Lecture 8

Question 1

Define wounds

Answer 1

A disruption of the normal structure and function of the skin and soft tissue architecture.
Acute: normal physiology
Chronic: impaired physiology

Question 2

Define the hemostasis phase

Answer 2

Platelet aggregation
Vasoconstriction initially
Clot stabilization occurs within 10 minutes of injury

Question 3

Descr the inflammatory phase of wound healing

Answer 3

Days 0-4
Vasodilation: Inflammatory cells to wound site
Edema, erythema, inflammation, pain
Neutrophils enable phagocytosis and allow for decontamination of the wound

Question 4

Describe the proliferative phase of wound healing

Answer 4

1) Fibroblast migration as impetus
2) Granulation tissue formation
3) Neovascularization: angiogenesis & vasculogenesis
4) Re-epithelialization
5) ECM production
6) Collagen production: gives the wound its strength
7) Wound contraction

Question 5

Describe the Remodeling (maturation) phase of wound healing

Answer 5

1) Remodeling process reorganizes the collagen & increases cross-linking
2) Strength increases quickly over first 6-8 weeks
3) Breaking strength of the wound (the force required to break a wound regardless of its dimension):
-3% at 1 week
-20% at 3 weeks
-Peaks at 80% of its uninjured counterpart by 3 months

Question 6

What are some systemic factors affecting wound healing?

Answer 6

Diabetes mellitus
Tissue hypoxia (PVD)
Nutrition (protein, Vit. C, zinc)
Albumin/prealbumin
Smoking (abstain 4-weeks prior & after surgery)
Immunosuppression (steroids)
Advanced age (heal slower, less scarring)

Question 7

Define:
1) Hypertrophic scar
2) Keloid

Answer 7

1) Remain in boundaries, regress spontaneously, rarely recur after surgical excision
2) Extend beyond boundaries, continue growth, commonly recur after excision, present minimum 1 yr (familial predisposition)

Question 8

What are the mainstays of local wound care?

Answer 8

Controlling bacterial contamination
Maintaining appropriate amount of moisture
Treating edema
Preventing further injury

Question 9

What should you do regarding surgery in relation to wound care?

Answer 9

Assess most appropriate surgical approach
Consider referral to plastic surgeon for complex wounds

Question 10

Descr how to control bacterial contamination of a wound

Answer 10

1) State of inflammation
2) Debridement:
-Wound base preparation (bleeding, irrigation, surgical, enzymatic, biologic)
-May require serial debridement
-Drainage of purulence
-Frequent dressing changes
3) Maintaining appropriate amount of moisture

Question 11

Descr the role of wound packing in wound care

Answer 11

1) Reduce physiologic dead space
2) Absorb exudate/seroma collection
3) Reduce potential for infection
4) Temporary dressing between serial debridement

Question 12

List some Adjunctive topical therapies for wound care

Answer 12

1) Growth factors: platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), & granulocyte-macrophage colony-stimulating factor (GM-CSF)
2) Antiseptic & antimicrobial agents
3) Iodine-based
4) Silver-based
5) Honey (broad-spectrum antimicrobial activity)

Question 13

Descr the role of wound dressings

Answer 13

No single dressing is perfect for all wounds (case-by-case)
Degree of drainage/moisture should help guide selection
Continuous monitoring
Typically changed once daily or every other day

Question 14

What are some characteristics of an ideal wound dressing?

Answer 14

-Absorbs excessive wound fluid while maintaining a moist environment
-Protects the wound from further mechanical or caustic damage
-Prevents bacterial invasion or proliferation
-Conforms to the wound shape and eliminates dead space
-Debrides necrotic tissue
-Does not macerate the surrounding viable tissue
-Achieves hemostasis and minimizes edema through compression
-Does not shed fibers or compounds that could cause a foreign body or hypersensitivity reaction
-Eliminates pain during and between dressing changes
-Minimizes dressing changes
-Is inexpensive, readily available, and has a long shelf life
-Is transparent in order to monitor wound appearance without disrupting dressing

Question 15

Give examples of:
1) Open dressings
2) Semi-occlusive dressings

Answer 15

1) Gauze (typically moistened with saline) covered by thicker absorbent pads
2) Films, foams, alginates, hydrocolloids, and hydrogels

Question 16

Describe/ give examples of semi-open dressings

Answer 16

Fine mesh gauze impregnated with petroleum, paraffin wax or other ointment (ie, Xeroform, Adaptic, Jelonet, Sofra Tulle) covered by dressing of absorbent gauze & padding, then tape (or other adhesive)

Question 17

Descr dressing a Post-operative surgical incision

Answer 17

1) Typically covered with dry dressing
2) Secured with adhesive (ie, tape, Tegaderm)
3) Initial post-operative dressing removed in 48-hours (provided wound has remained dry)
4) Timing for patient to resume bathing/showering based on incision, surgery, surgeon, etc.

Question 18

Descr the role of Negative pressure wound therapy in healing

Answer 18

1) Reduces edema
2) Stimulates circulation
3) Increases rate of granulation tissue formation
4) Used on open (primarily) and even closed wounds