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Surgical skills > Second intention healing > Flashcards

Second intention healing Flashcards

1
Q

What are the key components of second intention healing?

A
  1. granulation
  2. contraction
  3. epithelialization
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2
Q

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

A

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

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3
Q

How does contraction occur?

A

myfibroblasts (actin, fibronectin)

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4
Q

What are the two contraction theories?

A
  1. picture frame theory

2. pull theory

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5
Q

What are the limits to contraction? (3)

A
  1. contact inhibition
  2. opposing tension
  3. myofibroblasts disappear (large old wounds)
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6
Q

What is usually the greatest limit to contraction on limbs?

A

opposing tension

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7
Q

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

A

scrape the granulation tissue/wound to cause upregulation of myofibroblasts

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8
Q

What is the rate of contraction on the body?

A

1mm/day (each side)

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9
Q

What is the rate of contraction on the limbs?

A

0.2mm/day

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10
Q

why is contraction slower on the limb?

A
  1. inelasticity of skin
  2. vascular insufficiency
  3. fewer myofibroblasts
  4. cytokines
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11
Q

What is the rate of epithelialization on the body?

A

0.2mm/day

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12
Q

What is the rate of epithelialization on the limb?

A

0.09mm/day

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13
Q

Why is epithelialization slower on the limb?

A

unknown

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14
Q

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

A

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

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15
Q

How do you prevent exuberant granulation tissue?

A
  1. debridement
  2. sterile dressing
  3. pressure bandages
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16
Q

Why is prevention better than treatment with exuberant granulation tissue?

A

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

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17
Q

What is the bandage philosophy in second intention healing?

A
  1. pressure bandage early to minimize swelling and reduce wound size–less retraction
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18
Q

What is the bandage philosophy in second intention healing?

A
  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!
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19
Q

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

A

1) no treatment

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20
Q

What can be a problem with wound medications?

A

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

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21
Q

When is immobilization indicated?

A
  1. wounds in high motion areas
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22
Q

What requires critical observation?

A

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

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23
Q

How could you distinguish equine sarcoids and exuberant granulation tissue?

A

exuberant granulation tissue will eventually become exuberant over the whole wound

24
Q

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

A
  1. sharp debridement

2. topical medicaments

25
Q

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

A
  1. predictable result
  2. can repeat as needed

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

26
Q

In what direction do you go when performing wound debridement?

A

start from bottom and work way up

27
Q

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

A
  1. owner friendly

2. control granulation tissue

28
Q

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

A
  1. impede healing (slow contraction, slow epithelialization)
29
Q

Does sharp debridement of exuberant granulation tissue slow healing?

A

no

30
Q

What does topical corticosteroids do?

A

inhibit granulation tissue
(also slows epithelialization)

(judicious use)

31
Q

What are common preparations of topical corticosteroids?

A
  1. panalog–$
  2. green wound cream–penicillin + corticosteroid–sensitization?
  3. 0.1% dexamethasone :)
32
Q

What is white wound lotion?

A

lead acetate and zinc sulfate

33
Q

Why is white wound lotion not good to use on wounds?

A
  1. metabolic toxins (lead acetate, zinc sulphate)
  2. kill fibroblasts
  3. slow epithelialization
  4. lead poisoning–not bandaged–lick–poisoned
34
Q

What is the cheapest topical medication

A

copper sulfate (10% concentration mix with corn starch)

35
Q

What is a negative effect of copper sulfate?

A

it is astringent/caustic and kills fibroblasts

36
Q

What is a negative effect of copper sulfate?

A

it is astringent/caustic and kills fibroblasts

37
Q

Which is preferred, topical corticosteroids or copper sulfate to manage exuberant granulation tissue? (if must be topical?)

A

corticosteroids

38
Q

Is Furacin (nitrofurazon) a good choice for topical application on open wounds?

A

no,

  1. it causes granulation tissue. not a good choice on open wounds
  2. inhibits epithelialization
  3. harbors pseudomonas
39
Q

What is preparation H?

A

it is yeast extract

40
Q

What can preparation H (yeast extract) be used for?

A

to stimulate the production of granulation tissue early on (n long effects)

41
Q

What is a negative consequence of preparation H?

A

slows contraction and epithelialization

42
Q

What is a negative consequence of preparation H?

A

slows contraction and epithelialization

43
Q

What is the effect of amnion as a topical medication?

A

as a wound dressing

  1. inhibits granulation tissue
  2. promotes epithelialization
  3. speeds healing
44
Q

What is a problem with amnion:

A

not available commercially

45
Q

What is the effect of honey as a topical medication?

A
  1. osmotic effect on bacteria–antibacterial
  2. unpasteurized my have enzymes to activate hydrogen peroxide

good to use in early wound management

46
Q

What is the current data on collagen preparations as topical medications?

A
  1. no negative effects demonstrated
  2. so far no benefits
  3. expensive
47
Q

What is biosyst?

A

procine small intestinal submucosa

48
Q

What does biosyst have?

A
  1. collagen
  2. protepglycans
  3. cytokines
49
Q

What is biosyst promoted as doing? Is there evidence of this?

A
  1. scaffold
  2. healing modifier

no good research to support

50
Q

What are two benefits of using split thickness skin grafts?

A
  1. inhibit granulation tissue

2. promote wound contraction

51
Q

What are three types of skin grafts?

A
  1. zenographs (pig)
  2. allografts
  3. autograft
52
Q

Give an example where the medical preparation had an effect on wound healing

A
  1. gentamicin cream vs solution

trial revealed that the cream affected contraction and inhibited epithelialization. The solution caused faster healing

53
Q

What is a good saying for what to put on a wound?

A

If you wouldn’t put it in your eye, don’t put it on a wound

54
Q

What are examples of topical medications?

A
  1. corticosteroids
  2. white wound lotion
  3. copper sulfate
  4. furacin
  5. preparation H
  6. amnion
  7. honey
  8. collagen preparation
  9. biosyst
  10. split thickness skin grafts
55
Q

If you see exuberant granulation tissue, what should you do?

A

look for a reason!

Surgical skills (23 decks)

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