Wounds and Wound Healing Flashcards
What is primary wound healing?
What is the advantages of this approach?
When wound is created by clean incision and wound edges are approximated (brought together)
Quicker healing, decreased infection risk, minimal scar
What is secondary wound healing?
What are the downfalls of this approach?
When is it a preferred method?
No artificial wound closure; healing ONLY via physiologic closure
Wound is left open and granulation tissue forms (consists of new capillaries, fibroblasts, ECM)
Longer healing, increased infection (?), scaring
Puncture wounds due to infection risk
What is tertiary wound closure?
AKA Delayed primary closure
Usually secondary to concern for infection in a “dirty wound”
What are the four stages of wound healing?
- Hemostasis: seconds to hours after wound
- Inflammation: Inflammatory phase; hours to days
- Proliferation: Proliferative phase; days to weeks
- Remodeling: weeks to months
In what phase of wound healing is the compliment system activated?
Inflammatory phase
What is essential for complete wound healing?
Granulation tissue
What are the 3 main functions of granulation tissue?
Immune (protection from infection)
Proliferation (filling the gap)
Replacement (removal of non-viable tissue)
What cell type makes up the “scaffolding” of granulation tissue?
Fibroblasts
What is the management for clean wounds?
What is a “clean wound”
What Class of Surgical Wounds is a “clean wound”
Primary closure, normal post-op course
Clean (not infected) or the result of a non-penetrating, blunt trauma
Class I
What is the management of clean-contaminated wounds?
What is a clean-contaminated wounds
What class of surgical wounds is a clean-contaminated wound?
Delayed primary closure (tertiary)
Evidence of infection or major break in technique
Class II
What is the management for contaminated wounds and dirty wounds?
Secondary Intention
What suture material requires removal if external?
Non-absorbable
What suture material can “spit out” or lead to a sinus tract?
Non-absorbable
In patients with a history of or risk of keloids to reduce inflammatory reaction what should be used for wound closure?
Surgical glue
What are some advantages to surgical glue?
- Less painful procedure
- More rapid repair time
- Creation of a waterproof and antimicrobial barrier
- Better acceptance by patients
- No need for suture removal or follow-up
- Cosmetically similar results post-repair
- Safer for the provider than sutures because needlesticks are avoided
Can surgical glue be used on the hands and feet?
No contraindicated, unless the affected areas are immobolized
Can surgical glue be used on areas that require a high level of precision (i.e. Vermilion border)?
No
What are the goals of wound dressings?
- Hemostasis
- Infection prevention (mechanical barrier)
- Absorb drainage/exudate
- Keep wound moist
What genetic conditions are associated with delayed wound healing?
- Ehlers-Danlos
- Osteogenesis imperfecta
What are the preventative measures of wound healing complications in Ehler’s Danlos?
Why are they at risk for delayed wound healing?
- Multilayer closure
- Sutures left in place 2x longer
- Other interventions to reduce tensile forces
Easy bruising, slow wound healing, and abnormal scar formation
due to overly elastic skin
Why is Osteogenesis Imperfecta associated with poor wound healing?
Gene mutation of COL1A1 or COL1A2 causes decreased collagen production and abnormal collegen crosslinking
What are some causes of delayed wound healing?
- Infection
- Anti-inflammatory/steroids/immunomodulators
- Anticoagulants
- DM (especially poorly controlled)
- Obesity
- Malnutrition
- Smoking/ETOH use
- Arterial insufficiency/poor cardiac status
- Stress states
What are Keloids?
Who is at higher risk?
Excess wound healing - from any tissue insult
Firm, rubbery flesh-colored nodule of various sizes
African Americans
What are common locations of keloids?
- Deltoids
- Anterior Chest
- Back
- Earlobe
What is the treatment for keloids?
Intralesional steroid first line
Cryotherapy (prone to pigment changes)
Surgical excission (prone to recurrance)
What are the risk factors for developing a pressure ulcer?
What are the highest risk areas?
- Increasing age
- Think skin or low body weight
- Malnutrition
- Immobility
- Medical co-morbidities that delay wound healing
Heels, sacrum/coccyx, greater trochanters
Describe a Stage I Pressure Ulcer?
When does it move to a Stage II?
- Nonblanchable erythema
- Painful
- No other color change
When the dermis exposed and partial thickness of skin is lost
Describe a Stage III Pressure Ulcer?
What deferentiates a Stage IV from Stage III Ulcer?
- Full thickness skin loss
- Visible adipose tissue
- No deep structures visible
- Presence of granulation
- +/- undermining or tunneling
In stage IV, there is full thickness skin AND tissue loss
Additionally, there is exposed fascia, muscle, ligament or bone
What is the treatment for pressure ulcers?
Debridement, wound cleansing, and antibiotics
Efforts to improve mobility
When is amputation considered in diabetic ulcers?
If there is no healing in 4+ weeks
