Wound Overview Flashcards
what are four major characteristics of the epidermis
- avascular
- water resistant protective barrier
- melanocytes
- regenerates quickly in healthy people
the dermis is the thickest layer. what are four occupants of the dermis
- BV
- lymph
- nerves
- glands
what does the hypodermis do? (2)
- provides stability to the integument system
2. CT and fat cells provide insulation and protection to underlying layers
what is the most important layer in prevention of pressure injuries
hypodermis
how does aging affect the epidermis (4)
- variable skip permeability
- decreased inflammatory response (basal cell)
- increased risk of skin cancer and allergen response (Langerhans’)
- loss of photo protection (melanocytes)
how does aging affect the dermis (2)
- decreased elasticity (elastin)
2. decreased vascularity
how does aging affect the dermal appendages (3)
- decreased sweating/altered thermoregulation (dec # of sweat glands)
- impaired sensory (altered nerve endings)
- hair color and loss (dec follicles/melanocytes)
wound healing occurs in three overlapping phases. Describe the wound healing process
the first event is hemostasis followed by
- inflammatory phase
- repair and proliferative phase
- remodeling and maturation phase
what are some inflammatory cells involved in wound healing
neutrophils, lymphocytes, mast cells, monocytes/macrophages
what are some repair cells involved in wound healing
fibroblasts, myofibroblasts, fibrocytes
what are epithelial cells involved in wound healing
keratinocytes
what are soluble proteins involved in wound healing
cytokines, chemokines, enzymes, growth factors
what signs would indicate that hemostasis is occuring
clot formation and cessation of active bleeding
what are signs of the inflammatory process
drainage/pus, loss of function, and usual culprits
what are events of the inflammatory process
cessation of bleeding, fibrin clot, inflammatory mediators migrate to wound
what are early signs of the reparative phase and what does it mean
granulation tissue is a sign of fibroblast migration and neovascularization to provide a surface for migration of keratinocytes
what are the late signs of the reparative phase and what does it mean
red to pink appearance of the skin denotes epithelialization and wound closure
what are signs of remodeling (3)
- strengthening of the scar
- reduction of neovascularization (reduced redness as pink turns to white)
- raised and rigid to flat and flexible
what is wound healing by primary intention
closure by healthcare providers
surgery, staples, stitches, grafts, and flaps
what is the advantage of healing by primary intention
fibroblast and proliferation is minimal cuz the cells are approximated
what is the advantage of delayed primary intention
allows for swelling/exudate/infection to resolve prior to closure
when would you use healing by secondary intention
pressure injuries and deeper wounds
what are two unique features of superficial wound healing
epidermis only and no scar formation
how far does a partial-thickness wound go?
damage to the dermis occurs but dermal appendages are spared
what types of patients tend to have no inflammation?
individuals taking steroids, older folks, immune compromised, malnourished
what causes wounds to have chronic inflammation
wounds with foreign bodies, continued trauma, and cytotoxic agents
what is hypogranulation defined by and how is it managed
characterized by no proliferative stage and managed by lightly packing the wound/surgery
what is hypergranulation defined by and how is it managed
proliferation occurs even after closure and acts as a deterrent to epithelialization - managed by special dressings, cleaning agents, and pressure
what is hypertrophic scarring
overproduction of immature collagen seen as red, raised, fibrous lesions within the confines of the original wound
what are interventions for hypertrophic scarring
compression garments, silicone gel sheets, scar mobs, steroid injections, and surgery
what are keloids and how do they differ from hypertrophic scarring
excessive collagen synthesis similar to hypertrophic scarring except keloids extend beyond the confines of the original wound
what is wound dehiscence
separation of wound edges due to insufficient collagen formation or tensile strength
what types of patients experience wound dehiscence
long term steroiders, older patients, malnutrition, immune pts
why is proper nutrition important for wound healing
active cells require carbs, but if not present they will rely on other sources of fuel
what is the ideal wound healing environment
moist, warm, minimal dead tissue, no excess exudate
how does dead tissue impact wound healing
slough and necrotic tissue will keep wound in early phases of healing and prevent keratinocyte migration from periphery to center
how does excess exudate impact wound healing
too much exudate can cause edema and neighboring skin irritation
what is strikethrough
exudate soaks through the gauze creating a portal from the environment into the body
