Term
| Most soft tissue heals as a result of ____ and concurrent ____. |
|
Definition
| epithelialization and concurrent fibroplasia |
|
|
Term
| define "epithelialization" |
|
Definition
| growing of epithelial cells over a denuded surface; eg epidermis over cut skin |
|
|
Term
|
Definition
| formation of fibrous CT which lies under the epithelial tissue |
|
|
Term
| What supports the migration of epithelial cells across the defect? |
|
Definition
| bed of granulation tissue |
|
|
Term
| Debridement minimizes ___ and ___, and provides _______________. |
|
Definition
| minimizes inflammation and infection, provides a viable wound bed |
|
|
Term
| What is granulation tissue? |
|
Definition
| A combination of new capillaries, fibroblasts, and fibrous tissue that forms a characteristic red, moist, glistening surface |
|
|
Term
| 5 Functions of granulation tissue: |
|
Definition
-fill the wound
-protect the wound
-provide barrier to infection
-provide surface for epithelials to move across
-source of myofibroblasts which are responsible for wound contraction |
|
|
Term
| Wounds heal from the ____ ____. |
|
Definition
|
|
Term
| All healing requires ___ and a ___ ___. |
|
Definition
| inflammation, blood supply |
|
|
Term
| Cardinal signs of inflammation: |
|
Definition
-redness (erythema)
-heat
-pain
-swelling (edema)
-altered function |
|
|
Term
| What are the 4 phases of wound healing? |
|
Definition
1- inflammatory phase
2- debridement phase
3- repair phase
4- maturation phase |
|
|
Term
| Sirois merges which two of the wound healing phases together? What is their rationale for this? |
|
Definition
| inflammation and debridement, they occur simultaneously |
|
|
Term
| Infection of wounds is the process by which... |
|
Definition
| microorganisms bind to tissue, multiply, and invade viable tissue, eliciting an immune response |
|
|
Term
| What type of topical antibacterial product tends to impede healing the most? |
|
Definition
| water-soluble, because as it evaporates it dries out the wound |
|
|
Term
|
Definition
Exudate: thick, sticky, viscous drainage from a wound that is high in protein
Transudate: watery, less sticky, clear/yellowish drainage from a wound that is lower in protein |
|
|
Term
| When does the inflammatory stage start, and how long does it last? |
|
Definition
| starts immediately, predominants in first 6 hours but lasts ~5days (to sev. weeks) |
|
|
Term
| What happens in the inflammatory stage? |
|
Definition
| initial vasoconstriction followed by vasodilation |
|
|
Term
| Function of the inflammatory stage: |
|
Definition
| control bleeding, then clean and fill wound, form clot |
|
|
Term
| Exudates have a high ___ and ___ content. |
|
Definition
|
|
Term
|
Definition
| dilute contamination, spread WBCs around wound |
|
|
Term
| When does the debridement phase start, and how long does it last? |
|
Definition
| starts 6-12 hours after wound made, lasts days to weeks |
|
|
Term
| What happens during the debridement phase? |
|
Definition
-WBCs arrive
-lymphocytes come later |
|
|
Term
| Function of WBCs in wound healing: |
|
Definition
| neutrophils and monocytes (macrophages) phagocytize microbes and debris |
|
|
Term
| Functions of lymphocytes in wound healing: |
|
Definition
Help fight microbes by:
-provide Abs if needed
-complement system |
|
|
Term
| When does the repair phase begin, and how long does it last? |
|
Definition
| begins 3-5 days after wound made, PP doesn't say how long it lasts |
|
|
Term
| What happens in the repair stage? |
|
Definition
-fibroblasts cover the wound
-endothelial cells proliferate (capillary infiltration)
-lymphatic vessels develop
-neutrophils decrease, macrophases increase
-granulation tissue produced, then epithelialization can occur
-wound contraction begins |
|
|
Term
| Cell responsible for wound contraction? |
|
Definition
|
|
Term
|
Definition
| immature fiber-producing cell that makes collagen and elastin |
|
|
Term
| What is capillary infiltration? |
|
Definition
| endothelial proliferation; extension of capillaries into the wound |
|
|
Term
| During what phase of healing does wound contraction begin? |
|
Definition
|
|
Term
| During what phase of healing does granulation tissue start to form? |
|
Definition
|
|
Term
| During what phase of healing do exudates leak into the wound? |
|
Definition
|
|
Term
| During what phase of healing do WBCs arrive? |
|
Definition
|
|
Term
| When does the maturation phase begin, and how long does it last? |
|
Definition
| begins after 2-3 weeks, can last for years |
|
|
Term
| What happens during the maturation phase? |
|
Definition
-collagen remodeling
-scar develops |
|
|
Term
| What is the purpose of collagen remodeling? |
|
Definition
| increase tissue strength, but full strength never fully regained (maybe 80%) |
|
|
Term
| Why are scars generally paler than surrounding tissue? |
|
Definition
| less capillaries in fibrous tissue |
|
|
Term
| Which phase of wound healing is the longest? |
|
Definition
| maturation phase - can last for years! |
|
|
Term
| Over time, scars will ___. |
|
Definition
| remodel (flatten, contract) |
|
|
Term
| The primary goal of wound management is... |
|
Definition
| a healthy wound bed without necrotic or unhealthy tissue, foreign matter, or infection |
|
|
Term
| What two things will minimize dead space in a wound? |
|
Definition
| drains, bandages (to compress, soak up exudates) |
|
|
Term
| When should a Penrose drain be removed? |
|
Definition
| at or before 4-5 days, otherwise you risk secondary infection or an inflammatory response |
|
|
Term
| Before removing an adherent bandage, what should you do to minimize pain of removal? |
|
Definition
| soak the gauze with lidocaine |
|
|
Term
| Use a ___ dressing once the granulation bed forms. |
|
Definition
|
|
Term
| Traits of an occlusive / semi-occlusive dressing? |
|
Definition
-moist for epithelialization and healing
-semi-permeable or permeable synthetic membrane
-H20 can pass out of wound |
|
|
Term
| Triple antibiotic ointment increases the ___ of wounds. |
|
Definition
|
|
Term
| Type of topical antibacterial that can penetrate necrotic tissue? |
|
Definition
| silver sulfadiazine cream |
|
|
Term
| Silver sulfadiazine cream is best used on wounds that... |
|
Definition
|
|
Term
| Type of topical antibacterial that draws fluid from the body? |
|
Definition
|
|
Term
| Type of topical antibacterial that is mostly effective against Gm- bacteria? |
|
Definition
|
|
Term
| Gentamicin sulfate is effective against what specific bacteria? |
|
Definition
| Pseudomonas, E. coli, Proteus |
|
|
Term
|
Definition
| rupture of a wound along a suture line |
|
|
Term
| During what phase of wound healing do leukocytes leave the blood vessels? |
|
Definition
|
|
Term
| During what phase of wound healing do fibroblasts differentiate? |
|
Definition
|
|
Term
| During what phase of wound healing do endothelial buds grow into damaged/intact blood vessels, and mesenchymal cells follow the budding endothelium and secrete ground substance? |
|
Definition
|
|
Term
| What is first intention / primary healing? |
|
Definition
-using sutures, adhesives, or bandages to appose clean wound edges to heal
-bone Fx: internal fixation |
|
|
Term
| All wounds should be considered infected if they are over ___ hours old. |
|
Definition
|
|
Term
| First intention healing promotes what 2 things? |
|
Definition
-faster healing
-less scarring |
|
|
Term
| Phases, Types, Categories of wounds/healing? |
|
Definition
phases- wound healing (inflamm, debrid, repair, matur)
types- 1st, 2nd, 3rd intention
categories- clean, clean-contam, contam, dirty |
|
|
Term
| What is second intention healing? |
|
Definition
| -wound is left open and allowed to heal by filling in the inner areas with granulation tissue, and healing from the inside-out |
|
|
Term
| What sort of wounds can be healed by first intention? |
|
Definition
-clean wounds made aseptically like in surgery
-not grossly contaminated or infected, or old
-internal fixation of bones |
|
|
Term
| What sort of wounds can be healed by second intention? |
|
Definition
-large / very little skin available to cover
-complicated
-infected
-external fixation of bones |
|
|
Term
|
Definition
| softening of tissues into a gel-like substance; occurs when wounds are in contact with wetness/soil for too long |
|
|
Term
| Casts, splints, bandages, and KE apparatuses are examples of what type of wound healing? |
|
Definition
|
|
Term
| IM pins, plates, screws, and cerclage wire are examples of what type of wound healing? |
|
Definition
|
|
Term
| What occurs at the ends of broken bones when they are healed by second intention? |
|
Definition
|
|
Term
|
Definition
| exuberant granulation tissue produced in some horse wounds that heal by second intention |
|
|
Term
| How to prevent proud flesh? |
|
Definition
-primary wound closure
-decrease movement (bandage, cast, stall) |
|
|
Term
| How to treat proud flesh? |
|
Definition
-Sx removal
-caustic substances (eg silver nitrate)
-topical steroids
-skin grafting |
|
|
Term
| Downside to using corticosteroids topically on proud flesh? |
|
Definition
| could increase the chance of infection because the wound will heal slower |
|
|
Term
| Other terms for third intention healing? |
|
Definition
| delayed primary healing, tertiary healing |
|
|
Term
| What happens in third intention healing? |
|
Definition
-granulation bed forms, no infection, then outer wound sutured closed
-freshen edges before suturing |
|
|
Term
| Third intention healing is a combination of ___ and ___. |
|
Definition
| first and second intention |
|
|
Term
| Third intention healing offers an infected large wound the chance to ____ without as much _____ or ____. |
|
Definition
| chance to heal faster, with less scarring or contraction |
|
|
Term
| What are the 4 categories of wounds? |
|
Definition
clean
clean-contaminated
contaminated
dirty |
|
|
Term
| From Sirois, 3 examples of clean wounds: |
|
Definition
| -surgical wound -elective incision -highly vascular tissues not predisposed to infection |
|
|
Term
| From Sirois, 4 examples of clean-contaminated wounds: |
|
Definition
| -minor contamination evident -surgical wounds with minor break in aseptic technique -elective surgery in tissues with normal resident bact. flora (GI, Resp, urogenital) -no spillage of organ contents |
|
|
Term
| From Sirois, 5 examples of contaminated wounds: |
|
Definition
| -moderate contamination evident -fresh traumatic injuries, open Fx, penetrating wounds -surgery with gross spillage of organ contents -presence of bile or infected urine -surgical wound with major break in aseptic technique |
|
|
Term
| From Sirois, 3 examples of dirty wounds: |
|
Definition
-grossly contaminated or infected
-contaminated traumatic wounds more than 4hr old
-perforated viscera, abscess, necrotic tissue, foreign material |
|
|
Term
|
Definition
uninfected tissue where Sx done aseptically and does not cut into resp/aliment/urogenital tracts
-elective, aseptically made, not predisposed to infection |
|
|
Term
| What category of wounds are castrations and spays? |
|
Definition
|
|
Term
| What is a clean-contaminated wound? |
|
Definition
| operative wound in which resp/aliment/urogenital tracts are entered under controlled conditions with minimal contamination |
|
|
Term
| What category of wounds are appendectomies and cholecystectomies? |
|
Definition
|
|
Term
| A surgical wound is contaminated by minor spillage of organ contents. What category of wound is it now? |
|
Definition
|
|
Term
| What is a contaminated wound? |
|
Definition
-open, traumatic wound/injury such as soft tissue laceration, open Fx, or penetrating wound
-gross spillage of GIT
-urogen. / biliary tract procedures w/infected bile or urine
-major break in aseptic technique |
|
|
Term
| What category of wound is an open Fx? |
|
Definition
|
|
Term
| What category of wound is a penetrating wound? |
|
Definition
|
|
Term
| What category of wound involves gross spillage from the GIT? |
|
Definition
|
|
Term
| If the urogenital or biliary tract are infected, what category of wound is the surgical site? |
|
Definition
|
|
Term
| What category of wound is it when a major break in aseptic technique occurs? |
|
Definition
|
|
Term
| What category of wound is a pyometra? |
|
Definition
|
|
Term
|
Definition
-grossly contaminated or infected
-perforated viscera, abscess, neglected traumatic wound, devitalized tissue or foreign matter
-contaminated wound > 4 hrs old
-any untreated wound > 12 hrs old is considered infected |
|
|
Term
| Factors that impair healing (9 major): |
|
Definition
-infection
-debris
-necrotic tissue
-very old age (catabolism)
-malnutrition
-poor perfusion
-hypothermia
-trauma to wound
-immunosuppressed |
|
|
Term
| Examples of why a wound pt may be immunosuppressed? |
|
Definition
-concurrent disease (Cushings, diabetes mellitus, chronic anemia)
-drugs (chemo, radiation, corticosteroids)
-low serum protein (liver, renal- azotemia) |
|
|
Term
| What diseases can delay wound healing? |
|
Definition
-Cushing's
-diabetes mellitus
-chronic anemia
-liver dz
-renal dz |
|
|
Term
| What diseases can cause low serum protein that delays wound healing? |
|
Definition
|
|
Term
| What drugs can delay wound healing? |
|
Definition
-chemotherapy
-radiation
-corticosteroids |
|
|
Term
|
Definition
| the breakdown of complex molecules in living bodies to form simpler ones in order to obtain energy; occurs in very old age when the body breaks down its muscle for proteins |
|
|
Term
| Scientific term for "nosebleed"? |
|
Definition
|
|
Term
| First step of wound management? |
|
Definition
|
|
Term
| List the steps of wound management in order: |
|
Definition
1. control hemorrhage
2. stabilize Fxs
3. cleanse wounds (clip and lavage)
4. debride |
|
|
Term
| Ways to control hemorrhage: |
|
Definition
-apply pressure
-apply bandage
-use chemicals (epinephrine, caustics) |
|
|
Term
| Examples of chemicals that stop hemorrhage? |
|
Definition
Granulex
styptic pencil
silver nitrate |
|
|
Term
|
Definition
-splint/sling
-Robert Jones bandage |
|
|
Term
| What do you need to do before clipping hair around a wound? |
|
Definition
-coat wound in sterile KY jelly or other water-soluble lube so hairs don't get stuck inside
-can also use wet sponge |
|
|
Term
| What can you put on scissors when clipping around a wound? Why? |
|
Definition
| mineral oil - hair will stick to scissors rather than fall in wound |
|
|
Term
| What should you use to lavage a wound? |
|
Definition
-warmed sterile saline
-balanced electrolyte solution |
|
|
Term
| The use of what 3 things on a freshly clipped wound is debatable? |
|
Definition
-antiseptics
-antibiotics
-H2O2 |
|
|
Term
| define "devitalized tissue" |
|
Definition
| dead, dying, necrotic, avascular tissue |
|
|
Term
| What is H2O2 used for in the wound management process? |
|
Definition
| to blanche devitalized tissue before debridement |
|
|
Term
| Debridement can be done ___ or ___. |
|
Definition
| mechnically or enzymatically |
|
|
Term
| Enzymatic debridement products contain ___. |
|
Definition
|
|
Term
| When might you choose enzymatic debridement over surgical debridement? |
|
Definition
| copious debris that is hard to remove, little skin to cover - eg "road rash" |
|
|
Term
| Disadvantages of enzymatic debridement? |
|
Definition
-slower than mechanical debridement
-may damage surrounding tissue |
|
|
Term
| When using enzymatic debridement agents like Granulex, what do you need to do with the bandage? |
|
Definition
| tons of gauze because it liquifies dead tissue |
|
|
Term
| Granulex helps to ___ and ___. |
|
Definition
| debride, stimulate vessel formation |
|
|
