Dermacell Advanced Wound Training - Module 1 Wound Terminology - 2016 PDF

Advanced Wound Management: Module 1 Wound Terminology Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 1  Primary Material Types in Wound Management Synthetic Material: Substances derived from non-living sources such as metal...

Advanced Wound Management: Module 1 Wound Terminology Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 1  Primary Material Types in Wound Management Synthetic Material: Substances derived from non-living sources such as metals, ceramics and polymers. Biologic Material: Substances derived from living systems such as humans, animals, and cells. Autograft: Tissues transplanted within the same individual. Example: bone-tendon-bone from right knee transplanted to replace torn left ACL. Allograft: Tissue transplanted from an individual of one species into a different individual in the same species. Example: donated human tissue, bone-tendon-bone, taken from the donor and implanted into the recipient to repair torn ACL. Dermacell is an allograft Xenograft: Tissues transplanted from one species into a different species. Example: porcine (pig) heart valve transplanted into a human. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 2  Tissue Processing – Relevant Terms Freeze-Dried: A hydrated substance that is frozen and has all water removed using a vacuum without thawing. Cryopreserved: Tissue that is frozen at a controlled rate and contains cryo-protectant to maintain viability and matrix integrity. Hydrated: A substance that is theoretically ready to use out of the package and requires no rehydration prior to use. Dermacell is provided fully hydrated and is ready to use out of the package Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 3  Tissue Processing – Relevant Terms Aseptic Processing: Technique for cleaning and shaping donor tissue or other medical products in a clean room environment in an attempt to minimize the introduction of bacteria and other contaminates. Shelf Life: The validated length of time a product, including its packaging, can be stored after terminal sterilization or aseptic processing. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 4  Tissue Processing – Relevant Terms Decellularization: Process of removing cells and their debris from tissues. Important for potentially reducing immunological reactions. Dermacell is decellularized via Matracell technology, removing cell remnants and >97% of donor DNA Immunological Reaction/Response: A bodily response to an antigen that occurs when lymphocytes identify the antigenic molecule as foreign and induce the formation of antibodies and lymphocytes capable of reacting with it and rendering it harmless. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 5  Tissue Processing – Relevant Terms SAL (Sterility Assurance Level): The probability of a single viable microorganism being present on a product. 10-3: 1 in 1000 chance of there being a single viable microorganism on one tissue 10-6: 1 in 1,000,000 chance of there being a single viable microorganism on one tissue Terminal Sterilization: The process of sterilizing a material in final packaging. Dermacell is terminally sterilized with low dose gamma irradiation performed at ultra low temperatures to achieve a SAL of 10-6, or no more than a 1 in 1 million chance of there being a single viable microorganism on the graft. Cross-Linking: The process of forming bonds or linkages between molecules. Used to stabilize many materials. Post-terminal sterilization, Dermacell is shows no collagen alteration, which has been confirmed via Transmission Electron Microscopy (TEM). Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 6  Wound Healing – Relevant Terms Scaffold: A matrix of a biocompatible material which will allow host tissue cells to grow into the open spaces as a means of repairing or replacing the host tissue. Specific matrix materials can be designed for different tissues. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 7  Wound Healing – Relevant Terms Type I Collagen* Found in bone, tendon, ligament, skin, blood vessels, cornea, heart valves Type II Collagen Found in cartilage, intervertebral disc Type III Collagen* Found in blood vessels, fetal skin, heart valves * The primary types of collagen found in Dermacell* Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 8  Wound Healing – Relevant Terms Enzyme: A protein that catalyzes a biochemical reaction without being modified itself. Significant amounts of enzymes are present in wound repair to break down damaged or dead tissues. Collagenase: A specific enzyme that acts to break down collagen. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 9  Wound Healing Process Terminology Biohospitable: Is biocompatible (does not elicit an inflammatory or other adverse response from the recipient), facilitates recipient cellular infiltration, and provides a hospitable environment for cell replication and manufacture of site specific proteins like collagen, elastin, and smooth muscle actin to help drive constructive remodeling of the implant site. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 10  Wound Healing Process Terminology Inflammation: a local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration, redness, heat, pain, swelling, and often loss of function and that serves as a mechanism initiating the elimination of noxious agents and of damaged tissue.1 Scar Tissue: Connective tissue forming a scar. Composed primarily of fibroblasts in recent scars and dense collagenous fibers in old scars.2 1 "Inflammation." Merriam-Webster.com. Merriam-Webster, n.d. Web. 16 Nov. 2016. 2 "Scar Tissue." Merriam-Webster.com. Merriam-Webster, n.d. Web. 16 Nov. 2016. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 11  Wound Healing Process Terminology Resorption: Also known as reabsorption, the destruction, disappearance, or dissolution of a tissue or part by biochemical activity. Remodeling: The process of building and resorbing tissue. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 12  Wound Healing Process Terminology Tissue Digestion: A mechanism of breaking down dead and/or damaged tissue through the process of enzymatic degradation. Enzyme Resistance:The ability to resist enzymatic activity. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 13  Wound Healing Process Terminology Revitalization Typified by vitalization (repopulation and vascularization) of a tissue graft upon placing within a surgical site. This process is most likely accomplished as a result of the tissue graft’s stability (resistance to enzymatic degradation) and lack of a prolonged or undue inflammatory response (cell permissive and biocompatibility) to the bio-implant. The revitalization process is characterized by infiltration of appropriate cells accompanied with robust vascularization. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 14  Other Contributors to Wound Healing Matrix Metalloproteinases (MMPs): Enzymes that assist in the breakdown of proteins in the extracellular matrix of a wound site. Cytokines: Play a role in signaling cellular activity during the inflammatory and remodeling phases of wound healing. Growth factors: Play a role in cell signaling responsible for cell migration, division, protein expression, and differentiation during wound healing. DNA Residuals: The DNA remaining following decellularization. – Following Matracell, at least 97% of donor DNA is removed from Dermacell Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 15  Other Contributors to Wound Healing Macrophage: Scavenger cells that act to engulf and remove particulates and biologic debris and aid in the remodeling phase of wound healing. M1 Macrophage: The “janitors,” these macrophages are part of the inflammatory stage of wound healing and assist in the clean up of the wound site prior to M2 infiltration. M2 Macrophage: The “construction workers,” these macrophages assist in the remodeling phase of wound healing. Both types of macrophage are essential for effective healing. In particular, Dermacell was shown to have a “more constructive” mixed ratio of M1:M2 macrophages over a 42 day study period (Agrawal et al.) Giant Cell: Multiple macrophages which have joined together to engulf large particles or implants. Neutrophil: Multi-nucleated cell generally associated in large numbers with an infection. Also found in the early stages of the normal inflammatory response in wound healing. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 16  Other Contributors to Wound Healing Lymphocyte: A form of small leukocyte (white blood cell) with a single round nucleus. Play a role in identifying antigens during an immunological response/reaction. Fibroblast: A cell in connective tissue that produces collagen and other fibers. Copyright 2016 LifeNet Health® All rights reserved. 68-10-334-01.00 17