Chapter 11: Hemostasis, Wound Healing, and Wound Closure; Short Answer: Wound Healing

What is released from the damaged cells that causes the inflammatory response?

Histamine

Fill in the blanks:

Normal healing of wounds occurs from ____ to _____ across the wound, not from the inside out.

Side; Side

Describe the five signs of the inflammatory process.

1) Pain

2) Heat

3) Redness

4) Swelling

5) Loss of function

Identify the three phases of normal (primary intention) wound healing. What is the normal length of time for each?

Phase 1, Phase 2, Phase 3

Phase 1: Begins within minutes of injury and lasts ~3 to 5 days. Physiological changes associated with inflammation.

Phase 2: Begins about the 3rd day post-op and continues for up to 20 days. Fibroblasts multiply and bridge the wound edges.

Phase 3: Begins on the 14th day post-op and lasts until the wound is completely healed. Wound undergoes a slow, sustained increase in tissue tensile strength with an interweaving of the collagen fibers.

Indicate the correct type of wound healing for the description. Indicate if it is first, second or third intention healing.

(A) Granulation tissue occurs from the inside out or bottom upward

(B) Incision opened under ideal conditions, minimal scar

(C) Delayed closure

(D) Produces a weak union with a wide irregular scar

(E) Wound debrided then closed four to six days later to heal

(F) Used for dirty wounds; produces intermediate scar/tensile strength

(G) Incision made with rapid wound healing to 70-80 percent original strength

(H) Routine negative breast biopsy closure (mammogram mass)

(I) Type of healing most likely for a decubitus ulcer

(J) Type of initial healing most likely for a ruptured appendix

(A) Second intention

(B) First intention

(C) Third intention

(D) Second intention

(E) Third intention

(F) Third intention

(G) First intention

(H) First intention

(I) Second intention

(J) Third intention

Ordering: Identify the order in which normal primary-intention healing occurs. Place the events in the order of occurrence using the numbers 1-9. There are three primary phases of normal healing. Use the written description and Figure 11-1 in the textbook for reference.

1) Lag phase: Inflammation occurs, with heat, swelling, pain, redness, loss of function

2) Scab forms with a weak sealing of wound

3) Proliferation phase begins on third to fifth postoperative day

4) Fibroblasts secrete collagen; capillary networks form up to 20 days

5) 25-30 percent tensile strength returns at the end of this phase

6) Maturation or remodeling phase begins 14-21 days post-injury

7) May last up to 12 months or longer

8) Wound contraction occurs as fibroblasts cause the scar to pale

9) Cicatrix appears, slow increase in tensile strength until 70-80 percent

Research: Complete an Internet search on the topic of "wound healing" and each of the following issues. Analyze your research and describe how each of the following issues can affect wound healing.

Age: Slowing everything down including the phases of wound healing, skin thinner, decreased inflammatory response.

Nutrition: Eating well helps you heal faster, during healing your body needs more calories, protein, fluid, vitamin A and C, and zinc.

Disease (e.g., diabetes, obesity): Chronic diseases have a direct impact on the body's ability to heal. Diabetes and immunodeficiency slow wound healing.

Radiation Exposure: Most affected by radiation. Irradicated tissue becomes hypoxic and fibroblasts become dysfunctional.

Smoking: Slows the process since it lowers the level of oxygen in the blood, thus providing less oxygen to the wound.

Immunocompromised or immunosuppressed patient: Have an increased risk for hypothermia, which affects wound healing process and increases the risk of infection.

Describe the appropriate intraoperative tissue handling techniques that should be used during any case.

Wound security, tissue handling, sterile technique, duration of surgery, methods of hemostasis, elimination of dead space, length and direction of incision, and dissection technique.