Wound Healing Overview
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Questions and Answers

What primarily replaces neutrophils within 48 to 96 hours during tissue repair?

  • Macrophages (correct)
  • Basophils
  • Eosinophils
  • Lymphocytes
  • What is a key feature of scar formation after a wound healing?

  • Enhanced leukocytic infiltrate
  • Persistence of edema
  • Increased vascularity
  • Blanching due to collagen accumulation (correct)
  • During wound contraction, what is primarily reduced?

  • The gap between dermal edges (correct)
  • The number of fibroblasts
  • The blood flow to the area
  • The size of the scar tissue
  • What type of repair tissue is formed in healing a fracture?

    <p>Specialized bone-forming tissue (D)</p> Signup and view all the answers

    What characterizes woven bone compared to lamellar bone?

    <p>Irregular arrangement of collagen bundles (D)</p> Signup and view all the answers

    What happens during stage 1 of fracture healing?

    <p>Haematoma formation occurs (B)</p> Signup and view all the answers

    Which of the following occurs during the inflammation stage of fracture healing?

    <p>Increased polymorphonuclear leucocyte infiltration (C)</p> Signup and view all the answers

    What is the primary process by which lost tissue is replaced by similar tissue?

    <p>Regeneration (D)</p> Signup and view all the answers

    Which type of wound involves the skin being split or cracked?

    <p>Open Wound (A)</p> Signup and view all the answers

    Labile cells have a high capacity for regeneration. Which of the following is an example of labile cells?

    <p>Surface epithelium of the skin (D)</p> Signup and view all the answers

    Which cells are categorized as having a low level of replication but can proliferate in response to injury?

    <p>Stable cells (D)</p> Signup and view all the answers

    Which type of cells cannot be replaced if lost due to their non-dividing nature?

    <p>Permanent cells (B)</p> Signup and view all the answers

    What determines whether healing occurs by regeneration or repair?

    <p>Type of cells in the damaged organ (C)</p> Signup and view all the answers

    Which of the following represents a closed wound?

    <p>Haematoma (B)</p> Signup and view all the answers

    Which type of healing involves the formation of scar tissue?

    <p>Repair (A)</p> Signup and view all the answers

    What effect does early motion have on wound healing?

    <p>It can cause persistent trauma. (C)</p> Signup and view all the answers

    How does prior irradiation affect wound healing?

    <p>It blocks cell proliferation. (A)</p> Signup and view all the answers

    What condition often contributes to delayed wound healing in older adults?

    <p>Impaired circulation. (D)</p> Signup and view all the answers

    Which of the following is true about systemic infections?

    <p>They delay wound healing. (B)</p> Signup and view all the answers

    What is a common complication associated with deficient scar formation?

    <p>Wound dehiscence. (B)</p> Signup and view all the answers

    What role does diabetes mellitus play in wound healing?

    <p>It is associated with delayed wound healing. (A)</p> Signup and view all the answers

    How do anti-inflammatory drugs affect wound healing?

    <p>They do not interfere when taken at usual doses. (D)</p> Signup and view all the answers

    What is the result of inadequate formation of granulation tissue?

    <p>Deficient scar formation. (D)</p> Signup and view all the answers

    Which factor is NOT associated with poor wound healing?

    <p>Excessive hydration. (B)</p> Signup and view all the answers

    What does wound dehiscence refer to?

    <p>Inappropriate suture techniques. (C)</p> Signup and view all the answers

    What are the two main objectives of wound healing?

    <p>Restoration of an intact epithelial surface and tensile strength of sub-epithelial tissue (A)</p> Signup and view all the answers

    Which of the following is NOT part of the processes involved in wound healing?

    <p>Rapid cell apoptosis (B)</p> Signup and view all the answers

    What is the primary function of growth factors in the healing process?

    <p>To stimulate cell division and proliferation (B)</p> Signup and view all the answers

    Which source of growth factors is activated after endothelial damage?

    <p>Platelets (D)</p> Signup and view all the answers

    What term describes the mechanical reduction in the size of a wound defect?

    <p>Wound contraction (B)</p> Signup and view all the answers

    Which factor does NOT influence the capacity of a tissue for regeneration?

    <p>Presence of inflammatory cells (C)</p> Signup and view all the answers

    What leads to a faster healing process during wound healing?

    <p>Wound contraction (B)</p> Signup and view all the answers

    Which of the following processes occurs during wound healing?

    <p>Collagenization and progressive acquisition of wound strength (A)</p> Signup and view all the answers

    What happens when wound contraction is prevented?

    <p>A large ugly scar is formed (A)</p> Signup and view all the answers

    What defines the renewal of lost tissue with identical cells?

    <p>Regeneration (C)</p> Signup and view all the answers

    What is the role of myofibroblasts in wound healing?

    <p>They assist in reducing the size of the wound through contraction. (B)</p> Signup and view all the answers

    Which event occurs first within the first 24 hours after a surgical incision?

    <p>Fibrin clot forms and undergoes dehydration. (B)</p> Signup and view all the answers

    What pattern of wound healing describes a clean surgical incision that is well approximated by sutures?

    <p>Healing by primary union (D)</p> Signup and view all the answers

    After how many days does granulation tissue typically fill the incision space?

    <p>5 days (B)</p> Signup and view all the answers

    What changes in the wound occur approximately two weeks post-surgery?

    <p>Scar tissue forms and collagen continues to accumulate. (C)</p> Signup and view all the answers

    What is a characteristic of scar tissue formed after one month of wound healing?

    <p>It has an intact epidermal covering with dense connective tissue. (C)</p> Signup and view all the answers

    Which cellular process primarily takes place during the second and third days of healing by first intention?

    <p>Epithelial cell proliferation and basal cell thickening. (B)</p> Signup and view all the answers

    What occurs within 24-48 hours after the injury process?

    <p>Basal cells proliferate and epithelial cells migrate and deposit basement membrane components. (A)</p> Signup and view all the answers

    Which of the following best describes healing by second intention?

    <p>It is used for heavily contaminated or irregular wounds. (D)</p> Signup and view all the answers

    What cellular change is expected around the fifth day post-injury?

    <p>Optimal proliferation of blood vessels and collagen fibers bridging the incision. (B)</p> Signup and view all the answers

    Flashcards

    Wound Healing

    The body's process of replacing destroyed tissue with living tissue.

    Wound

    A breach or defect in living tissue caused by injury, accompanied by inflammation.

    Closed Wound

    A wound where the skin is intact, but underlying tissues are damaged. Examples include contusions, hematomas, and pressure ulcers.

    Open Wound

    A wound where the skin is broken or cracked, exposing underlying tissue.

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    Regeneration

    Wound healing where lost tissue is replaced by similar tissue.

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    Repair (healing by scarring)

    Wound healing using granulation tissue forming scar tissue to replace lost tissue.

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    Labile cells

    Cells that frequently divide and regenerate well, found in the skin, gut, urinary tract and blood cells.

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    Permanent cells

    Non-dividing cells, if lost, they cannot be replaced. Examples include neurons in the brain and specialized cardiac muscle cells.

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    Wound Healing Objectives

    The primary goals of wound healing are to restore the skin surface and the strength of the underlying tissue.

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    Wound Healing Processes

    Wound healing involves seven key processes: inflammation, regeneration, cell migration, ECM synthesis, tissue remodeling, collagenization, and wound contraction.

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    Growth Factors in Healing

    Growth factors are small proteins that stimulate cell division and proliferation, playing a crucial role in the wound healing process.

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    Growth Factor Sources

    Growth factors are released from various sources during the healing process, including platelets, serum, macrophages, and lymphocytes.

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    Healing by Regeneration

    Regeneration is the replacement of lost tissue with identical cells, restoring the original structure.

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    Regeneration Process

    Regeneration occurs through the proliferation of surviving cells and their migration to fill the gap left by the lost tissue.

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    Factors Affecting Regeneration

    A tissue's capacity for regeneration depends on its ability to proliferate, the damage to its supporting structures, and the severity of the injury.

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    Wound Contraction

    Wound contraction is the reduction in the size of a wound by pulling the edges together.

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    Benefits of Wound Contraction

    Contraction accelerates healing by reducing the amount of tissue that needs to be replaced, but if excessive, can cause scarring.

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    Cause of Wound Contraction

    Wound contraction is primarily driven by myofibroblasts, specialized cells that have contractile properties.

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    Myofibroblasts

    Cells that have characteristics of both fibroblasts and smooth muscle cells, playing a crucial role in wound contraction.

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    Wound Healing by First Intention

    The process of healing a clean, uninfected surgical wound that is closed with sutures, resulting in minimal scarring.

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    Healing by Second Intention

    The process of healing a wound with significant tissue loss, characterized by larger scar formation.

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    Fibrin Clot

    A meshwork of fibrin and blood cells that forms at a wound site, providing a temporary barrier and scaffolding for healing.

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    Granulation Tissue

    New tissue formed during wound healing, consisting of blood vessels, fibroblasts, and collagen, which gradually replaces the fibrin clot.

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    Epithelialization

    The process by which epithelial cells migrate across the wound surface to restore the skin barrier.

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    Scar Tissue

    Dense, fibrous connective tissue that replaces the original tissue after a wound has healed, often lacking the function of the original tissue.

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    What is the primary function of myofibroblasts in wound healing?

    Myofibroblasts are key in wound contraction, bringing the edges of the wound together to minimize the gap and facilitate healing.

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    How do epithelial cells contribute to wound healing?

    Epithelial cells migrate across the wound surface, forming a continuous barrier and protecting the underlying tissues from infection.

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    Why does healing by second intention result in larger scars compared to healing by first intention?

    Healing by second intention involves a larger area of tissue loss, requiring greater deposition of collagen and the formation of more extensive scar tissue.

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    Macrophage Role in Healing

    Macrophages are the key cells in tissue repair. They clear debris, fibrin, and foreign material, promoting angiogenesis and ECM deposition.

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    Scar Formation Stages

    Scar formation involves a decrease in inflammation, increased collagen deposition, and regression of blood vessels, resulting in a pale, avascular scar.

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    Wound Contraction Purpose

    Wound contraction helps to close large wounds by decreasing the gap between dermal edges and reducing the wound surface area.

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    Bone vs. Soft Tissue Healing

    Fractures heal with bone-forming tissue, unlike soft tissue wounds which heal with fibrous scar tissue.

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    Bone Structure

    Bone consists of calcified osteoid tissue made up of collagen fibers embedded in a mucoprotein matrix.

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    Woven Bone

    Immature bone with irregular collagen arrangement and less calcium content.

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    Lamellar Bone

    Mature bone with parallel collagen bundles, forming a stronger, organized structure.

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    Early Motion and Healing

    Early movement can disrupt healing by causing persistent trauma to the wound, delaying the healing process.

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    Radiation and Healing

    Prior exposure to radiation can damage blood vessels, making it harder for the wound to get the nutrients it needs to heal.

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    Circulation and Healing

    A good blood supply is crucial for wound healing, as it delivers oxygen and nutrients to the injured area.

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    Infection and Healing

    Systemic infections can delay wound healing because the body is fighting the infection, and less energy is available for repair.

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    Diabetes and Healing

    Uncontrolled diabetes can slow down wound healing due to impaired circulation and nerve damage, making wounds more susceptible to infection.

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    Protein Deficiency and Healing

    A lack of protein in the diet can hinder wound healing because protein is the building block for new tissue.

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    Anti-inflammatory Drugs and Healing

    While some anti-inflammatory medications can delay wound healing, most are safe at usual doses.

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    Wound Dehiscence

    Wound dehiscence is when the edges of a wound separate or come apart, often due to poor suture material or technique.

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    Wound Ulceration

    Wound ulceration is when a wound fails to heal properly and forms an open sore, often due to inadequate granulation tissue formation.

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    Incisional Hernias

    An incisional hernia occurs when tissue bulges through a weakened abdominal wall resulting from inadequate scar formation.

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    Study Notes

    Wound Healing

    • Healing, in a pathological context, is the body's replacement of damaged tissue with living tissue.
    • A wound is a breach or defect in intact living tissue, caused by injury and accompanied by inflammation.
    • Wounds can be accidental or surgical.

    Types of Wounds

    • Closed Wounds: Skin surface is intact, but underlying tissues are damaged (e.g., contusions, hematomas, Stage 1 Pressure Ulcers).
    • Open Wounds: Skin is split or cracked, exposing underlying tissues to the environment.

    Processes of Wound Healing

    • Regeneration: Replacement of lost tissue with similar tissue types.
    • Repair (healing by scarring): Replacement of lost tissue with granulation tissue that matures into a scar.
    • Healing type depends on the damaged organ's cell type and stromal framework integrity.

    Types of Cells

    • Labile Cells: High proliferative capacity, found in surface epithelium of GI tract, urinary tract, and skin; lymphoid and hematopoietic cells; excellent regeneration potential.
    • Stable Cells: Lower replication rates, few stem cells; can undergo rapid division in response to injury; smooth muscle cells, fibroblasts, osteoblasts, endothelial cells; good regeneration potential. Liver, endocrine glands, and renal tubular epithelium can regenerate.
    • Permanent Cells: Non-dividing; cannot be replaced if lost; adult neurons, striated muscle cells, lens cells.

    Objectives of Wound Healing

    • Restore an intact epithelial surface.
    • Restore tensile strength of sub-epithelial tissue.
    • Wound healing is a complex, orderly, systematic process that involves seven processes:
    • Acute inflammatory response upon injury
    • Regeneration of native cells of tissue involved.
    • Proliferation and migration of native and connective tissue cells.
    • Synthesis of extracellular matrix (ECM) proteins.
    • Remodelling of connective tissue and parenchymal components.
    • Collagenization and progressive acquisition of wound strength.
    • Contraction.

    Growth Factors

    • Healing is, in part, mediated by growth factors—low molecular weight polypeptides stimulating cell division and proliferation.
    • Sources of growth factors include platelets, circulating serum growth factors, macrophages, and lymphocytes recruited to the injury site.

    Healing by Regeneration

    • Regeneration is the renewal of lost tissue by replacing lost cells with identical ones.
    • It involves two processes: proliferation of surviving cells to replace lost tissue and migration of surviving cells into the vacant space.
    • Regenerative capacity depends on tissue's proliferative ability, degree of damage, and damage severity.

    Wound Contraction

    • Mechanical reduction in wound size, typically 70-80% of original size.
    • Faster healing due to reduced tissue needing replacement.
    • Slow and large ugly scar formation if prevented.
    • Myofibroblasts—features intermediate between fibroblasts and smooth muscle cells—cause contraction.
    • Migrate to wound site 2-3 days post-injury, decreasing wound area.

    Patterns of Wound Healing

    • Healing by First Intention (Primary Union): Clean, uninfected surgical wounds with well-approximated sutures heal quickly. Minimal epithelial and connective tissue cell death; minimal basement membrane disruption. Immediately filled by clotted blood which dehydrates to form scab.
    • Healing by Second Intention: Extensive cell loss, large tissue defects; wide margins; includes infarction, inflammatory ulceration, and abscesses. Requires abundant granulation tissue, more fibrin, necrotic debris, and a significant inflammatory reaction for healing. Myofibroblasts are important for wound contraction, which is critical for healing large wounds.

    Granulation Tissue

    • New connective tissue with microscopic blood vessels and myofibroblasts forming at wound site during healing.
    • Fills wound spaces; crucial for wound contraction and epithelial cell migration.

    Factors Influencing Wound Healing

    • Local Factors: Type, size, location of wound, vascular supply, infection, movement, ionizing radiation.
    • Systemic Factors: Circulatory status, infection, metabolic status, nutritional deficiencies, anti-inflammatory drugs.

    Complications of Wound Healing

    • Infection: A wound provides a portal of entry for microorganisms and delays or stops healing. Severe infection may cause extensive granulation tissue formation (proud flesh) and possible large, deforming scars.
    • Deficient Scar Formation: Inadequate granulation tissue formation or inability to form suitable extracellular matrix; leads to;
    • Wound dehiscence and incisional hernias: Improper sutures, infection; increased mechanical stress by vomiting, coughing, or ileus are risk factors.
    • Ulceration: Inadequate blood supply, insufficient vascularization, and persistent trauma may lead to ulceration. Commonly found in diabetics, leprosy, and tertiary syphilis.
    • Excessive Scar Formation: Excessive extracellular matrix deposition; leads to:
    • Hypertrophic scars: Raised or thickened scar tissue.
    • Keloids: Prominent, raised scar tissue extending beyond the wound boundaries.
    • Contractures: Excessive wound contraction; can restrict movement or function.

    Fracture Healing

    • Unlike skin wounds, fracture healing involves specialized bone-forming tissue.
    • Bone is comprised of calcified osteoid tissue (collagen and osteomucin matrix)
    • Woven (immature/non-lamellar) bone shows collagen bundle irregularity.
    • Lamellar (adult) bone has parallel collagen bundles in sheets.
    • Fracture healing process occurs in seven stages, including hematoma formation, inflammation, demolition, granulation tissue formation, woven bone/cartilage formation, lamellar bone formation, and remodeling.

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    Description

    Explore the complex processes of wound healing, including types of wounds and cellular responses involved. This quiz provides insights into regeneration and repair mechanisms, crucial for understanding how the body heals after injury.

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