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Oral Surgery 1 > Wound Repair > Flashcards

Wound Repair Flashcards

1
Q
  • Noted with abrasions
  • Renewal of epithelium occurs within hours after injury
  • Completion occurs at 24 – 48 hours
  • Free edge of epithelium migrate until it contacts the opposite edge
  • Signal is terminated in CONTACT INHIBITION
  • Occurs over wound bed but under scabbing/superficial blood clot
  • Occurs faster with moisten substrate over wound
  • Epithelium does cross over desiccated surface
A

Epithelialization

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2
Q
  • Also called LAG PHASE:
  • No increase in wound strength
  • Due to little collagen deposition
  • FIBRIN principle material holding wound together
  • Has little tensile strength
  • 2 phases of the it
  • Vascular
  • Cellular
A

Inflammatory phase

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3
Q

____ phase of inflammatory phase
• Vasoconstriction of disrupted vessels
• Coagulation (platelets and fibrin)
• Clot formation 5-10 minutes
• Vasodilation
• Increases permeability to site to allow healing factors and cells to
reach injury site
• Mediated by histamine and prostaglandins (E1 and E2) from WBCs
• Causes EDEMA (leak of cells and fluid to site of injury)

A

Vascular phase

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4
Q

Does vasodilation or constriction occur first in inflammation?

A

Vasoconstriction

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5
Q

____ phase of inflammatory phase
• PMN (neutrophils) arrive within 24 hrs of injury
• Margination:
• PMNs stick to side of blood vessels
• Diapedesis:
• PMNs migrate through vessel walls
• Degranulation:
• PMNS releasing lysosomal enzymes to destroy bacteria/foreign
materials/necrotic tissue
• Macrophages continue clearance of debris

A

CELLULAR PHASE

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6
Q

_______ are the dominant cell of fibroblastic phase of wound healing

A

• Fibroblasts

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7
Q
  • Fibroblasts are the dominant cell
  • Deposits ground substance and TROPOCOLLAGEN over fibrin lattice
  • Ground substance contains mucopolysaccharides →cement collagen fibers together
  • Secretes FIBRONECTIN
  • Stabilize fibrin
  • Assists in recognizing foreign material
  • Chemotactic factor to aid recruitment of fibroblasts and macrophages
  • Angiogenesis occurs:
  • Increase vascularity (from wound edges inward)
  • Causes raised and red color of wound
  • Superfluous fibrin strands removed by plasmin
  • Excessive collagen deposited in haphazard manner
  • Increases tensile strength (~ 5-7 days after injury →timing for suture removal)
  • 70%-80% tensile strength compared to uninjured tissue
A

Fibroblastic phase of wound healing

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8
Q

What percentage of the tensile strength is retained after healing in the fibroblastic phase compared to normal skin areas around it?

A

70-80%

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9
Q

____ phase of wound healing
• Increase in collagen ORGANIZATION AND STRENGTH
• Collagen oriented in direction to better resist tension
• Type III collagen replaced by Type I
• Excess collagen removed →scar softens
• Wound strength never reaches above 80% - 85% of
uninjured tissue
• Peak tensile strength at 60 days
• Wound erythema decreases as vascularity decreases to site
• Wound contraction occurs by migration of wound edges
toward each other

A

Remodeling phase

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10
Q

FACTORS THAT IMPAIR WOUND HEALING

  • Dirt, wood, glass, suture, bacteria
  • “Non-self” material causes chronic inflammation
  • Decreases fibroplasia
  • Bacteria proliferation causing infection
  • Destroys host tissue with bacteria byproducts
  • Non-bacteria causes a harbor for bacteria
A

• Foreign material

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11
Q

FACTORS THAT IMPAIR WOUND HEALING

  • Free bony fragment in extraction site is classic example
  • Barrier to ingrowth of reparative cells
  • Serves as a protected niche for bacteria
  • Hematoma formation:
  • Nidus for bacteria, as well as food source for bacteria
  • Blood clot is small and functional, hematoma is large and of no use
A

• Necrotic tissue

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12
Q

FACTORS THAT IMPAIR WOUND HEALING

  • Decreased blood supply, resulting in poor oxygen delivery to needed site
  • Increases wound infection by halting delivery of PMNs, WBCs, antibodies, ABX
  • Results from:
  • Poorly designed flaps
  • Tight sutures
  • Internal pressure from edema/hematoma
  • Hypotension during surgery
A

• Ischemia

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13
Q

FACTORS THAT IMPAIR WOUND HEALING

• Wounds closed under tension will cause ischemia at
margins with eventual opening (dehiscence)
• If suture removed too early, the wound under tension will
reopen and heal with excessive scar formation

A

• Tension

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14
Q 
• Overgrowth of tissue within border of 
wound edges
• Any race
• Common in pediatrics
• Regresses with time
• Common on flexor surfaces
A

HYPERTROPHY

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15
Q 
• Overgrowth beyond border of wound 
edges
• Common in darker skin/hereditary
• Rare in pediatrics
• Grows for years
• Common on upper body, head/neck
A

KELOID

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16
Q
  • Triple therapy:
  • Surgical excision
  • Corticosteroid injection
  • 40 mg/cc injection intralesional
  • 2-3 times per month for 6 months
  • Silicone pressure dressing
  • Worn 12-24 hours per day
  • For 2-3 months
A

Keloid/Hypertrophy Treatment

17
Q

MOst healing of extraction sockets is via ______ intention

A

Secondary intention

18
Q

______ intention
• Edges of wound returned to anatomic position
• Wound edges directly next to each other
• Little loss of tissue
• Minimal scar
• Closure stabilized and accomplished with
sutures/staples/adhesives
• Examples:
• Lacerations
• Well reduced bone fractures

A

Primary intention

19
Q 
\_\_\_\_ intention
• Wound is allowed to granulate in
• May be packed by surgeon with gauze or drain
• Granulation results in broad scar
• Slower healing process
• Examples:
• Gingivectomy
• Tooth extraction
• Poorly reduced fracture
A

SECONDARY INTENTION

20
Q

_____ intention
• Delayed primary closure
• Related to contaminated wounds
• Wound cleaned, debrided and observed
• Closure attempted after 4-5 days
• Purposely left open to observe for any signs and
symptoms of infection or further tissue necrosis
• Skin grafting or flaps can be used to cover these type of
wounds

A

TERTIARY INTENTION

21
Q

(what point in extraction wound healing?)
• Immediately after extraction:
• Remnants of periodontal ligament remain attached to the lamina dura
• Gingival epithelial margin is separated at the crest
• Coagulated blood seals socket

A

Immediately

22
Q

(what point in extraction wound healing?)

• Inflammatory phase
• WBCs break down and digest bacteria and debris
• Fibroplasia begins
• Fibroblast proliferate forming granulation tissue
• Neovascularization penetrates clot
• Clinical correlation: Localized osteitis, “dry socket,” occurs if this
phase fails
• Epithelium begins to migrate down towards first granulation tissue
it comes into contact with

A

• First week

23
Q

(what point in extraction wound healing?)

  • Granulation tissue increase and matures
  • Small socket may close off at 14 days, molars by 3 weeks
A

• Second week

24
Q

(what point in extraction wound healing?)

  • Almost all sockets will have epithelial closure by 21 days
  • Deposition of early bone (osteoid) within the socket
A

• Third and Fourth week

25
Q

(what point in extraction wound healing?)
• Continued resorption and recontouring of alveolus
• Total resorption of lamina dura by 1 year
• Clinical correlation:
• What is time frame to wait before building a final prosthesis?

A

• Four to six months

26
Q

• Where do osteogenic cells responsible for bone repair come from? 3 places

A
  • Periosteum
  • Endosteum
  • Circulating pluripotential mesenchymal cells
27
Q

• Factors most important to proper bone healing

  • If low oxygenation →cartilage will form instead of bone
  • If severe →fibrous tissue may never calcify →fibrous union
A

• VASCULARITY

28
Q

• Factors most important to proper bone healing

  • Intermaxillary fixation (IMF), bone plates, direct wires
  • Mobility prevents fibrous tissue from ossifying →fibrous union, non-union,
A

• IMMOBILITY

29
Q

What are the 3 phases of nerve repair?

A

Degeneration and Regeneration

30
Q
  • Myelin sheath dissolved in isolated segments (slows nerve conduction)
  • Symptoms: paresthesia, dysesthesia, hyperesthesia, hypoesthesia
A

• Segmental demyelination

31
Q

• Axons and myelin sheath of nerve distal to site of interruption undergo disintegration in their
entirety
• Axons proximal to the site of interruption undergo some degeneration generally a few Nodes of
Ranvier away

A

• Wallerian Degeneration

32
Q

• Growth cone (growth of new nerve fibers from proximal nerve stump) starts growing down
remnant Schwann cell tube
• Progresses 1 mm per day
• Continues until site innervated by the nerve is reached
• New myelin sheaths may form as axons increase in diameter
• Abnormal nerve healing →NEUROMA
• Mass of aimless nerve fibers
• Painful when disturbed (temperature, pressure, etc…)

A

• Regeneration

33
Q

• Spontaneous and subjective altered sensation that IS NOT PAINFUL/UNCOMFORTABLE

A

• Paresthesia

34
Q

• Spontaneous and subjective altered sensation that IS PAINFUL/UNCOMFORTABLE

A

Dysesthesia

35
Q

• Excessive sensitivity of a nerve to stimulation

A

Hyperesthesia

36
Q

• Decreased sensitivity of a nerve to stimulation

A

Hypoesthesia

37
Q

• No sensation when stimulated

A

Anesthesia

Oral Surgery 1 (11 decks)

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