Wounds

Question 1

What is an Abrasion?

Answer 1

an abrasion is a wound caused by a combo of friction and shear forces which typically presents over a rough surface resulting in a scarping away of the skin’s superficial lay

Question 2

What is an avulsion?

Answer 2

sometimes referred to as “degloving”

a serious wound resulting from tension that causes skin to become detached from underlying structures

Question 3

What is a laceration?

Answer 3

irregular tear of tissues often associated with trauma and can result from shear, tension, or high force compression with the resultant wound characteristics depending on the MOI

Question 4

What is a penetrating wound?

Answer 4

a wound that enters the interior of an organ or cavity

Question 5

What is a puncture wound?

Answer 5

a wound made from a sharp pointed object that penetrates the skin and underlying tissues

there is typically very little tissue damage except for the site of penetration, however there is a high risk of contamination and infection

Question 6

What is a skin tear?

Answer 6

a wound that results from trauma of fragile skin such as bumping into an object, adhesive removal, shear or friction forces

severity can range from flap-like tear to a full-thickness tissue loss

Question 7

What types of wounds should be classified based on depth of injury?

Answer 7

wounds that are not classified as pressure or neuropathic ulcers

Question 8

What are the characteristics of superficial wounds?

Answer 8

trauma to the skin with the epidermis remaining intact such as with a non-blistering sunburn

typically heals as part of the inflammatory process

Question 9

What are the characteristics of partial-thickness wounds?

Answer 9

extends through the epidermis and possibly into (but not through) the dermis

abrasion, blisters, and skin tears are common types of acute partial-thickness wounds

typically heal by re-epithelialization or epidermal resurfacing depending on the depth of injury

Question 10

What are the characteristics of full-thickness acute wounds?

Answer 10

extends through the dermis into deeper structures such as subcutaneous fat

wounds deeper than 4 mm are typically considered full thickness and heal through secondary intention

Question 11

What are the characteristics of subcutaneous acute wounds?

Answer 11

extend through the integumentary tissues and involve deeper structures such as subcutaneous fat, muscle, tendon, or bone

typically require healing through secondary intention

Question 12

What are the 3 main phases of healing?

Answer 12

Inflammatory Phase
Proliferative Phase
Maturation Phase

Question 13

What is the Inflammatory phase of healing?

How long does it usually last?

Answer 13

• first phase of wound healing
• initial response to a wound that rapidly attempts to re-establish hemostasis through platelet activation and the clotting cascade

Lasts 1-10 days

Question 14

During the inflammatory phase of healing what cells actively remove debris and necrotic tissue and kills bacteria?

Answer 14

mast cells, neutrophils, and leukocytes

Question 15

How long does it take for re-epithelialization to begin during the inflammatory phase of healing?

Answer 15

typically begins within 24 hours at the wound borders but visible signs usually are not observed earlier than 3 days post injury

Question 16

What is the proliferative phase of healing?

How long does it usually last?

Answer 16

• the formation of new tissue
• capillary buds and granulation tissue begin to fill the wound bed creating a support structure for the migration of epithelial cells

Lasts 3-21 days

Question 17

What cells are active and form the collagen matrix during the Proliferative Phase of healing?

Answer 17

Keratinocytes, endothelial cells, and fibroblasts

Question 18

How is skin integrity restored during the Proliferative Phase of healing?

Answer 18

wound closure occurring through epithelialization and wound contraction

Question 19

What is the Maturation Phase of wound healing?

How long does it typically last?

Answer 19

(Remodeling Phase)

• initiated when granulation tissue and epithelial differentiation begin to appear in the wound bed
• as phase progressed, mechanisms of fiber reorganization and contraction shrink and thin the scar

Lasts 7 days to 2 years

Question 20

How will a new scar look compared to a mature scar?

Answer 20

immature scars appear red, raised, and rigid

Mature scars appear pale. flat, and pliable

Question 21

Approximately what percentage of tensile integrity does a newly formed scar have compared to pre-injury integrity?

Answer 21

15% which is why they should be protected to prevent re-injury

Question 22

Approximately what percentage of tensile integrity does a fully matured scar have compared to pre-injury integrity?

Answer 22

as much as 80% tensile integrity

Question 23

What is the difference in maturation time for a burn that does have hypertrophic scarring and one that does not have hypertrophic scarring?

Answer 23

Hypertrophic scarred burn=up to 2 years

non-hypertrophic scarring burn=4-8 weeks

Question 24

What is Primary Intention wound healing?

Answer 24

• most common in acute wounds with minimal tissue loss
• smooth clean edges are re-approximated and closed with sutures, staples, or adhesives to facilitate re-epithelialization
• superficial partial thickness wounds such as abrasion and blisters also heal by primary intention via epithelial migration over the wound bed
• typically have minimal scarring and heal quickly in an uncomplicated and orderly progression

Question 25

What is Secondary Intention wound healing?

Answer 25

• permits wounds to close on their own without superficial closure
• usually wounds with significant tissue loss or necrosis, irregular or nonviable wound margins that cannot be re-approximated, infection, or debris contamination typically heal by secondary intention
• require ongoing wound care and have significantly larger scars than those healed via primary intention

Question 26

What types of pathologies typically cause wounds that are healed via secondary intention?

Answer 26

diabetes, ischemic conditions, pressure damage, or inflammatory diseases

Question 27

What are types of wounds that are typically healed with primary intention?

Answer 27

surgical incisions, lacerations, punctures, and superficial/partial thickness wounds

Question 28

What are types of wounds that are typically healed via secondary intention?

Answer 28

neuropathic/arterial/venous/pressure ulcers, most full thickness wounds, and chronically inflamed wounds

Question 29

What is tertiary intention healing?

Answer 29

• also referred to as delayed-primary intention
• wounds that are in high risk of infections such as sepsis or dehiscence may be temporarily left open and once those risks are diminished they would be closed with primary intention