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ABSITE > 14 Wound Healing > Flashcards

14 Wound Healing Flashcards

1
Q

Stages in wound healing: inflammation

A

Days 1-10
PMNs, Macrophages
Epithelialization

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2
Q

How fast does epithelialization occur?

A

1-2mm/day

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3
Q

Stage in wound healing: proliferation

A

5 days - 3 weeks
Fibroblasts
Collagen deposition, neovascularization, granulation tissue formation
Type III collagen replaced with type I

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4
Q

Stage in wound healing: remodeling

A

3 weeks - 1 year
Decreased vascularity
Collagen cross-linking - remodeling

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5
Q

How fast do peripheral nerves regenerate?

A

1mm/day

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6
Q

What cells arrive in wounds - what order?

A 
Platelets
PMNs
Macrophages
Lymphocytes
Fibroblasts
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7
Q

What cells are essential for wound healing?

A

Macrophages (release of growth factors, cytokines, etc)

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8
Q

Fibronectin

A

Chemotactic for macrophages

Anchors fibroblasts

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9
Q

Fibroblasts

A

Replaces fibronectin-fibrin with collagen

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10
Q

What is the predominant cell type by days 0-2?

A

PMNs

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11
Q

What is the predominant cell type by days 3-4?

A

Macrophages

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12
Q

What is the predominant cell type by days 5+?

A

Fibroblasts

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13
Q

What makes up a platelet plug?

A

Platelets and fibrin

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14
Q

What forms the provisional matrix?

A

Platelets, fibrin, fibronectin

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15
Q

Accelerated wound healing

A

reopening a wound results in faster healing the second time around - healing cells are already present

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16
Q

What is the most important factor in healing open wounds (secondary intention)?

A

Epithelial integrity

Migration across granulation tissue

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17
Q

Where does epithelization migrate from?

A

Hair follicles*
Wound edge
Sweat glands

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18
Q

Why do unepithelialized wounds promote bacterial growth?

A

They leak serum and proteins

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19
Q

What is the most important factor in healing closed wounds (primary intention)?

A

Tensile strength

Depends on collage deposition and cross-linking of collagen

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20
Q

What is the strength layer of the bowel?

A

Submucosa

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21
Q

What is the weakest time point for small bowel anastamosis?

A

3-5 days

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22
Q

Myofibroblasts

A

Smooth muscle cell-fibroblast
Communicates by gap junctions
Involved in wound contraction and healing by secondary intention

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23
Q

Collagen type I

A

Most common type of collagen
Skin, bone, tendons
Primary collagen in a healed wound

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24
Q

Collagen type II

A

Cartilage

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25
Q

Collagen type III

A

Increased in healing wounds

Blood vessels, skin

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26
Q

Collagen type IV

A

Basement membranes

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27
Q

Collagen type V

A

Widespread

Cornea

28
Q

What are required collagen co-factors?

A

Alpha-ketoglutarate, vitamin C, oxygen and iron

HYdroxylation and cross-linking of proline residues

29
Q

What improves the wound tensile strength?

A

Proline cross-linking

30
Q

Scurvy

A

Vitamin C deficiency

31
Q

What is the tensile strength of a healed wound compared to normal? When?

A

80%

By 8 weeks

32
Q

Predominant collagen type synthesized for days 1-2?

A

Type III collagen

33
Q

Predominant collagen type synthesized for days 3-4?

A

Type I collagen

34
Q

When is type III collagen replaced by type I collagen?

A

3 weeks

35
Q

When does a healing wound reach the maximum collagen accumulation?

A

2-3 weeks

After that, collagen is remodelled, but no extra is added

36
Q

Effect of d-Penicillamine

A

Inhibits collagen cross linking

37
Q

What is essential for wound healing?

A 
Moist environment (avoid desiccation)
Oxygen delivery
Avoid edema (leg elevation)
Remove necrotic tissue
38
Q

What transcutatneous oxygen measurement do you want for good healing? how do you improve it?

A 
TCOM > 25mmHg
Optimize fluids
No smoking
Pain control
Arterial revascularization
Supplemental oxygen
39
Q

What are impediments to wound healing?

A 
Bacteria >10^5/cm2
Devitalized tissue
Foreign bodies
Cytotoxic drugs
Diabetes
Albumin < 3.0
Steroids
Wound ischemia
40
Q

How does ____ effect wound healing?

Bacteria

A

Decreases oxygen content
Collagen lysis
Prolonged inflammation

41
Q

How does ____ effect wound healing?

Devitalized tissue and foreign bodies

A

Retards granulation tissue formation and wound healing

42
Q

How does ____ effect wound healing?

Cytotoxic drugs

A

5-FU, methotrextae, cyclosporine, FK-506

Impairs wound healing in the first 14 days of healing

43
Q

How does ____ effect wound healing?

Diabetes

A

Impedes the earl-phase inflammation response

Hyperglycemia can cause poor leukocyte chemotaxis

44
Q

How does ____ effect wound healing?

Steroids

A

Inhibit macrophages, PMNs, and collagen synthesis b fibroblasts
Decrease wound tensile strength as well

45
Q

How can you counteract the detrimental effects of steroids on healing?

A

Vitamin A (25,000 IU qd)

46
Q

How does ____ effect wound healing?

Wound ischemia

A

Hypoxia

Causes: fibrosis, pressure, poor arterial inflow, poor venous outflow, smoking, radiation, edema, vasculitis

47
Q

Osteogenesis imperfecta

A

Type I collagen defect

48
Q

Ehlers-Danlos syndrome

A

10 types - all collagen disorders

49
Q

Marfan’s syndrome

A

Fibrillin defect (connective tissue protein)

50
Q

Epidermolysis bullosa

A

Excessive fibroblasts

Tx: phenytoin

51
Q

Charcot’s joint

A

2nd MTP joint
Secondary to neruopathy (can’t feel feet, pressure from walking leads to ischemia)
Also on toes

52
Q

Most common cause of leg ulcers?

A

Venous insufficiency

Tx Unna boots (elastic wrap)

53
Q

Contents of scars

A

Proteoglycans, hyaluronic acid and water

54
Q

When do you perform scar revisions?

A

Wait 1 year to allow maturation

May improve with age

55
Q

How does cartilage get nutrients/oxygen?

A

Diffusion

No blood vessels

56
Q

Impact of denervation on wound healing?

A

Nothing

57
Q

Impact of chemotherapy on wound healing?

A

Inhibits healing

No effect after 14 days

58
Q

Keloids

A

Autosomal dominant
Dark skin
Collagen goes beyond original scar
Tx: intra-lesion steroid injection, silicone, pressure garments, XRT

59
Q

Hypertorphic scar tissue

A

Dark skinned, flexor surfaces of upper torso
Collagen stays within confines of original scar
Often occurs in burns or wounds that take a long time to heal
Tx: steroid injections, silicone, pressure garments

60
Q

Platelet - alpha granules

A

Platelet factor 4
Beta-thrombomodulin
Platelet-derived growth factor
Transforming growth factor beta

61
Q

Platelet factor 4

A

Alpha granules

Platelet aggregation

62
Q

Beta-thrombomodulin

A

Alpha granules

Binds thrombin

63
Q

Platelet-derived growth factor

A

Alpha granules

Chemoattractant

64
Q

Transforming growth factor beta

A

Alpha granules

Modulates the response of the other alpha granules

65
Q

Platelets - dense granules

A

Adenosine
Serotonin
Calcium

66
Q

Platelat aggregation factors

A

TXA2
Thrombin
Platelet factor 4

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