Phases of Wound healing Acute Wound/ Wound Healing

Acute wounds vs Chronic wounds A. ____ Wounds that have failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result B.____ Progress through the normal phases of wound healing in a timely process

A. Chronic wounds B. Acute wounds

Match drug with delaying factor A. Steroids B. Anticoagulation C. NSAIDS 1. Inhibit angiogenesis 2. Interfere with platelet 3. Delay inflammatory phase of healing and all other phases

C. 1 B. 2 A. 3 (Steroids are anti- inflammatory, can also decrease collagen and angiogenesis, decrease wound contraction and epithelial migration) (NSAIDS can also decrease platelet aggregation. Decreased neutrophil migration to wound site increasing risk of infection. Decreased collagen synthesis with decreased tensile strength of new tissue)

_______ • Kills microbes through phagocytosis & lysosomal degradation • Producing free radicals which affects all tissue • Predominant infiltrating cells for first 3 days, peaking at 48 hours A. T lymphocytes B. Macrophages C. Neutrophils

C. Neutrophils

Blisters are _____ thickness wounds

Partial thickness wounds

Patients who have undergone a transplant may likely be put on _____ Drug that can delay wound healing

Steroids

What are three types of medications that can prolong wound healing?

Steroids Anticoagulation Non-steriodal anti-inflammatory drugs

All of these are examples of what kind of wound: - Stage 1 pressure ulcer - Contusion - First degree burn

Superficial/Erosion (Skin is still intact but there is some damage to the skin superficially)

True/False Full thickness wounds may have slough or eschar

True, different types of necrotic tissue

List types of Partial wounds

- Blisters - Abrasions - Skin tears - Stage II pressure wounds

__________ • Peak at 72 - 84 hours • Enhance debridement through phagocytosis of matrix and cellular debris left • Serve as transitional marker between the inflammatory and reparative phases of healing • They can promote or inhibit angiogenesis A. T lymphocytes B. Macrophages C. Neutrophils

B. Macrophages

_______ - No granulation tissue formation -No necrotic tissue A. Full thickness wound B. Partial thickness wound C. Superficial wound

B. Partial thickness wound (epithelial tissue)

During the proliferative phase of wound healing with full thickness wounds, wound closes _______ ______ facilitate wound contraction

Closes from edges only Myofibroblasts facilitate wound contraction

The Hemostasis Phase The main purpose of it ______ ____ is released to attempt to minimize bleeding into the soft tissues. When is this substance released? What cells are involved ?

Clot formation (platelet aggregation reduce bleeding & fibrin clot)

______ Multiplication of organisms with an absence of local invasion consequently impaired healing

Critical colonization

Remodeling/Maturation Phase Day 8 to 2 years after wound closure • Consists of collagen maturation and reorganization orchestrated by fibroblasts and growth factors 1 week post wound closure, scar is ____% of ultimate strength 3 weeks post wound closure ____% 3 months to 2 years the scar becomes ____ of original strength of skin

Day 8 to 2 years after wound closure • Consists of collagen maturation and reorganization orchestrated by fibroblasts and growth factors • 1 week post wound closure, scar is *3%* of ultimate strength • 3 weeks post wound closure *30%* • 3 months to 2 years the scar becomes *80%* of original strength of skin

In partial thickness wound what new tissue type grows in

Epithelial tissue

In acute inflammation the five signs:

Erythema - Pain - Edema - Heat - Loss of function

Full thickness extend through the _____ and ____ and into _____

Extend through the epidermis and dermis and into deeper structures

True/false Partial thickness wound extends through the epidermis but never into the dermis

False Extend through the epidermis and sometimes into the dermis but very small like the top of the dermis - Shallow wound

True/ False Dehydration is not a factor that affects chronic wound healing

False, dehydration can prolong

Proliferative Phase Goal ? hallmark sign?

Goal: Fill defect with new tissue and restore integrity of the skin Hallmark: granulation tissue consisting of macrophages, fibroblasts, developing blood vessels, immature collagen & newly forming ECM

Full thickness wounds heal by secondary intention with _____ tissue

Granulation tissue

It's primary intention pt role

Maintaining suture line, decline if we see signs of infections, and if there are breaks down of suture line staying on top of it and helping it heal

In full thickness wounds ________ facilitate wound contraction form the wound edges Heal by contraction and scaring

Myofibroblasts • Heal by wound contraction and scarring • Have capacity to become 80% tensile strength up to 2 years

Patient is a 73 year old male with Scleroderma and a wound infection. The wound is dry on admission. Patient taking on Immunosuppression therapy In this case, what parts of the overlap theory are playing a role in hindering wound healing

Overlap Theory - Local —> Age - Systemic —> scleroderma, wound infection - Clinician Induced—> immunosupresion therapy

Three "p" associated with partial thickness wound

Pink, partial, painful

Different types of healing for Healing Full thickness wounds below. Explain each Primary intention Delayed primary intention Secondary

Primary intention (primary wound closure)- surgical closure Delayed Primary intention- starts off as surgery but then because of some infection have to keep it open with intention to still go in and surgically close Secondary intention- your body healing itself. Allow wound to fill in completely with granulation tissue, epithelialization, contraction & scar tissue.

Physical therapy mostly work with _____ intention, preparing the wound bed and allowing a period of time for generation of granulation tissue

Secondary Intention Often we heal full thickness wounds with 2° intention in effort to prepare a wound for the next phase - Skin graft - Skin flap

True/ False Temperature can be a systemic factor for chronic wounds

True

True/False All wounds need moisture to heal. But too much or too little of it is a problem and can delay wound healing

True

Match: Vitamins with their effects on wounds Vitamin A Vitamin B Vitamin C Vitamin D 1. collagen synthesis and increase activation of leukocytes and macrophages to wound 2. maintenance of calcium homeostasis affecting action of tissue collagenase 3. required for inflammatory response 4. required for cross-linking of collagen fibers to rebuild tissue

Vitamin A - 3 Vitamin B- 4 Vitamin C - 1 Vitamin D- 2

Inflammatory Phase in Acute Wounds Overall purpose _____ Typically last ___-___ Infiltration of ______ ______ most predominant cell and first to arrive on scene

Where your body is now reacting, trying to get rid of pathogens, rebuilding , etc •Typically lasts 3-7 days • Infiltration of leukocytes • *Neutrophil* most predominant cell and first to arrive on scene

What is wound dehiscence

Wound dehiscence, a previously closed wound reopening.

Adnexal structures

all the other structures like glands, hair follicles, blood vessels, in skin.

T lymphocytes Arrive _____ During _____ phase Participate in ____ and Control of _____

• *Arrive last*, around day 5 • During *proliferative phase,* peak at day 7 and participate both in down regulation of excessive inflammation and control of *proliferation* • Monitor for infection and control inflammation & proliferation