Healing of Skin Wounds
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Questions and Answers

What is the primary cause of venous leg ulcers in elderly individuals?

Chronic venous hypertension is the primary cause of venous leg ulcers in elderly individuals.

How do arterial ulcers develop in patients with atherosclerosis?

Arterial ulcers develop due to ischemia caused by atherosclerosis of peripheral arteries, leading to tissue necrosis.

What is the mechanism behind the formation of pressure sores in immobile patients?

Pressure sores form due to prolonged mechanical pressure against a bone, causing local ischemia and tissue necrosis.

Identify the key histological feature of diabetic ulcers.

<p>The key histological feature of diabetic ulcers is epithelial ulceration with extensive granulation tissue in the underlying dermis.</p> Signup and view all the answers

What underlying conditions contribute to the poor healing of venous leg ulcers?

<p>Poor delivery of oxygen to the ulcer site contributes to the failure of venous leg ulcers to heal.</p> Signup and view all the answers

What role does nutritional status play in tissue repair?

<p>Nutritional status is critical as deficiencies can impair cell function and decrease the overall healing rate.</p> Signup and view all the answers

How does diabetes mellitus affect the healing process?

<p>Diabetes mellitus delays healing due to poor metabolic control, which impairs blood flow and oxygen delivery.</p> Signup and view all the answers

Explain the significance of vascular adequacy in tissue repair.

<p>Vascular adequacy is vital as it ensures adequate blood supply, delivering necessary nutrients and oxygen while removing waste.</p> Signup and view all the answers

What effect do glucocorticoids have on the repair process?

<p>Glucocorticoids impede the inflammatory and reparative processes by suppressing immune response.</p> Signup and view all the answers

In what way does the type of tissue influence regeneration capabilities?

<p>Labile and stable tissues have better regeneration potential, while permanent tissues can only form scar tissue.</p> Signup and view all the answers

Identify local factors that can delay wound healing.

<p>Infections, ischemia, mechanical forces, and presence of foreign bodies can all delay wound healing.</p> Signup and view all the answers

Outline the first step in the healing process by first intention.

<p>The first step involves activation of coagulation pathways, leading to clot formation which stops bleeding.</p> Signup and view all the answers

What are the changes that occur at the incision site by day 3 post-injury?

<p>By day 3, neutrophils are replaced by macrophages, and granulation tissue begins to invade the incision space.</p> Signup and view all the answers

What process allows the epidermis to recover its thickness following injury?

<p>Differentiation of surface cells leads to the maturation of epidermal architecture with surface keratinization.</p> Signup and view all the answers

How does the inflammatory reaction differ between first and second intention healing?

<p>Healing by second intention involves a more intense inflammatory reaction due to larger tissue defects.</p> Signup and view all the answers

What is the primary outcome for dermal appendages during healing by second intention?

<p>Dermal appendages destroyed in the incision are permanently lost.</p> Signup and view all the answers

Describe the progression of wound strength over time after the initial injury.

<p>Wound strength is about 10% after one week and rises to 70-80% of normal by three months.</p> Signup and view all the answers

What role do myofibroblasts play in the healing process by second intention?

<p>Myofibroblasts contribute to wound contraction, reducing the size of large surface wounds.</p> Signup and view all the answers

How does granulation tissue formation differ between healing by first and second intention?

<p>Second intention healing results in much larger amounts of granulation tissue formation.</p> Signup and view all the answers

What happens to granulation tissue over time during the healing process?

<p>Granulation tissue is eventually converted into a pale, avascular scar.</p> Signup and view all the answers

What is the relationship between TGF-β and collagen deposition in fibrosis?

<p>TGF-β is largely responsible for the mechanisms driving abnormal collagen deposition in fibrosis.</p> Signup and view all the answers

In what timeframe can skin defects contract significantly when healing by second intention?

<p>Within six weeks, large skin defects can contract to 5% to 10% of their original size.</p> Signup and view all the answers

What marks the difference in healing between superficial wounds and extensive wounds?

<p>Extensive wounds exhibit a greater volume of necrotic debris and require more granulation tissue for healing.</p> Signup and view all the answers

What is the consequence of excessive collagen accumulation in wound healing?

<p>It results in the formation of a hypertrophic scar.</p> Signup and view all the answers

How does fibrosis contribute to organ dysfunction?

<p>Fibrosis can lead to substantial organ dysfunction or even organ failure, such as liver cirrhosis and end-stage kidney disease.</p> Signup and view all the answers

What characterizes keloid formation?

<p>Keloids progress beyond the original injury area and do not regress.</p> Signup and view all the answers

Describe the phenomenon of exuberant granulation tissue.

<p>Exuberant granulation tissue is characterized by excessive growth of granulation tissue that protrudes above the skin level.</p> Signup and view all the answers

What typically triggers the deficiency in scar formation post-surgery?

<p>Increased abdominal pressure from actions like vomiting or coughing can lead to inadequate scar formation.</p> Signup and view all the answers

Explain the role of myofibroblasts in hypertrophic scars.

<p>Myofibroblasts contribute to the rapid growth of hypertrophic scars and their collagen accumulation.</p> Signup and view all the answers

In what situations are contractures commonly seen in wound healing?

<p>Contractures are often seen after serious burns and can limit joint mobility.</p> Signup and view all the answers

What is a common treatment for excessive granulation tissue?

<p>Excessive granulation tissue may be treated by cautery or surgical excision.</p> Signup and view all the answers

Identify a condition that may follow incisional scars or traumatic injuries.

<p>Desmoids, or aggressive fibromatosis, may follow these injuries.</p> Signup and view all the answers

What is the main difference between a hypertrophic scar and a keloid?

<p>A hypertrophic scar tends to regress while a keloid does not and may grow beyond the original injury site.</p> Signup and view all the answers

Flashcards

Tissue Repair

The process by which tissues repair themselves after an injury, involving multiple stages and cellular mechanisms.

Tissue Regeneration

The ability of a tissue to regenerate and restore its original structure after injury. Labile tissues, like skin and blood cells, regenerate readily.

Fibrosis

The formation of scar tissue, which is fibrous connective tissue, replacing lost tissue. Some tissues, like heart muscle and nervous tissue, cannot regenerate and form scar tissue.

Healing by First Intention

A type of wound healing characterized by minimal tissue loss, where the edges of the wound are brought together and healing occurs quickly with minimal scarring.

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Healing by Second Intention

A type of wound healing characterized by significant tissue loss, where the wound edges are not approximated. Healing takes longer and involves more inflammation and scar tissue formation.

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Nutritional Status and Tissue Repair

Nutrients like vitamins (C, A, B) and proteins are essential for cellular growth and repair, affecting healing process.

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Metabolic Status and Tissue Repair

Diabetes can impair blood sugar regulation and hinder blood flow, delaying healing and increasing infection risks.

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Circulation and Tissue Repair

Adequate blood flow is essential for delivering nutrients and oxygen to the wound site, promoting tissue regeneration.

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Healing by Primary Intention

The process of wound healing where the edges of the wound are brought together, resulting in minimal scarring. This occurs in clean, sutured wounds.

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Healing by Secondary Intention

The process of wound healing where the wound edges are not approximated, leading to a larger scar. This occurs in larger wounds, ulcers, and abscesses.

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Granulation Tissue

Specialized connective tissue formed during wound healing, composed of fibroblasts, new blood vessels, and extracellular matrix.

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Wound Contraction

The process by which fibroblasts contract, pulling the edges of a wound closer together, aiding in wound closure.

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Regeneration

The process of building new tissue to replace damaged tissue, often involving cells that retain their ability to divide.

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Scar Formation

The process of scarring, where fibrous connective tissue replaces damaged tissue, often in cases where regeneration is not possible.

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Wound Strength

The structural strength of a wound after healing. It increases with time as collagen deposition and cross-linking occur.

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Transforming Growth Factor Beta (TGF-β)

A key growth factor that plays a central role in scar formation, wound healing, and fibrosis.

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Debridement

The process of removing dead cells, debris, and microorganisms from a wound site during the inflammatory phase of wound healing.

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Deficient Scar Formation

Inadequate formation of scar tissue, leading to wound reopening or ulceration, often due to increased abdominal pressure.

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Exuberant Granulation Tissue

Excessive granulation tissue formation that protrudes above the surrounding skin, hindering re-epithelialization and requiring removal.

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Hypertrophic Scar

A raised scar caused by excessive collagen accumulation, often occurring after deep injuries. Tends to regress over time.

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Keloid

Scar tissue growth that extends beyond the original wound area and doesn't regress, often seen in individuals of African descent.

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Desmoids (Aggressive Fibromatosis)

Aggressive form of scar tissue proliferation that can recur after excision, often following incisional scars or traumatic injuries.

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Contracture

A severe wound contraction that causes abnormal deformities, limiting joint mobility. Often seen after burns.

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Chronic Wounds

Chronic wounds that persist for a prolonged time.

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Venous Leg Ulcers

Ulcers that occur in the lower extremities due to chronic venous hypertension, often caused by varicose veins or heart failure. Poor oxygen supply hinders healing.

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Arterial Ulcers

Ulcers that develop in individuals with atherosclerosis affecting the peripheral arteries, often associated with diabetes. Insufficient blood flow leads to tissue death.

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Pressure Sores

Ulcers caused by prolonged pressure on tissues, especially in bedridden individuals. The pressure restricts blood flow causing tissue damage.

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Diabetic Ulcers

Ulcers that affect the feet of diabetic individuals. Poor blood sugar control, nerve damage, and infections contribute to tissue death.

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Diabetic Ulcer Histology

A type of tissue repair seen in diabetic ulcers characterized by epithelial ulceration and extensive granulation tissue in the dermis. It's a complex process involving inflammation, cell death, and new tissue formation.

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Study Notes

Factors Modulating Repair

  • Factors influencing tissue repair include nutritional status, metabolic status (e.g., diabetes), circulatory status, hormones (like glucocorticoids), size and location of the wound, tissue type, local factors (infections, ischemia, mechanical forces), and foreign bodies.

Healing of Skin Wounds

  • Healing by First Intention (Primary Union): Occurs when injury only affects the epithelial layer. Repair is primarily through epithelial regeneration. In clean, uninfected incisions, there's minimal cell death. Healing involves:

    • Coagulation to stop bleeding, forming a clot as a scaffold.
    • Neutrophils arrive within 24 hours to clear debris.
    • Epithelial cells migrate and proliferate across the wound, depositing basement membrane components.

  • Healing by Second Intention (Secondary Union): Occurs with extensive tissue loss (e.g., large wounds, abscesses, ulcerations). Repair involves a combination of regeneration and scarring. Characteristics include:

    • Inflammation and granulation tissue formation are more intense.
    • Large amounts of granulation tissue are formed to fill the wound.
    • Scarring is more extensive.
    • Wound contraction occurs, reducing the wound size.

Fibrosis in Parenchymal Organs

  • Fibrosis is the abnormal deposition of collagen in parenchymal organs, often in chronic diseases.
  • Mechanisms are similar to scar formation (primarily driven by TGF-β).
  • Fibrosis can lead to substantial organ dysfunction or failure (e.g., liver cirrhosis, pulmonary fibrosis).

Abnormalities in Tissue Repair

  • Deficient scar formation: Impaired granulation tissue or collagen deposition. Can cause wound dehiscence or ulceration.
  • Exuberant granulation tissue (proud flesh): Excessive granulation tissue that protrudes beyond the wound edges, hindering re-epithelialization. Requires removal.
  • Hypertrophic scar: Raised, thickened scar due to excessive collagen accumulation. Often regresses over time.
  • Keloid: A progressive scar, spreading beyond the original injury site. Predisposition can exist.
  • Desmoid: Aggressive fibromatosis—excessive fibroblast proliferation potentially leading to recurrence.
  • Contractures: Exaggerated wound contraction leading to deformity.

Defects in Healing: Chronic Wounds

  • Venous leg ulcers: Caused by chronic venous hypertension, often in elderly individuals due to poor oxygen delivery.
  • Arterial ulcers: Occur due to atherosclerosis of peripheral arteries, frequently in combination with diabetes. Ischemia and atrophy result.
  • Pressure sores (decubitus ulcers): Result from prolonged pressure and ischemia in bedridden or immobile individuals.
  • Diabetic ulcers: Characterized by tissue necrosis and delayed healing due to small vessel disease, neuropathy, and infections in diabetics.

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Factors Modulating Repair PDF

Description

This quiz covers the factors that modulate tissue repair and the two types of skin wound healing: primary and secondary intention. Learn about the biological processes involved in healing and the influences on repair such as nutritional and circulatory status. Test your knowledge of the healing mechanisms and their physiological significance.

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