflammatory cells, fibroblasts, matrix components

37
Q

what are the five processes that occur during the repair stage

A
  1. fibroplasia
  2. angiogenesis
  3. granulation tissue formation
  4. epithelialization
  5. contraction
38
Q

what are some purposes of granulation tissue

A
  • resistant to infection
  • provides surface for epithelial migration
  • role in wound contracture
39
Q

what type of collagen is most common in wounds

A

type 3

40
Q

What is “proud flesh”

A

excessive granulation tissue that becomes irregular, grows above skin edge, and interferes with contraction and epithelialization

41
Q

where does epithelialization begin

A

at the wound margin. requires granulation surface in open wounds. Stops with contact inhibition

42
Q

what heals faster: a dry wound or a moist wound? Why?

A

a moist wound. This is because O2 is more available. Moist wounds heal 50% faster

43
Q

What is contraction simultaneous with

A

granulation and epithelialization

44
Q

what changes phenotype during contraction phase?

A

fibroblasts become myofibroblasts so that they can contract

45
Q

what is myofibroblast persistence?

A

pathologic tissue development, excessive contracture, fibrosis, disfigurement

46
Q

what are the three phases of wound contraction

A
  1. lag phase
  2. rapid contraction phase
  3. slow contraction phase
47
Q

what is the lag phase of wound contraction

A

wound increases in size due to swelling, movement, etc. lasts 5-10 days

48
Q

how long does the rapid contraction phase last

A

10-14 days

49
Q

what is the slow contraction phase

A

follows complete epithelialization. gradual change of myofibroblasts returning to fibroblasts. begins after 2+ weeks

50
Q

The only layer contracting during the wound contraction phase is the

A

epidermis, NOT the dermis. adnexal structures therefore do NOT return, as they are part of the dermis.

51
Q

what is contact inhibition

A

growth of cells until they touch another cell

52
Q

What is involved with the maturation stage of wound healing

A

deposition, reorganization, and rearrangement of collagen fibers. The cell population matures, so myofibroblasts revert to normal fibroblasts.

53
Q

maturation changes the ___

A

ECM. Type 3 collagen is replaced by type 1, increased cross-linking, and reorganization along lines of tension

54
Q

T/F: the gain in mechanical strength of tissue during maturation is slow

A

true. most rapid between 7-14 days, 20% normal at 3 weeks, and 80-85% of normal at final result. will never return to original tensile strength of uninjured tissue.

55
Q
A

VETM 411: Basic Surgical Principles (10 decks)

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