Wound Management

Question 1

What are the 3phases of wound healing?

Answer 1

1. Inflammatory/ Debridement
2. Proliferative
3. Maturation

Question 2

What happens to collagen during the inflammatory phase?

Answer 2

It is broken down and the wound weakens. The opposite occurs during the proliferative phase

Question 3

What cell type predominates during early vs late inflammation?

Answer 3

Early inflammation: neutrophils

Late inflammation: macrophages

Question 4

What is responsible for the first molecular signals being sent to recruit cells to come in to aid in healing?

Answer 4

The original blood clot composed of fibrin and platelets

Question 5

What are the 5 classic signs of inflammation and their pathophysiology?

Answer 5

1. Heat- increased blood flow, exudate of fluids, inflammatory mediators
2. Redness- increased blood flow
3. Swelling- exudation of fluids, influx of cells
4. Pain- chemical mediators, stretching due to exudates
5. Loss of function- disruption of tissue structure, fibroplasia, metaplasia and pain

Question 6

What are the gross characteristics of the inflammatory phase?

Answer 6

Purulent exudate, necrotic tissue, cardinal signs of inflammation

Question 7

What is the main cell type present in the proliferative phase?

Answer 7

Fibroblasts

Question 8

What are the 3 key characteristics of the proliferative phase?

Answer 8

1. Granulation tissue formation
2. Epithelization
3. Contraction

Question 9

Describe the unique characteristics of granulation tissue?

Answer 9

-Angiogenesis- capillary formation in a deep-superficial orientation perpendicular to the wound surface (provides high tissue oxygen tension)
-high collagen and fibroblast presence
-grossly appears bright red to pale pink
-highly resistant to infection

Question 10

What cell type is responsible for contraction during wound healing?

Answer 10

Myofibroblasts

Question 11

Contrast contraction vs contracture

Answer 11

Contraction lessens the size of the wound and improves cosmetic appearance, contracture is due to the same physiological mechanism but results in the inability to move joints or orifices normally

Question 12

T/F: wound healing can result in 100% of the original strength of the skin

Answer 12

False

Question 13

What 4 factors influence tissue oxygen tension?

Answer 13

1. Capillary oxygen tension
2. Blood flow
3. Capillary density
4. Tissue cell oxygen use

Question 14

Why is oxygen so essential for wound healing?

Answer 14

It is required for collagen production and for neutrophils to kill bacteria

Question 15

Can you move to the proliferative phase if there is still necrotic tissue in the wound?

Answer 15

NO

Question 16

What should be done on day one of seeing a wound?

Answer 16

Clip and clean surrounding skin, lavage, and debride

Question 17

What is the goal of debridement?

Answer 17

To remove necrotic tissue, severely contaminated tissue, and foreign material to prevent infection and allow for the movement from the inflammatory phase to the proliferative phase

Question 18

What are the different types of debridement?

Answer 18

Surgical
Autolytic
Bandage associated
Maggots
Chemical

Question 19

What is the most effective way to reduce bacterial numbers on the surface of a wound?

Answer 19

Lavage! -with tap water, saline or any IV fluid
- can add dilute chlorhex or iodine SOLUTION

Question 20

What is the ideal pressure for lavage?

Answer 20

8 psi

Question 21

Define Primary, Delayed primary and secondary wound closure

Answer 21

Primary- closing the wound the day you meet it (must be in first 6 hours)
Delayed primary: closing days later but before granulation tissue has formed
Secondary: closing the skin over the granulation tissue (during proliferative phase)

Question 22

When should you never consider primary closure?

Answer 22

If the wound is NRC classification of dirty, if you are worried that the tissue will become necrotic, if its a specific type of wound (burn, bite wound, gunshot wound, snake bite), if theres not enough skin to close without tension

Question 23

What are the 3 layers of the traditional bandage and their purposes?

Answer 23

Primary layer: the “dressing” or “contact layer”. This manipulates the wound environment
Secondary layer: allows for absorption, stabilization, and pressure +/- rigid support
Tertiary layer: provides additional protection/pressure over the secondary layer

Question 24

What are the goals of the primary layer in the inflammatory phase vs the proliferative phase?

Answer 24

Inflammatory phase: debridement, reducing bacterial contamination

Proliferative phase: holding cells and cytokines in, not disrupting fragile new tissue

Question 25

Which wound dressings are ideal for the inflammatory phase?

Answer 25

Wet to dry bandage, honey/sugar, calcium alginate

Question 26

Which wound dressings are ideal for the proliferative phase?

Answer 26

Tefla pad + triple antibiotic, petroleum infused gauze, honey/sugar, hydrogel, polyurethane foam, calcium alginate

Question 27

Describe the properties of the wet to dry bandage and what it entails.

Answer 27

A small amount of slightly moist sterile gauze in wound followed by a large amount of highly absorbent dry material on top
- should change as soon as strike through (at least once a day)
- this is painful to remove, so use sedation
-debridement is non-selective so this is no longer a preferred dressing

Question 28

Why is honey/sugar antimicrobial?

Answer 28

They have high osmolarity and dehydrate bacteria