Patho- Wound Healing

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Tensile strength: primary intention

-Sutured wound: 70% strength. -After sutures are removed (one week), tensile strength is 10% -Tensile strength increases rapidly for 4 weeks then plateaus at 70-80% after 3 months

How long does inflammatory phase last?

1-2 days

What are the three ways to fill in the gap and restore continuity to the injured part?

Primary, secondary, and tertiary intention

When does proliferative phase occur?

3-4 days after

What is fibroblast?

A connective tissue cell that synthesizes and secretes collagen and other intercellular elements needed for wound healing.

Keloid

Abnormality in wound healing by scar tissue. Tumor-like mass caused by excess production of scar tissue.

What is the first step of wound healing?

Acute Inflammation

What does adequate wound healing require?

Adequate protein, CHO, fats, vitamins minerals. Protein for rebuilding tissue, CHO for energy, fats for cell membranes and synthesis of new cells, Vitamins A and C, and Zinc.

Wound separation in wound healing

Affects wound healing. Approximation of wound edges greatly enhances healing and prevents infection. Poor nutrition and lots of adipose tissue causes the wound to separate.

Foreign bodies (include sutures) in wound healing.

Affects wound healing. Foreign bodies invite bacterial invasion and delay healing.

Infection in wound healing

Affects wound healing. Impairs all dimensions of wound healing by prolonging inflammatory phase, impairing formation of granulation tissue, inhibiting proliferation of fibroblasts, and inhibiting deposit of collagen fibers.

Impaired inflammatory and immune responses in wound healing

Affects wound healing. Inflammation is an important first phase of wound healing that prevents infection.

What occurs during proliferative phase?

Building new tissue to fill in wound space using granulation tissue.

What is the key cell in proliferative phase?

Fibroblast

What is Epithelialization?

Final component of proliferative phase.It is the migration, proliferation, and differentiation of epithelial cells to wound edges to form new surface layer. These cells are similar to the cells originally there. It closes the wound from the outside in.

What allows for epithelialization to occur in wounds?

Formation of granulation tissue in an open wound allows epithelial cells to migrate across the new tissue to form a barrier between the wound and the environment.

What elements needed for wound healing does fibroblast secrete?

Growth factors that induce angiogenesis, and induce endothelial cell proliferation and migration.

Wound healing in ischemic tissue due to poor blood supply

Ischemic tissue become infected more readily

Secondary intention

Leaving it open, healing from the base up

Tertiary intention

Leaving the infected wound open until the infection is gone, and then closing it up.

What does contraction of scar tissue over joints and other body structures tend to do?

Limit movement and cause deformity

Evisceration

Organs pop out

What type of patients are at risk for foreign body invasion in wound healing?

Patients with orthopedic devices, cardiac pacemakers, dialysis catheters The infections may be difficult to treat; device may need to be removed.

What intention produces the least scaring?

Primary intention

When do cells stop dividing?

When they meet in the middle and hit each other.

What allows for the shrinking of the scar in secondary intention?

Wound contraction during proliferative and remodeling phases

Age related effects on wound healing

Wound healing progressively becomes more impaired with aging. Reduced collagen and fibroblast synthesis, impaired wound contraction, and slower reepilthelialization of open wounds causes delayed wound healing. Although delayed, most wounds do heal.

What occurs during remodeling phase?

Scar maturation and tensile strength increasing

What is the purpose of inflammation?

To prepare for wound enviornment for healing

How long does proliferative phase last?

Up to 2 weeks

What does the wound look like during proliferative phase?

Beefy red, fragile w/ lots of vascular tissue, bleeds easily

Who is prone to poor inflammatory response?

Diabetics due to poorly controlled blood glucose inhibiting phagocytosis. Small blood vessel disease is common in diabetics.

What occurs during inflammation?

Hemostasis controls the bleeding, vasodilation increases capillary permeability, plasma & blood components leak into injured area, Cellular Phase allows for debris removal & release of growth factors.

What affects inflammatory and immune responses in wound healing?

Immunosuppressive drugs, corticosteroids

Impaired blood flow and oxygen delivery during wound healing

Impaired ability to supply nutrients, remove resulting waste, and lack of oxygen needed for collagen synthesis. Affects wound healing.

What are the three steps of wound healing?

Inflammation, proliferative phase, and maturational or remodeling phase

When does remodeling phase occur and how long does it last?

Several weeks after and lasts for 2 years

What is tensile strength?

Strength before the injury

Dehiscence

Surgical wound pops open

Primary intention

Suturing the wound closed

What is also happening during remodeling phase?

Synthesis of collagen by fibroblasts and lysis by collagenase enzymes. It is building up and breaking down the tissue which is why it takes so long.


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