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Pathophysiology: Wound healing

Terms in this set (36)

What is the primary intention of wound healing?
Wounds that heal under conditions of normal tissue loss.

Original tissue structure and function have been restored.
What is the secondary intention of wound healing?
Wounds that require significantly more tissue replacement (open wound)

Wounds that cause scar formation.
What is the first phase of wound healing?
Inflammation
What is the second phase of wound healing?
Reconstruction
What series of events characterizes the proliferative phase (reconstruction)?
Macrophage invasion of the dissolving blood clot
Recruitment and proliferation of fibroblasts (connective tissue cell).
Fibroblast collagen synthesis,
Epithelialization
Contraction of the wound and cellular differentiation.
Macrophages secrete a variety of biochemical mediators that promote healing, including?
TGF-B
Angiogenesis factors (VEGF and FGF-2)
Matrix metalloproteinases (MMPs)
What is the function of TGF-B?
Fibroblast proliferation occurs accompanied by collagen synthesis and deposition.
What is the function of VEGF and FGF-2 in reconstruction?
Stimulate vascular endothelial cells to form capillary buds extending into the matrix.
What is the function of matrix metalloproteiniases (MMPs)?
Degrade and remodel matrix proteins resulting in wound contraction.
What stage does epithelialization happen?
During reconstruction.
What is granulation tissue in the reconstruction stage?
Highly vascular tissue with residual inflammatory cells, fibroblasts, capillaries, and lymphatics.
What is the 3rd phase of wound healing?
Remodeling and maturation.
Scar tissue forms during which phase?
Phase 3
A decrease in blood supply (ischemia), oxygenation (hypovolemia), or nutrient supply (hypoproteinemia) can result in what?
Dysfunction in wound healing during the inflammatory response.
The larger the hemorrhage, the ____ wound healing will be.
Longer
Fibrous adhesions within pleural, pericardial, and abdominal cavities are problematic because?
They can bind organs together by fibrous bands and distort or strangulate the affected organ.
If a patient with a wound is malnourished, what could happen during the reconstructive phase of wound healing?
Decreased collagen synthesis.
Keloid scars or hypertrophic scars are a result of?
Increased collagen synthesis ("over healing").
Using anti-inflammatory steroids, hypoxemia, and nutritional deficiencies can cause?
Impaired epithelialization.
What medications can delay wound healing?
Antineoplastic (anticancer), NSAIDs, and steroids.
If a patient has a reduced range of motion of a joint after sustaining a wound, what may be the cause?
Excessive wound contraction and tension mediated by myofibroblasts.
What type of wounds are especially susceptible to the development of contractures?
Burn wounds
Excessive strain, wound infection, and obesity causing a wound to pull apart is called?
Wound dehiscence.
Wound dehiscence usually occurs ____ days after a suture which is paradoxically at the time when ____ is at its peak.
5-12; collagen synthesis
Characteristics of wound dehiscence are:
Increased serous drainage from the wound.
Patients may report a feeling that "something gave way."
Prompt surgical attention is required.
Jake recently underwent bowel resection to treat chronic diverticulitis. His wound was sutured closed but 9 days later has pulled apart at the suture line. This is an example of ____.
Wound dehiscence
Neonates have transiently depressed ____ and ____ function.
Inflammatory; immune
Neonates have ____ that are not capable of efficient chemotaxis.
Neutrophils
Neonates have a ____ complement system.
deficient
Neonates have an undeveloped adaptive immune system but are partially protected by _____.
Transplacental maternal antibodies.
Scar tissue is primarily composed of ___ to restore the tensile strength of the tissue.
Collagen
While thumbing through your giant pathophysiology book you sustain a papercut. Upon arrival to the ED via EMS, His Majesty Cameron, PA-C, sees your wound has minimal tissue loss, close apposition of the wound edges, and will require very little epithelialization and contraction. Your wound will heal by ____.
Primary intention
Jake is a 47 year old male with a h/o hydrocephalus, obesity, and methamphetamine use, who presents to the ED after being found down by his bed soaked in urine. Upon exam you see x2 stage IV bedsores to the bilateral buttocks. The wounds will require a great deal of epithelialization, scar formation, and contraction. Healing will occur through ___.
Secondary intention.
Proliferation of new tissue (reconstruction) occurs ____ days after the injury and continues for ____ weeks.
3-4; 2+
What are some predisposing disorders that can cause dysfunctional wound healing?
DM, obesity, wound infection, inadequate nutrients, numerous drugs, and tobacco smoke.
Why does ischemia delay healing?
Reduces energy production and impairs collagen synthesis which reduces the tensile strength of regenerating connective tissue.
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