Wound Management Flashcards
What is a wound?
It is any disruption of anatomic structure and function in any body part.
Healing is the restoration of structure and function.
What are the phases of wound healing?
Primary healing:- Wound closure within hours of its creation. Done using stitches, staples, glues etc.
Secondary healing:- No wound closure is involved. The wound closes spontaneously by contraction and reepithelialization.
Tertiary wound healing:- Involves initial debridement for an extended period and then formal closure using skin graft or flap cover.
NB:- Skin graft does not come with blood supply and it is less technical while skin flap comes with blood supply and is more technical.
What is regenerative healing
This is the healing without scarring. This is seen in injuries that affect only the dermis of the skin.
What is reparative healing?
This is injury that usually heals with a scar due to formation of surrogate tissue. Seen in injuries that affect the semis and subcutis.
What are the various ways of wound classification?
1) OPEN or CLOSE
2) LOW VELOCITY or HIGH VELOCITY
3) BLUNT or PENETRATING
4) CLEAN, CLEAN CONTAMINATED, CONTAMINATED or DIRTY
5) INCISION, LACERATION, AVULSION, CRUSH or DEGLOVING
What are the 3 stages of wound healing?
Inflammatory phase
Proliferative phase
Maturation phase
Briefly discuss the inflammatory phase of wound healing
It is characterized by hemostasis and inflammation.
Collagen is exposed from cell damage during wound formation. This activates clotting cascade room both intrinsic and extrinsic pathway leading to inflammation.
Damaged cell membrane releases ** thromboxane a2 and prostaglandin 2-alpha** which are potent vasoconstrictors. Also histamine release helps to secure hemostasis.
Clot formation is achieved from the release of chemokines (vWF, fibronectin, fibrinogen, serotonin etc) from platelets. They stabilize the wound.
Leukocytes and macrophages (monocytes) secrete numerous enzymes and cytokines (TNF, collagenases, collagen, TGF, interleukins) that helps in wound healing.
What is the first cell that responds to wound formation?
Platelets
Which cell is referred to as the orchestrator that is essential for wound healing?
Macrophages
What is the function of collagenases in wind healing?
Debrides the wound
What is the function of interleukins and tumor necrosis factor (TNF) in wound healing?
Stimulate fibroblast (produce collagen) and promote Angiogenesis
What is the function of Transforming Growth Factor (TGF) in wound healing
It stimulates keratinocytes
Tissue reconstruction occurs in which stage of wound healing?
Proliferative stage
What are the principal steps in the anabolic Proliferative phase of wound healing?
Epithelialization
Angiogenesis
Tissue granulation formation
Collagen deposition
EAT Collagen
Which cytokine stimulates angiogenesis?
Tumor necrosis factor alpha (TNF-alpha)
How long does it take after wounding for fibroblasts to begin synthesizing collagen
5 - 7 days
The net increase for collagen deposition plateaus at what day?
21 days
How long does it take a wound to reach its maximal strength
1 year
In contracture wounds, maximum tensile strength is achieved at what time?
12th week and it’s only about 80% of the original strength of the skin.
List the factors that affect wound healing
GENERAL FACTORS
- Age
- Nutrition
- Medications (eg steroids causes healing retardation)
- Psychological state
LOCAL FACTORS
- Site of injury
- Blood supply
- Moist wound healing
- Wound infection
- Temperature
List the role of vitamins and trace elements in wound healing
• Vitamin A reverses healing retardation caused by steroid
• Vitamin c deficiency causes scurvy
• Zinc is needed for epithelialisation and fibroblast formation
• Ferrous iron and copper are necessary for normal collagen metabolism
What are some of the functions of oxygen in wound healing?
• Energy metabolism
• Neo-vascularization
• Oxygen and bacteria
• Collagen synthesis
• Oxygen and antibiotics
List some of the aims of treatment in wound healing
• To produce rapid and cosmetically acceptable healing,
• To remove or contain odour,
• To reduce pain,
• To prevent or combat infection,
• To contain exudate,
• To cause minimum distress or disturbance to the patient,
• To hide or cover a wound for cosmetic reasons.
What are the 3 layers of dressing design?
● Inner layer: called the contact layer-in direct physical approximation with the wound.
● Middle layer: directed towards physical protection or absorption
● Outer layer: used for compression, positioning and immobilsation
What are the 4 components of wound bed preparation? AKA TIME preparation.
●T= tissue management (involves debridement)
●I=inflammation and infection control
●M=moisture balance
●E=epithelial(edge) advancement
What are the aims of time framework
Optimize the wound bed by
- Reducing edema
- Reducing bacterial burden
- Correcting abnormalities contributing to wound healing
Why is moisture balance important in the TIME framework?
Dry surfaces;
- Impedes delivery of nutrients and immune defenses to the wound surface.
- Markedly impedes the ability of cells to migrate across the wound surface
What are the benefits of moisture in wound management?
Increase reepithelialization
Increase rate of reepithelialization
Increase collagen deposition
Decrease wound surface fluid loss
What are the clinical benefits of vacuum assisted closure?
• Provides a closed moist wound healing environment.
• Decreases wound volume
• Removes excess fluids that can inhibit wound healing
• Helps remove interstitial fluid
• Promotes granulation.
List 3 abnormal wound healings
Keloids
Hypertrophic scars
Contractures
Which connective tissue disease can affect wound healing
Marfan’s syndrome
Ehlers danlos syndrome
Progeria
In ascending order, list the reconstructive ladder.
- Healing by secondary retention
- Direct closure
- Skin graft
- Local flap
- Distant flap
- Free flap
