Wounds Flashcards
What is an Abrasion?
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
What is an avulsion?
sometimes referred to as “degloving”
a serious wound resulting from tension that causes skin to become detached from underlying structures
What is a laceration?
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
What is a penetrating wound?
a wound that enters the interior of an organ or cavity
What is a puncture wound?
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
What is a skin tear?
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
What types of wounds should be classified based on depth of injury?
wounds that are not classified as pressure or neuropathic ulcers
What are the characteristics of superficial wounds?
trauma to the skin with the epidermis remaining intact such as with a non-blistering sunburn
typically heals as part of the inflammatory process
What are the characteristics of partial-thickness wounds?
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
What are the characteristics of full-thickness acute wounds?
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
What are the characteristics of subcutaneous acute wounds?
extend through the integumentary tissues and involve deeper structures such as subcutaneous fat, muscle, tendon, or bone
typically require healing through secondary intention
What are the 3 main phases of healing?
Inflammatory Phase
Proliferative Phase
Maturation Phase
What is the Inflammatory phase of healing?
How long does it usually last?
- 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
During the inflammatory phase of healing what cells actively remove debris and necrotic tissue and kills bacteria?
mast cells, neutrophils, and leukocytes
How long does it take for re-epithelialization to begin during the inflammatory phase of healing?
typically begins within 24 hours at the wound borders but visible signs usually are not observed earlier than 3 days post injury
What is the proliferative phase of healing?
How long does it usually last?
- 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
What cells are active and form the collagen matrix during the Proliferative Phase of healing?
Keratinocytes, endothelial cells, and fibroblasts
How is skin integrity restored during the Proliferative Phase of healing?
wound closure occurring through epithelialization and wound contraction
What is the Maturation Phase of wound healing?
How long does it typically last?
(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
How will a new scar look compared to a mature scar?
immature scars appear red, raised, and rigid
Mature scars appear pale. flat, and pliable
Approximately what percentage of tensile integrity does a newly formed scar have compared to pre-injury integrity?
15% which is why they should be protected to prevent re-injury
Approximately what percentage of tensile integrity does a fully matured scar have compared to pre-injury integrity?
as much as 80% tensile integrity
What is the difference in maturation time for a burn that does have hypertrophic scarring and one that does not have hypertrophic scarring?
Hypertrophic scarred burn=up to 2 years
non-hypertrophic scarring burn=4-8 weeks
What is Primary Intention wound healing?
- 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
What is Secondary Intention wound healing?
- 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
What types of pathologies typically cause wounds that are healed via secondary intention?
diabetes, ischemic conditions, pressure damage, or inflammatory diseases
What are types of wounds that are typically healed with primary intention?
surgical incisions, lacerations, punctures, and superficial/partial thickness wounds
What are types of wounds that are typically healed via secondary intention?
neuropathic/arterial/venous/pressure ulcers, most full thickness wounds, and chronically inflamed wounds
What is tertiary intention healing?
- 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
