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When no complications exist, how long does it take a full thickness wound to close?
Can mechanical force and early motion help control adhesions? T/F
Stage III of Wound Healing is called?
Maturation Phase or Remodeling Phase
The Maturation Phase of wound healing starts around day ___ and can last____to ____.
- starts around day 25
- last 6 months to up to 2 years
In the Maturation Phase collagen fibers become?
more organized and add strength to the wound
Cross linking of collagen results in what?
Major gains in tensile strength and scar stabilization
A completely healed wound will gain ____% of it's normal tensile strength.
What is Primary Intention Healing?
When the wound edges are held together by suture, staples, tape, etc
Primary intention healing is most appropriate for?
tidy- surgical wounds with clean edges
Reliance on artificial means to hold a wound together stops at __-__days?
What is Secondary Wound Phenomena?
when a primary wound ruptures or dehisces, and is reclosed, the rate of healign is accelerated due to immediate onset of fibroplasia without inflammation.
What is Secondary Intention Healing?
when a wound is allowed to remain open and to close by the biologic process of contraction and epithelization.
The wound in allowed to contract in primary intention healing or secondary intention healing?
secondary intention healing
Which cells allow the wound to contract on its own and resembles smooth muscle?
Can secondary intention healing be used when the wound is across a joint?
Delayed Primary Closure is when?
the wounds are allowed to heal for a short time by secondary intention(by themselves) and then are closed mechanically
When is Re-epitheliazation or Tertiary Closure used?
wehn there is a significant loss of skin/tissue, which if closed via primary or secondary intention would result in deformity or loss of function
Skin grafts can be used to cover wound bed that has good _______ and no gliding structures are exposed.
STSG: Split Thickness Skin Graft
viable in 3-5 days, may be meshed to allow drainage
FTSG: Full Thickness Skin Graft
viable in 5-7 days
Loss of skin grafts mostly occurs from?
fluid accumulation under the graft or shearing forces
Skin grafts can be exposed to water between days _-_, but should avoid modalities for at least _-_ days.
What type of graft is used when there is limited blood supply to the wound or exposed gliding structures?
Local flaps (random pedicle flaps) come from where?
tissue adjacent to the wound and receives blood supply for the sub-dermal layer
Examples of Local flaps include: (3)
- V-Y advancement flaps
- Moberg Advancement flaps
Which kind of grafts/flaps requires vascular dissection and micro vascular anatomosis to blood supply? (2)
Pedicle Flaps and Free Tissue Transfers
Example of Pedicle Flaps include: (5)
Thenar flap, cross finger flaps, radial forearm flap, Littler Neurovascular island flaps & groin flaps
Which flap requires immobilization for 3 weeks to avoid compreession to protect circulation?
Which flap has immediate vascularity, can handle early mobilization and is completed in one surgical procedure?
Free Tissue Transfers
Types of Flap Classification are? (2)
- Random: receives blood supply from sub dermal or subcutaneous plexus
- Axial: receives blood from a single blood vessel
Wounds exposed 2-3 hours will dehydrate and become _____.
Wound healing is inhibited by reflex vasospasm brought on by ______ in temperature, or by alternating _________.
____________ has been shown to stimulate local growth factors and lead to greater collagen synthesis?
In Vitro Electrical Stimulation
The US institute of surgical research defines wound sepsis caused by bacterial overgrowth as contamination exceeding __ organisms per gram of tissue.
A _____ can block cell migration and create an increased inflammatory response.
Controlling edema in the inflammatory phase will delay healing? T/F
Describe wound in terms of:
- location, size, drainage (amount/consistency/odor)
Beefy red tissue =
- uninfected, borders, granulation
- goal: protect & maintain humidity
- clean with gentle soap/Ringer's Solution
- NO ANTISEPTICS
- topical antibiotics OK
- yellow, pseudomonas will give color and odor
- draining exudates
- debride then use antiseptics/antibiotic, we to dry dressing or one to absorb the exudates
- black necrotic tissue (eschar)
- pus and limited wound closure
- debridement, dress to protect
Dressing for non-infected red wounds
- 3 layers
- 1. non-adherent layer (xeroform/adaptic/telfa)
- 2. cling gauze
- 3. wrap/coban/tubigrip
Use a dry dressing for?
Use a wet dressing for?
dirty or infected wounds
What kind of dressing do you NOT use with infected wounds? (5)
- hydrocolloids (Duoderm)
- calcium alginates
Silvadene is used with?
What is Bactraban and what is it used for?
What is Bactracin/Neosporin used for?
antibacterial, provides a moist environment for wounds
What is Silver Nitrate used for?
hypertrophic granulation tissue
When is a keloid scar formed?
when the rate of collagen production exceeds collagen breakdown
Assessment of Scars include: (5)
- texture (thick/rigid/raised/supple)
- vascularity (immature/mature)
- sensibility (hyper vs insensate)
Which scars extend beyond the original wound site?
Which kind of scars are bulky and stay within the boundaries of the wound?
Keloids can be treated with (3):
- surgical excision
Which kind of scar occurs soon post injury but will regress spontaneously?
Which kind of scar will improve with pressure, silastic gel sheeting or surgery?
When does a Wide Spread Scar form?
during the 3rd phase of healing when tension and mobility of wound leads to flat/wide/or depressed scarring
Therapeutic management of scars includes (6):
- prevent excessive inflammartory response
- prevent excessive wound tension
- Controlled motion to aid in collagen synthesis
Therapeutic goals of wound management are: (4)
- debride the wound
- cleanse the wound
- promote coverage of the defect
- restore function
When evaluating a wound, after patient history you want to include: (7)
- Classify stage/ full thickness?/ color code
- Color or Texture Changes
Which Stage of Wound?
when full thickness involving fascia with possible bone/muscle involvement
Which Wound Stage?
when full thickness involving fascia
Which Wound Stage?
when epidermis with invovement of dermis, subcutaneous fat discontinuity of skin
Which Wound Stage?
when epidermis invovement
A partial thickness wound is equivalent to which stages?
Stages 1 &2
A full thickness wound is equivalent to which stages?