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Pathology Exam 2 > Wound Repair 3 > Flashcards

Wound Repair 3 Flashcards

1
Q

4 components of repair

A

Angiogenesis
Migration and proliferation of fibroblasts
Deposition of ECM
Remodeling (maturation/reorganization of fibrous tissues)

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2
Q

Granulation tissue

A

3-5 days of tissue repair specialized tissue appears
Name for pink soft appearance of tissue
Characterized by fibroblast proliferation and new, thin walled delicate capillaries
Dense fibrosis

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3
Q

Angiogenesis

A

Develops at site of ischemia
Contributes to tumor factor growth
bFGF induced and VEGF induced
Collateral circulations at site of ischemia

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4
Q

Vasodilation

A

Response to NO

VEGF induced increased permeability of preexisting vessel

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5
Q

Proteolytic degradation of basement membrane

A

Matrix metallioproteinases MMPs

Disrupt cell-cell contact between endothelial cells by plasminogen activator

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6
Q

Migration of endothelial cells

A

Go towards the angiogenic stimulus

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7
Q

Proliferation of endothelial cells

A

Just behind leading front of migrating cells

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8
Q

Maturation of endothelial cells

A

includes inhibition of growth and remodeling into capillary tubes

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9
Q

Recruitment

A

Periendothelial cells, pericytes and vascular smooth muscle cells to form a mature vessel

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10
Q

bFGF

A

basic fibroblast growth factor

Induces angiogenesis

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11
Q

VEGF

A

vascular endothelial growth factor
Induces angiogenesis
Increases vessel permeability and edema

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12
Q

3 stages of wound healing

A

Inflammation
Proliferation
Maturation

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13
Q

Inflammation

A

initial injury causes platelet adhesion and aggregation

Formation of a clot in surface of wound

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14
Q

Proliferation

A

formation of granulation tissue
Proliferation and migration of CT cells
Re-epithelialization of wound surface

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15
Q

Maturation

A

Involves ECM deposition, tissue remodeling and wound contraction

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16
Q

Incision damage

A

Death of limited number of epithelial cells and CT
Disrupt epithelial basement membrane continuity
Re-epithelialization to close wound
Makes a thin scar

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17
Q

Exiscional Wounds

A 
Large defects on the skin surface
From extensive loss of cells/tissue
Abundant granulation tissue
Extensive collagen deposition
Substantial scarring
Secondary intention healing
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18
Q

Blood Clot Formation

A

Entrapped RBCs, fibrin, fibronectin and complement components
Clot stops bleeding, scaffolding for migrating cells
Releases VEGF
Dehydration external surface
~24 hours neutrophils at margins, infiltrate with fibrin clot scaffolding, release enzymes clean debris

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19
Q

Granulation formation

A 
24-72 hours of repair
Hallmark of tissue repair
Pink, soft, granular
Presence of new small BVs (angiogenesis)
Proliferation of fibroblasts
Leaky vessels, plasma proteins/fluid into extravascular space
Invades incision space
Seen in secondary union
20
Q

Replaces Neutrophils in 48-96 hours

A

Macrophages

21
Q

Macrophage functions

A

Replace neutrophils
Clear extracellular debris, fibrin, other foreign material at site of repair
Promote angiogenesis and ECM deposition
Chemotaxis and proliferation of fibroblasts/keratinocytes
Antimicrobial activity

22
Q

What drives fibroblast migration?

A

Chemokines, TNF, PDGF, TGF-B and FGF
Triggered by multiple GFs
PDGF, EGF, TGF-B, FGF and cytokines IL-1 and TNF

23
Q

Collagen deposition

A

Present at margins of incision
Vertically oriented
Epithelial cells move from cut margins and deposit basement membrane components
Fuses at midline beneath scab

24
Q

Macrophage Secretions

A

Stimulate fibroblasts

Produce FGF-7 and IL-6

25
Q

FGF-7

A

keratinocyte growth factor

Secreted by macrophages

26
Q

IL-6

A

Enhances keratinocyte migration and proliferation

27
Q

What happens at the same time with epitheliazation?

A

Collagen fibrils become more abundant

Bridge incision

28
Q

What replaces type III collagen?

A

Replaced by matrix of type I collagen

29
Q

What is the function of TGF-B?

A

Most important fibrogenic agent
Produced by cells in granulation tissue
Causes fibroblast migration/proliferation
Synthesis of collagen and fibronectin, decreased degradation of ECM by metalloproteinases

30
Q

When does luekocytic infiltrate, edema and increased vascularity disappear?

A

2nd week

Blanching follows

31
Q

What happens to granulation tissue after the 1st month?

A

Scar made up of acellular CT
Devoid of inflammatory infiltrate
Coverred by intact epidermis

32
Q

Wound contraction

A

Occurs in large surface wounds
Contraction helps to close the wound by decreasing the gap between its dermal edges and by reducing the wound surface area
Replacement of granulation tissue with a scar

33
Q

Fibrillar collagens

A

Type I collagen
Forms a major portion of CT in repair sites
Essential for the development of strength in healing wounds

34
Q

Net collagen accumulation

A

Depends not only increased collagen synthesis, also on degradation

35
Q

Strength of wounds

A

Due to excess collagen synthesis during the 1st and 2nd months of healing
Sutures removed from incision surgical wound
End of the 1st week, wound strength is approximately 10% that of unwounded skin
Wound strength increases rapidly over the first 4 weeks
Slows down approximately 3rd month after incision
Plateau 70-80% of tensile strength of unwounded skin

36
Q

Lower tensile Strength

A

Healed area might persist for life

37
Q

Recovery tensile strength

A

Excess collagen synthesis over collagen degradation during first 2 months of healing
Structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis has occured

38
Q

Factors that influence wound healing

A 
Nutrition
Metabolic status
Circulatory status
Hormones
Infection
Mechanical factors
Foreign bodies
Size, location, type
39
Q

Glucocorticoids

A

Anti-inflammatory effect
Influences various aspects of inflammation
Inhibit collagen synthesis

40
Q

What are the 3 complications of wound healing?

A
  1. Wound dehiscence

2. Ulceration

41
Q

Wound Dehiscence

A

Rupture of wound common after abdominal surgery

Increased abdominal pressure-vomiting, coughing, or ileus

42
Q

Ulceration

A

Inadequate vascularization during healing

Areas devoid of sensation

43
Q

Hypertrophic scars

A

develop after thermal or traumatic injury
deep layers of dermis
raised scar, excessive amounts of collagen involved

44
Q

Keloid

A 
Individual predisposition
More common black folks
Excessive granulation tissue
Protrude above level of surrounding skin and block re-epithelialization
Cautery or surgical excision
45
Q

Exuberant Granulation

A

Deviation in wound healing
Formation of excessive amounts of granulation tissue
Protrudes above the level of surrounding skin
Blocks re-epithelialization
Removed by cautery or surgical excision

46
Q

Contraction

A

Exaggeration of normal healing process
Deformities of the wound and surrounding tissue
Develop on palms, soles, anterior aspect of thorax
Commonly seen after burns and compromise joint movement

47
Q

Fibrosis

A

Excessive deposition of collagen and ECM components in tissue
Chronic diseases

Pathology Exam 2 (6 decks)

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