Wound Healing Student Notes

A comprehensive vocabulary review deck covering types of wounds, wound healing intentions and phases, healing complications, and wound classifications based on student lecture notes.

Wound

Any tissue that has been damaged either by intentional (surgical) or accidental (traumatic) means.

Incisional Wound

An intentional cut made through intact tissue for the purpose of exposing or excising underlying structures.

Excisional Wound

A surgical wound characterized by the removal of tissue.

Traumatic Wound

A wound occurring when a blunt, chemical, thermal, extrinsic agent, or penetrating force has injured living body tissue.

Abrasion

A wound caused by mechanical irritation, such as boot rubbing, scraping, or friction against sandpaper (road rash).

Avulsion

A traumatic injury in which a portion of the skin and soft tissue is partially or completely torn away.

Contusion

A bruise caused by a blunt instrument in which the skin is not broken, but underlying tissues are damaged and blood vessels have ruptured, causing discoloration.

Crushed Wound

A wound that has been squeezed or forced by pressure so as to alter or destroy the tissue structure.

Incised Wound

A wound with smooth edges made by a cutting instrument, which may be classified as contaminated or clean.

Laceration

A wound characterized as a cut or tear in the tissue.

Puncture

A wound made by a sharp-pointed instrument resulting in tissue penetration.

Perforation

A wound in which the vulnerating body both enters and emerges from a body cavity.

Closed Wound

A wound category in which the skin remains intact, but the underlying tissue is injured (e.g., simple fractures, torn ligaments, blisters).

Open Wound

A wound category in which the skin integrity is broken (e.g., abrasions, lacerations, penetrations).

Complicated Wound

An open wound in which the skin and underlying tissues are injured or destroyed by crushing, burning, or implantation of a foreign object that remains present.

First Intention Healing (Primary Union)

Optimal wound healing typical of an incision opened under ideal conditions with cut edges in direct contact; heals rapidly from side to side with no dead space, minimal scar formation, and no infection.

Lag Phase (Inflammatory Response Phase)

The substrate phase of healing beginning within minutes of injury and lasting $3$ to $5\text{ days}$, during which arterial dilation, exudate clotting, and leukocyte phagocytosis occur with no tensile strength gained.

Proliferation Phase

The healing phase beginning on the $3\text{rd}$ postoperative day and continuing up to $20\text{ days}$, characterized by rapid fibroblast multiplication and collagen secretion yielding $25\text{--}30\%$ of tissue tensile strength.

Maturation Phase (Remodeling Phase)

The differentiation phase beginning on the $14\text{th}$ postoperative day and continuing until healed, during which collagen cross-links increase tensile strength, vascularity decreases, and a cicatrix forms.

Second Intention Healing (Granulation)

Healing from the bottom of an open wound upward by granulation tissue formation and contraction, occurring when primary closure is not achieved and resulting in excessive scar formation.

Third Intention Healing (Delayed Primary Closure)

Healing utilized for contaminated wounds where debridement is performed and the wound is left open for about a week before granulated surfaces are approximated for closure.

Cicatrix

A normal scar formation appearing as a small white surface scar during the maturation phase.

Keloid

A raised, thickened scar caused by excess collagen formation, occurring most frequently in dark-skinned individuals.

Proud Flesh

A descriptive term for excessive granulation tissue that protrudes from a healing wound.

Granuloma

A neoplasm that appears to consist of many small particles (grains).

Tensile Strength

The ability of a tissue or healed wound to resist rupture or withstand a pulling force without tearing.

Contracture

Abnormal shortening of a muscle or tendon resulting in a deformity that is resistant to stretching.

Ischemia

Loss of blood supply to a body part caused by compression or blood vessel blockage; prolonged ischemia leads to tissue death from lack of oxygen.

Dead Space

Separation of wound layers that have not been closely approximated, or trapped air, which can allow serum or blood to collect and provide a medium for microbial growth.

Dehiscence

A partial or total separation of a layer or layers of tissue after closure, occurring most commonly between the $5\text{th}$ and $10\text{th}$ postoperative day.

Evisceration

A protrusion of the viscera through the edges of a totally separated wound; an emergency surgical condition requiring intervention to prevent peritonitis.

Hemorrhage

Bleeding that may be concealed or evident, typically seen in the first few postoperative hours and potentially leading to postoperative hypovolemic shock.

Adhesion

An abnormal attachment of two surfaces that are normally separate, consisting of a band of scar tissue between abdominal and pelvic organs.

Herniation

A protrusion of tissue or an organ resulting from wound dehiscence, occurring most often in lower abdominal incisions and potentially leading to bowel incarceration.

Fistula

An abnormal tract between two epithelial-lined surfaces that is open at both ends (a complete tunnel).

Sinus Tract

An abnormal tract between two epithelium-lined surfaces that is open at one end only (an incomplete passage or cave).

Serosanguinous Drainage

Wound drainage consisting of serous fluid that is blood-tinged or colored.

Necrosis

The death of tissue cells.

Seroma

A collection of fluid that develops in a healing surgical wound as a result of tissue trauma incurred during surgery.

Hematoma

A collection of blood that forms in a surgical wound due to incomplete hemostasis during surgery, increasing the risk of wound infection.

Gangrene

Tissue death that is often accompanied by bacterial infection.

Class I: Clean

A surgical wound created under ideal surgical conditions with no break in sterile technique, no entry into the GI or GU tract, and closed by primary closure without drains.

Class II: Clean Contaminated

A surgical wound characterized by primary closure, potential drain placement, minor breaks in sterile technique, or controlled entry into the GI (including biliary) or GU tracts.

Class III: Contaminated

A surgical wound classification encompassing open traumatic wounds less than $4\text{ hours}$ old, major breaks in sterile technique, acute inflammation, or entry into GI/GU tracts with spillage.

Class IV: Dirty / Infected

A surgical wound category involving open traumatic wounds older than $4\text{ hours}$, pre-existing microbial contamination, perforated viscus with fluid spillage, or necrotic tissue and fecal material.