Tissue Healing Overview

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Questions and Answers

What is the primary activity of fibroblasts during the proliferation stage of tissue healing?

Trigger vasoconstriction

Synthesize collagen (correct)

Increase capillary permeability

Produce inflammatory mediators

Which of the following is a sign that indicates the inflammation stage of wound healing?

Collagen synthesis

Pus formation

Redness and swelling (correct)

Moist red raised tissue

What initiates angiogenesis during the healing process?

Increased collagen production

Formation of scar tissue

Leaking of exudate into tissues

Vasodilatation and influx of inflammatory mediators (correct)

What is the most common complication associated with wound healing after the inflammation stage?

Infection Signup and view all the answers

Which treatment method is recommended during the inflammation stage of tissue healing?

Immobilization and positioning Signup and view all the answers

What is the primary purpose of performing an escharotomy in severe cases?

To relieve pressure by allowing tissue expansion Signup and view all the answers

Which symptom is NOT typically associated with vascular insufficiency due to compartment syndrome?

Increased peripheral pulses Signup and view all the answers

What position is commonly assumed in the hand during acute oedema, known as intrinsic minus?

Wrist flexion, MCP extension, PIP/DIP flexion Signup and view all the answers

How does intrinsic minus position affect the joints and surrounding structures?

Increases contracture predisposition due to fluid accumulation Signup and view all the answers

What long-term concern may arise after wound healing due to scar maturation?

Chronic oedema Signup and view all the answers

What is the primary purpose of splinting and exercise during the remodelling phase of healing?

To reduce oedema and prevent contracture Signup and view all the answers

During which weeks does the remodelling phase of wound healing begin?

4-6 weeks Signup and view all the answers

What key process occurs during the remodelling phase in relation to collagen?

Collagen fibers are organized along lines of stress Signup and view all the answers

What complication can occur if oedema increases rapidly after a severe burn?

Circulatory compromise Signup and view all the answers

What happens to scar tissue (eschar) that results from a severe burn?

It becomes inflexible and restricts expansion Signup and view all the answers

How long can the remodelling phase last after a burn injury?

Up to 2 years Signup and view all the answers

In burn healing, what role do fibroblasts play during the remodelling phase?

Fibroblast activity decreases and collagen synthesis dominates Signup and view all the answers

Which of the following is NOT a common characteristic of a mature scar?

It is red and raised Signup and view all the answers

Study Notes

1.6 Tissue Healing

Tissue healing depends on burn size and surgical intervention.
Clinical reasoning is crucial for applying timescales.

Inflammation

Duration: 0-5 days
Process: Vasoconstriction followed by vasodilatation, influx of inflammatory mediators and white blood cells (WBCs). Increased capillary permeability, exudate leaks into tissues, pus may form.
Signs: Redness, heat, swelling, pain.
Treatment: Reduce heat and oedema, prevent infection, immobilisation, and positioning.

Proliferation (Fibroplasia)

Duration: Day 3-5, lasting 2-6 weeks
Process: Fibroblasts synthesize collagen, laid down haphazardly. Angiogenesis continues.
Signs: Moist red raised tissue over wound.
Treatment: Early positioning, immobilisation. Later, gentle stress (splinting, exercise) to reduce oedema and prevent contracture.

Remodeling (Maturation)

Duration: Week 4-6, lasting up to 2 years.
Process: Collagen synthesis balanced by degradation. Organisation of collagen fibres along lines of stress. Wound closure progresses to flat, pale, and pliable scar tissue.
Signs: Wound closure, scar that's raised and red, progressing to flat, pale, and pliable. Scar tissue tightens.
Treatment: Optimise function through splinting, positioning, exercise, and stretching, strengthening.

1.62 Complications of Healing in Burn Patients

Oedema: Increased vascular permeability; may be exacerbated by severe burns; can last up to 36 hours.
Post-severe burn: Scar (eschar) is inflexible; restricts skin expansion. Increased compartment pressure can lead to circulatory compromise, nerve damage/necrosis, of distal muscles.
Escharotomy may be needed as a surgical procedure to split the scar and allow tissue expansion.

1.7 Burn Associated Pain

High percentage of major burn patients experience severe or excruciating pain.
100% of burn patients experience daily pain.
92% of burn patients experience pain at night.

1.71 Types of Pain in Burns

Procedural pain: Intense burning and stinging that continues after procedures. Typically throbbing and excruciating pain.
Background pain: Prolonged, relatively constant mild to moderate intensity pain.
Breakthrough pain: Transient worsening of pain, often associated with movement.

1.72 Pain Mechanisms

Primary hyperalgesia
Secondary hyperalgesia
Neuropathic pain
Chronic pain/Central Sensitisation

1.73 Pain Intensity

Pain intensity may change as inflammation subsides.
Higher pain intensity in areas of skin loss.
Infection may lead to increased pain.
New tissue growth may cause paraesthesia and local discomfort in healed areas.
Mechanical hyperalgesia is possible after subsequent injury.

1.74 Anxiety and Pain Experience

Pain experience is altered by treatment (surgery/debridement).
Pain during treatment may be higher than after the treatment, e.g. the harvest site of grafts.
Poor pain management results in treatment compliance issues and post-traumatic stress disorder.

3.1 Pharmacological Pain Management

Decreased organ blood supply can affect drug clearance.
Hyper metabolic state results in increased drug clearance.
Variations in acute phase plasma and total body water impact analgesia effectiveness.
Pain assessment is crucial to monitor analgesia effectiveness.

3.2 Non-Pharmacological Pain Management

Psychological techniques (relaxation, distraction, CBT) assist in managing anxiety and pain.
Hypnosis offers increased suggestibility, attention, and relaxation to manage procedural pain and anxiety.
Virtual reality offers distraction from pain; more effective than handheld games.
Musical therapy can help with pain by providing distraction.

3.26 Paediatric Burn Pain

Children (0-4 years) represent 20% of hospitalised burn patients.
Pain management is vital during physiotherapy, particularly pre-physiotherapy treatment to prevent pain-related anxiety.

Pain Assessment Tools

Wong-Baker FACES® Pain Rating Scale
FLACC Pain Rating Scale

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Description

This quiz explores the stages of tissue healing, including inflammation, proliferation, and remodeling. It focuses on the durations, processes, signs, and treatments associated with each stage, relying on clinical reasoning for effective care. Understanding these concepts is crucial for managing wounds and promoting healing.