Wounds Flashcards by Deema Baks

What are the phases of wound healing?

INFLAMMATORY
PROLIFERATIVE
REMODELING

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What occurs in a wound from day 0 to day 5?

HAEMOSTASIS & INFLAMMATION
1- clotting cascade initiated
2- platelet aggregation
3- release of cytokines & growth factors
4- chemotaxis of macrophages to help in phagocytosis & wound debridement
5- activation of fibroblasts & endothelial cells

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what are the signs of the inflammatory phase in wound healing?

redness 
heat 
swelling
pain
loss of function at wound site

(phase is short if there’s no infection or contamination)

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What are the characteristics of the proliferative phase?

FIBROBLASTS from surrounding tissue secrete collagen I & III
ENDOTHELIAL CELLS from intact venules form new capillary buds which will form granulation tissue with fibroblasts
EPITHELIAL CELLS from wound edges migrate to close the epithelial defect

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What occurs in the maturation phase?

deposition of collagen in the wound

collagen III first then collagen I
collagen fibers become thicker & arrange along the lines of stress to increase the tensile strength of the wound

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How long does remodeling continue for?

1 year

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When does wound contraction start?

starts immediately & continues for 2 - 3 weeks

MYOFIBROBLASTS help diminish the size of wound

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What are the general factors that affect wound healing?

AGE
decreased protein turnover in elderly slows healing

DEBILITATING DISEASE
like uremia, jaundice, cirrhosis, malignancy, & diabetes

IRRADIATION

inhibit wound contraction & granulation tissue formation
prior irradiation causes ischemia due to end arteries obliterans

NUTRITION

proteins: essential for collagen synthesis
Vit C: maturation of protocollagen
Vit. A: epithelialization
calcium, zinc, manganese & copper

DRUG INTAKE
steroids inhibit inflammatory response & fibroblast formation

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What are the local factors affecting wound healing?

VASCULARITY

good blood supply in face & scalp help rapid healing
bad blood supply below the knees delay healing

IMMOBILIZATION
wounds over joints or weight bearing have smaller healing powers

TENSION
cause ischemia & delayed healing

INFECTION
bacteria competes with fibroblasts for oxygen & nutrition
- they secrete collagenolytic enzymes

FOREIGN BODIES & NECROTIC TISSUE impair healing

ADHESION TO A BONY SURFACE
prevents wound contraction

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What are the types of wound healing?

PRIMARY INTENSION

clean wounds immediately closed by sutures or clips
minimal scar

SECONDARY INTENSION

edges not approximated or gaping due to hematoma or infection
filled with granulation tissue
ugly scar

TERTIARY INTENSION

contaminated wounds left open for 5 days
if there are no signs of infection delayed primary sutures could be done

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surgical incision & wounds caused by sharp objects are classified as? How should they be treated?

Tidy wounds

primary sutures
healed by primary intention

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crushing, tearing, avulsion, devitalised injury, vascular injury, multiple irregular wounds & burns are classified as? What complications could they cause?

Untidy wounds
Could cause: - wound dehiscence
- infection
- delayed healing

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What are the 2 types of wounds?

CLOSED

contusions
hematoma

OPEN

abrasions
incised
lacerated
penetrating
bites

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a blow with a blunt object causing extravasation from the injured blood capillaries, the area is painful & swollen & is bluish then brownish then green. What is this called & what is its treatment?

CONTUSION

elevation & anti-inflammatory ointment

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excessive bleeding that is cystic in the beginning then after hours begins to clot and later liquifies is called? What are the complications caused?

HEMATOMA

absorption
organization by fibrosis
abscess
liquifaction & cyst formation
calcification (myositis ossificans)
abscess
false aneurysm

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What are abrasions & why do they hurt? How should they be managed?

scraping of superficial layer of skin due to friction with hard rough surface
sensitive nerve endings are exposed
clean with anti-septic
nonadherent dressing

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how is an incised wound caused?

sharp cutting instruments
long than it is deep
edges are clean cut
tendons & nerves are liable to be cut

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severe violence with a blunt object will cause?

LACERATED wound

irregular in shape & severely traumatized
devascularized & contaminated

could cause DEGLOVING INJURY

in skin & subcutaneous tissue from deep fascia
skin devascularization becomes apparent in a few days

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How are penetrating wounds caused?

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penetration by a pointed object that could injure deep structures

small external opening
has poor drainage so it encourages infection

What type of wounds do bites cause?

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Lacerated wounds with bone, joint, tendon, vessel, & nerve involvement

Puncture wounds with high risk of infection (difficult to irrigate & decontaminate

A superficial wound involves?

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the epidermis alone

a partial thickness wound involves?

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epidermis

- dermis

a full thickness wound involves?

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epidermis
dermis
fat
fascia
exposes bone

How should any open wound be managed?

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1- direct local compression to stop BLEEDING
2- splint & arrange for x-ray if there is a suspected fracture
3- saline irrigation & removal of foreign bodies THEN antiseptic
4- inspection of all structures within wound
5- repair large veins or arteries & ligated small veins or arteries
6- repair nerves or tendons
7- repair muscles by mattress sutures if incised cleanly
excise ischemic or necrotic muscle
8- if there is a possibility of infection, external bone fixation
9- leave deep fascia open if wound is contaminated or there is extensive tissue destruction

What are the complications of WOUND HEALING?

HEMORRHAGE - slipped suture - erosion of blood vessels - infection - dislodged clot INFECTION - due to purulent material draining from wound - its greater when wounds contain necrotic tissue, foreign bodies, or blood supply & local tissue defense is reduced - bacteria inhibits wound healing EVISCERATION - visceral organs protrude through wound opening due to total separation of wound DEHISCENCE - partial or total separation of wound layers - BURST ABDOMEN STRETCHING CONTRACTURE - usually in burns

What are the signs & symptoms of an infected wound?

- contaminated or traumatic 2 - 3 days - post-op surgical wound 4 - 5 days - fever, tenderness & pain at wound site & inflamed edges - odorous & purulent drainage (yellow, green, or brown) - elevated WBC

What are the complications of wounds?

GENERAL - shock - crush syndrome - compartment syndrome LOCAL - infection: pyogenic or specific - gangrene: vascular or infective - complications of healing

a closed injury causing hematoma leading to increased pressure will cause?

COMPARTMENT SYNDROME | - usually associated with a bone fracture aggravating ischemia

What are the signs of compartment syndrome?

- Pallor - pulslessness - pain - paresthesia - diffuse swelling - cold limb IF IT PROGRESSES - gangrene - chronic ischemic contracture leading to a deformed limb

What are the problems associated with compartment syndrome?

- renal failure - gangrene of limb - chronic ischemic contracture - disabled limb

How should compartment syndrome be treated?

pressure will be more than 30mmHg 1- FASCIOTOMY should be done until muscle bulges out 2- antibiotics 3- catheterisation 4- mannitol or diuretics to flush the kidney 5- fresh blood transfusion 6- hyperbaric oxygen

What are the dreaded problems of crush injury?

- renal failure - hypovolemic shock - sepsis

What does crush syndrome lead to?

extravasation of blood & release of myohaemoglobin into the circulation leading to acute tubular necrosis & acute renal failure

What are the causes of crush syndrome?

- earthquakes - mining & industrial accidents - air crash - tourniquet

What is the pathogenesis of crush injury?

1- tension increases in the muscle compartment 2- circulation impeded & ischemic damage increases 3- urine becomes discolored & scanty in 3 days 4- patient becomes restless, apathic, & delirious with onset of uremia INJURY IS WORST THAN INITIAL LOOK (life threatening)

What are the effects of crush syndrome?

- renal failure - toxaemia - septicemia - disability with extensive tissue loss - gas gangrene

How is crush syndrome treated?

- relieve tension by multiple parallel deep incisions

Keloid is more common in?

- black people | - women

What are the predisposing factors for keloid?

- genetic (familial) | - defect in maturation & stabilization of collagen fibrils

What is the commonest site for Keloid formation?

over sternum

Whats the pathology of keloid?

- continues to grow even after 6 months - extends into adjacent normal skin - brownish?pinkish black in color (vascular) - painful, tender, & hyperaesthic proliferating immature fibroblasts & blood vessels & type III collagen

What diseases may be associated with Keloid?

Ehlers Danlos syndrome | Scleroderma

How should Keloid be treated?

- excision & skin grafting - irradiation - excision & irradiation - steroid injection - silicone gel sheeting - laser therapy - vitamin E/palm oil massage - intralesional excision

What are the different characters of a hypertrophic scar? (compared with keloid)

- not genetic or familial - occurs anywhere in the body - growth limits up to 6 months - limited to scar tissue only - pale brown in color - not tender or painful - self-limiting - responds to steroid injection

What are the common sites for a hypertrophic scar?

- wound crossing tension lines - deep dermal burns - wounds healed by secondary intension

What are the complications of a hypertrophic scar?

- breaks repeatedly & causes infection & pain | - may turn into Marjolin's ulcer (SSC) after repeated breakdown

Wounds Flashcards

(46 cards)