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Questions and Answers
Which statement best defines a wound?
Which statement best defines a wound?
Which of the following is a local factor affecting wound healing?
Which of the following is a local factor affecting wound healing?
In which phase of wound healing does platelet activation and the increase of vascular permeability occur?
In which phase of wound healing does platelet activation and the increase of vascular permeability occur?
What is the primary role of macrophages within the inflammatory phase of wound healing?
What is the primary role of macrophages within the inflammatory phase of wound healing?
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Which type of wound healing is characterized by a prolonged healing process, often resulting in a scar?
Which type of wound healing is characterized by a prolonged healing process, often resulting in a scar?
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What primarily causes chronic wounds like leg ulcers?
What primarily causes chronic wounds like leg ulcers?
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Which type of leg ulcer is most associated with venous hypertension?
Which type of leg ulcer is most associated with venous hypertension?
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What term describes necrotic tissue at the center of an ulcer?
What term describes necrotic tissue at the center of an ulcer?
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What is the primary method of preventing pressure sores?
What is the primary method of preventing pressure sores?
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What staging of pressure sores involves full-thickness skin loss with underlying fascia?
What staging of pressure sores involves full-thickness skin loss with underlying fascia?
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Which underlying cause is NOT a known aetiology for leg ulcers?
Which underlying cause is NOT a known aetiology for leg ulcers?
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Which of the following is a common site for pressure sores?
Which of the following is a common site for pressure sores?
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What should be performed if a leg ulcer is unresponsive to simple treatment?
What should be performed if a leg ulcer is unresponsive to simple treatment?
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What is the primary difference between primary and secondary intention in wound healing?
What is the primary difference between primary and secondary intention in wound healing?
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Which type of tissue is predominantly formed during the proliferative phase of wound healing?
Which type of tissue is predominantly formed during the proliferative phase of wound healing?
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What characterizes a tertiary intention wound healing process?
What characterizes a tertiary intention wound healing process?
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Which of the following factors would increase the risk of surgical wound infection?
Which of the following factors would increase the risk of surgical wound infection?
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What is a typical characteristic of tidy wounds?
What is a typical characteristic of tidy wounds?
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Which of the following is NOT a method in managing acute wounds?
Which of the following is NOT a method in managing acute wounds?
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What changes occur during the remodeling phase of wound healing?
What changes occur during the remodeling phase of wound healing?
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What does it indicate when a wound fails to heal in the expected time frame?
What does it indicate when a wound fails to heal in the expected time frame?
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What is a characteristic of immature scars?
What is a characteristic of immature scars?
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Which type of scar is known to grow beyond the initial wound area?
Which type of scar is known to grow beyond the initial wound area?
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What is the common treatment for hypertrophic scars?
What is the common treatment for hypertrophic scars?
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How does the onset timing of hypertrophic scars compare to keloid scars?
How does the onset timing of hypertrophic scars compare to keloid scars?
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What effect do hypertrophic scars have on joint movement?
What effect do hypertrophic scars have on joint movement?
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Which of the following is true about keloid scars?
Which of the following is true about keloid scars?
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What is a common characteristic of atrophic scars?
What is a common characteristic of atrophic scars?
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What is the recommended frequency for wheelchair-bound individuals to lift themselves?
What is the recommended frequency for wheelchair-bound individuals to lift themselves?
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Study Notes
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).
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Description
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.
