Wound Management

Question 1

what are the three phases of wound healing?

Answer 1

inflammation
tissue formation
tissue remodeling

Question 2

what are the three early phase phenomena of wound healing?

Answer 2

epithelialization
granulation tissue formation
contraction

Question 3

when does epithelialization of a wound start?

Answer 3

within hours of injury

Question 4

when does granulation tissue form?

Answer 4

3-4 days post injury

Question 5

what does granulation tissue do?

Answer 5

lends surface for epithelialization and is resistant to infection

Question 6

what drives contraction?

Answer 6

cytokines: PDGF, TGF-beta
myofibroblasts from the dermis attach to collagen matrix

Question 7

what are the options for the clinical management of wounds?

Answer 7

primary closure
delayed primary closure
secondary closure
tertiary closure

Question 8

what is the primary purpose of debridement?

Answer 8

remove foreign material, dead tissue, and bacterial contaminants

Question 9

what is the negative of topical antibacterial or antiseptic creams?

Answer 9

may slow healing

Question 10

why would you apply a plastic layer to a wound?

Answer 10

prevents spread of debris or bacteria from adjacent skin into wound

Question 11

what should you do with proud flesh?

Answer 11

surgically remove excess granulation tissue
may need repeated trimming

Question 12

what are the advantages of split thickness grafts?

Answer 12

neovascularization occurs faster
less “all or nothing phenomenon”
abundance of donor sites
donor site heals fast

Question 13

what happens in epithelialization?

Answer 13

epidermal cells undergo phenotypic alteration, lose their tight junctions- desmosomes, form cytoplasmic come-alongs- actin filaments
epidermis releases from dermis and migrates

Question 14

what happens in granulation tissue formation?

Answer 14

fibroblasts migrate along fibrin scaffold and secrete extracellular matrix

Question 15

how do the vascular and fibrous tissue components of granulation tissue change?

Answer 15

vascular component decreases with time as fibrous tissue component increases

Question 16

why is a bandage of a wound conducive of wound healing?

Answer 16

reduces granulation tissue
reduces dependent edema
immobilizes
decreases potential for excess granulation
speeds healing
maintains topical wound dressing

Question 17

what is the classic approach to wound debridement?

Answer 17

moderate pressure irrigation

Question 18

what is the primary purpose of debridement?

Answer 18

remove foreign material, dead tissues, and bacterial contaminants

Question 19

what are medical maggots?

Answer 19

sterilized larvae of the green blowfly

Question 20

what do the enzymes that medical maggots secrete do?

Answer 20

dissolve necrotic tissue and the biofilm that surrounds bacteria to make a nutrient-rich liquid

Question 21

do medical maggots consume all bacteria regardless of antibiotic resistance?

Answer 21

yes

Question 22

what are fibroblasts like in chronic wounds?

Answer 22

impaired responsiveness to growth hormone

Question 23

why are puncture wounds difficult?

Answer 23

low oxygen tension factors anaerobic bacteria and Clostridium tetani

Question 24

should drains exit from the incision?

Answer 24

no

Question 25

can drains potentiate infection?

Answer 25

yes- remove as soon as possible