Wound Healing Physiology
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Questions and Answers

What is the first stage of wound healing?

Hemostasis

During inflammation, which type of white blood cells arrives first at the site of injury?

Neutrophils

What type of tissue is created to fill the wound in the proliferation stage?

Granulation tissue

What is the wound strength during maturation, as compared to original tissue?

<p>70-90%</p> Signup and view all the answers

What should patients be advised to stop doing before surgery to help with wound healing?

<p>Smoking</p> Signup and view all the answers

Why should obese patients be encouraged to lose weight before surgery?

<p>Obese patients tend to have more complications related to wound healing.</p> Signup and view all the answers

What is used to prepare the skin for incision immediately before surgery?

<p>Povidone iodine or chlorhexidine.</p> Signup and view all the answers

What type of wound is closed using sutures or clips?

<p>Wounds that heal by primary intention.</p> Signup and view all the answers

What is the main difference between primary and secondary dressings?

<p>Primary dressings come into direct contact with the wound bed, while secondary dressings cover the primary dressings.</p> Signup and view all the answers

What are three symptoms of cellulitis?

<p>Redness, heat, and tenderness.</p> Signup and view all the answers

Flashcards

Haemostasis

The initial stage of wound healing that begins at the time of injury, involving clot formation to stop bleeding.

Inflammation

The stage where blood vessels dilate, allowing white blood cells to enter the injured area to fight infection.

Proliferation

The phase of wound healing where new granulation tissue forms to fill the wound and new epithelial cells seal it.

Maturation

The final phase of wound healing that can last up to 2 years, where tissue strengthens and scarring occurs.

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Surgical site infection prevention

Measures to reduce infection risks before surgery, including assessments and dietary advice.

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Obese patient pre-op care

Encourage weight loss to reduce surgical complications.

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Skin preparation for surgery

Use povidone iodine or chlorhexidine before surgery for skin cleansing.

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Wound healing by primary intention

Wounds closed with sutures or clips; requires aseptic technique during dressing changes.

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Necrotizing fasciitis

Rapidly spreading infection requiring urgent surgery and IV antibiotics; can cause multi-organ failure.

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Primary vs Secondary dressings

Primary dressings touch the wound; secondary dressings cover primary dressings.

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Study Notes

Wound Healing Physiology

  • Wound healing is a complex process involving the repair of the skin.
  • The process is divided into stages: haemostasis, inflammation, proliferation, and maturation.

Haemostasis

  • Initiated by injury, often surgical incision.
  • Chemicals trigger the clotting cascade.
  • Platelets activate at the injury site.
  • Fibrinogen forms a fibrin mesh, supporting the clot.
  • The clot prevents blood loss and bacterial entry.
  • Blood vessels at the injury constrict to reduce blood loss.

Inflammation

  • Blood vessels near the injury dilate due to histamine release.
  • Capillaries widen, allowing neutrophils (first white blood cells) to enter injured tissue.
  • Monocytes (larger white blood cells) arrive 24 hours later and exit the blood supply.
  • Macrophages coordinate the next healing stages.

Proliferation

  • New tissue (granulation tissue) forms to fill the wound.
  • Connective tissue builds and epithelial cells seal the wound.
  • Increased blood supply is crucial for granulation tissue development.

Maturation

  • Healing can last up to 2 years.
  • Unnecessary blood vessels are reabsorbed.
  • Wound strength increases to 70-90% of original.
  • Scar tissue forms, distinct from normal tissue, but improves over time.
  • Scarring is unavoidable in healing.

Prevention of Surgical Site Infections

Pre-Operative Assessment

  • Blood tests for anaemia and malnutrition—correct anaemia.
  • Advise well-balanced diet for adequate vitamins/minerals.
  • Advise smoking cessation.
  • Encourage weight loss for obese patients.

Pre-Operative Stage

  • Instruct patient to bathe/shower before surgery.
  • Hair removal (if needed) done by staff on the day of surgery using electric clippers with disposable heads.

Intra-Operative Stage

  • Use povidone iodine or chlorhexidine to prepare skin before incision.
  • Apply appropriate dressing to the wound.
  • Cavity wounds dressed following wound assessment.

Post-Operative Stage

Wound Healing by Primary Intention
  • If dressing change needed within 48 hours, use aseptic saline wound cleansing technique.
  • After 48 hours, patient can shower.
Wound Healing by Secondary Intention
  • Dress as dictated by wound assessment.

Wound Dressings for Primary Intention

  • Primary dressings are in direct contact with the wound.
  • Secondary dressings cover primary dressings; not always required.

Common Wound Infections and Treatment

  • Intact skin is a barrier to infection; breaches allow bacterial entry.
  • Infection types include:

Cellulitis

  • Spreading inflammation (redness, heat, tenderness).
  • Pus may form; tissue necrosis possible; lymph nodes may enlarge.

Necrotizing Infections of Skin and Soft Tissues

  • Commonly caused by Gram-negative bacteria.
  • Tissue necrosis present.
  • Wound swab, aspirated fluid, or tissue biopsy analysis helps diagnose and prescribe antibiotics.
  • Oral antibiotics (amoxicillin, co-amoxicillin, metronidazole).
  • IV antibiotics (amoxicillin, piperacillin/tazobactam, ciprofloxacin, clindamycin).
  • Topical antimicrobial dressings.

Necrotizing fasciitis

  • Rapidly spreading infection of tissues and subcutaneous layer.
  • Requires rapid radical debridement surgery (multiple visits may be needed).
  • Tissue sample analysis aids in bacterial identification.
  • Multi-organ failure possible.
  • Urgent IV antibiotics (multiple antibiotics due to varied bacteria).

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Description

This quiz explores the essential stages of wound healing, including haemostasis, inflammation, and proliferation. Test your knowledge on the physiological processes involved in skin repair and the body's response to injury. Understand how tissues regenerate and how the immune system contributes to healing.

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