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Flashcards in Second intention healing Deck (55)
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1

What are the key components of second intention healing?

1. granulation
2. contraction
3. epithelialization

2

How does the phases of wound healing in second intention differ from first intention (sutured wounds)

The phases are identical but the magnitude and duration of the CELLULAR phase is longer

3

How does contraction occur?

myfibroblasts (actin, fibronectin)

4

What are the two contraction theories?

1. picture frame theory
2. pull theory

5

What are the limits to contraction? (3)

1. contact inhibition
2. opposing tension
3. myofibroblasts disappear (large old wounds)

6

What is usually the greatest limit to contraction on limbs?

opposing tension

7

What can be done to old, large wounds to stimulate contraction?

scrape the granulation tissue/wound to cause upregulation of myofibroblasts

8

What is the rate of contraction on the body?

1mm/day (each side)

9

What is the rate of contraction on the limbs?

0.2mm/day

10

why is contraction slower on the limb?

1. inelasticity of skin
2. vascular insufficiency
3. fewer myofibroblasts
4. cytokines

11

What is the rate of epithelialization on the body?

0.2mm/day

12

What is the rate of epithelialization on the limb?

0.09mm/day

13

Why is epithelialization slower on the limb?

unknown

14

Why don't you see epithelialization until contraction has pretty well stopped?

because contraction occurs faster than epithelialization so it is just like the trickle in front of a wave and don't see significant epithelialization until contraction pretty well stops

15

How do you prevent exuberant granulation tissue?

1. debridement
2. sterile dressing
3. pressure bandages

16

Why is prevention better than treatment with exuberant granulation tissue?

because once a wound becomes exuberant, it tends to keep being exuberant

17

What is the bandage philosophy in second intention healing?

1. pressure bandage early to minimize swelling and reduce wound size--less retraction

18

What is the bandage philosophy in second intention healing?

1. pressure bandage early to minimize swelling and reduce wound size--less retraction b.c less swelling
2. after inflammatory phase it's a catch 22-may stimulate more granulation tissue and slow healing but also provides mechanical protection--abandon bandage when can!

19

Which of the following healed best 1) no treatment 2) cryosurgery 3) bandage 4) cast

1) no treatment

20

What can be a problem with wound medications?

t get a medication passed for wound healing, just have to show that causes no harm

21

When is immobilization indicated?

1. wounds in high motion areas

22

What requires critical observation?

equine sarcoids--horses are prone to develop equine sarcoids in areas of wounding. NOT granulation tissue--if trimmed will become more aggressive

23

How could you distinguish equine sarcoids and exuberant granulation tissue?

exuberant granulation tissue will eventually become exuberant over the whole wound

24

What are two ways that exuberant granulation tissue can be managed?

1. sharp debridement
2. topical medicaments

25

What are 2 advantages of surgical debridement? How is hemostasis acheived?

1. predictable result
2. can repeat as needed

achieve hemostasis by pressure bandage. (minimize by doing a fast debridement)

26

In what direction do you go when performing wound debridement?

start from bottom and work way up

27

What are two advantages of topical medications for the management of exuberant granulation tissue?

1. owner friendly
2. control granulation tissue

28

What is a disadvantage of topical medications for the treatment of exuberant granulation tissue?

1. impede healing (slow contraction, slow epithelialization)

29

Does sharp debridement of exuberant granulation tissue slow healing?

no

30

What does topical corticosteroids do?

inhibit granulation tissue
(also slows epithelialization)

(judicious use)