Wound Healing and Management Quiz

Wound Healing Overview

• A wound is a break in skin or other tissues, caused by injury or incision.
• Wound healing is a process where the body restores the integrity of the injured area.
• Factors affecting wound healing include local factors (skin tension, hypoxia, ischemia, vascular insufficiency, lymphoedema, contamination, infection, presence of foreign bodies, radiotherapy) and systemic factors (advancing age, obesity, malnutrition, smoking, diseases like diabetes mellitus and connective tissue disorders, immunocompromised conditions, medications like steroids, immunosuppressants, and chemotherapy).

Normal Wound Healing Phases

• Hemostasis: The initial phase following injury, involving vasoconstriction and platelet plug formation to stop bleeding.
• Inflammatory Phase:(1-2 days post-injury) The body's inflammatory response, involves platelet activation, influx of inflammatory cells (leukocytes & neutrophils), increased vascular permeability (due to histamine and serotonin). This phase is characterized by the signs of inflammation (redness, heat, swelling, pain).
• Proliferative Phase: (3rd day to 2-4 weeks) New tissue growth, angiogenesis (formation of new blood vessels), collagen type III formation (granular tissue), re-epithelialization, and wound contraction happen. This phase is crucial for restoring tissue structure and function.
• Remodeling Phase: (2-3 weeks to a year or more). Maturation and strengthening of the scar tissue; collagen type I replaces type III, and the wound gradually strengthens.

Wound Healing Types

• Primary Intention: Wound edges are closed (e.g., surgical incisions). Characterized by minimal inflammation and scarring.
• Secondary Intention: The wound is left open to heal (e.g., pressure sores) and granulation tissue is created before the edges are closed. This type involves more inflammation and a larger scar.
• Tertiary Intention: Delayed primary closure (e.g., infected wounds). Wound edges are closed later when inflammation decreases.

Wound Classification

• Class I (Clean): Uninfected surgical wounds where respiratory, alimentary or urinary tracts were not entered.
• Class II (Clean-Contaminated): Respiratory, alimentary or urinary tracts were entered under controlled conditions with no unusual contamination.
• Class III (Contaminated): Open wounds with breaks in surgical technique or gross contamination.
• Class IV (Dirty): Old traumatic wounds with devitalized tissue or infection.

Acute Wounds

• Acute wounds heal in a predictable manner (e.g., cuts, lacerations).
• Common examples include bites, puncture wounds, hematomas, degloving injuries, compartment syndrome, and high-pressure injection injuries.
• Management involves debridement, irrigation, wound exploration, repair of structures, hemostasis, suture choice, drains, dressing, and monitoring for complications.

Chronic Wounds

• Chronic wounds fail to heal in the expected time.
• Often associated with inflammation, infection, and a lack of blood supply.
• Common types of chronic wounds are Pressure ulcers, diabetic ulcers & leg ulcers.

Leg Ulcers

• Types: Arterial, venous, diabetic ulcers (caused by various factors including but not limited to vascular disease, diabetes, trauma, autoimmune disorders etc.)
• Mechanism: Inflammatory phase is prolonged.
• Management: Assess arterial/venous circulation/sensation, Treat underlying cause( if evident), Consider surgery ( if appropriate).

Pressure Ulcers

• Tissue necrosis due to prolonged pressure.
• Common sites: ischium, trochanter, sacrum, heel, malleolus, occiput.
• Factors: paralytic patients; immobile elderly; seriously ill patients. These wounds are caused due to prolonged pressure on a specific area of the body.
• Mechanism: Pressure exceeding capillary perfusion pressure leads to ischemia.
• Management: Prevention (good skin care, pressure dispersion, cushions etc.), surgical management (debridement, VAC), and consider alternative therapies.

Staging of Pressure Ulcers

• Stages 1 to 4 progressively describe the severity of skin damage, with Stage 4 being the most severe, involving deep tissue damage.

Scar Types

• Immature scar: Pink, hard, raised, itchy
• Mature scar: Paler, softer, flatter
• Atrophic scar: Pale, flat, stretched and easily traumatized. (tension areas)
• Hypertrophic scar: Raised, but stays within the wound area.
• Keloid scar: Raised, but grows beyond wound margin.

Scar Treatment

• Hypertrophic scar: Silicone sheeting/gel, intralesional steroids, fractional laser therapy, pressure/compression.
• Keloid scar: Silicone, intralesional steroids, 5-FU, excision, radiotherapy, alternative therapies (Bleomycin, mitomycin C).

Test your knowledge on the various aspects of wound healing and management with this comprehensive quiz. From definitions to the phases of healing and factors affecting it, ensure you understand the important concepts. This quiz is essential for anyone studying wound care in a clinical setting.