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Surg 2 Wound Healing

Surgery 2

Biggest determining factor of whether wound will heal: blood supply
Phases of Wound Healing: Hemostasis, plt plug / fibrin clot formation; inflam & recruitment; fibroblast proliferation & granulation; maturation (wound remodeling & contraction)
Order of arrival of cells to newly injured tissue Platelets; neutrophils; monocytes/ macrophages; fibroblasts
Fn of Platelets: plug any bleeding defects to form a clot, which provides a fibrous framework for later events.
Cells that stimulate mast cells to release histamine: Platelets and leukocytes
Fn of Neutrophils: phagocytosis of debris & release of cytokines to recruit other cells; die within 24-48 hrs; release lysosomal enzymes, which digest necrotic debris
Fn of Monocytes/macrophages arrive at approx. same time as neutrophils, but live longer and predominate after 3rd day
Fn of Fibroblasts appear at about 24 hrs; attach to fibrin scaffolding deposited in wound during initial clotting.
Predominant cells in a normal wound at 10 days: Fibroblasts
Reasons for difficult healing in Diabetes: Impaired microvasculature, impaired inflammatory response
Reasons for difficult healing in Glucocorticoids: Immunosuppression, reduced tensile strength
Reasons for difficult healing in Radiation and Chemotherapy: Arteriolar and fibroblast damage, BM suppression
Treatment for an abscess is: Drainage
Primary closure: prompt suture closure after irrigation; heals the most rapidly w/ the best scar; can be used in clean & clean-contaminated wounds; also clean, fresh traumatic lacerations.
Secondary intention: wound is left open & allowed to granulate in; generally involves debridement, irrigation, & frequent dressing changes
Delayed primary closure: wound is cleaned, debrided, irrigated, & closed 3 to 5 days later
Cofactors required for collagen synthesis Vitamins C&E; Iron; Oxygen; Protein; Galactose; Glucose; Manganese
Wound: Clean: non-traumatic, uninfected, incision under aseptic conditions as in the OR; e.g. median sternotomy incision, hernia; infection rate < 5%
Wound: Clean-contaminated: normal flora, wounds involving oral cavity, respiratory, upper alimentary, or GU surgery; e.g. esophageal, cholecystectomy, colectomy; infection rate < 10%
Wound: Contaminated: fresh traumatic lacerations, operative procedures with gross soilage; ex: colostomy, bowel resection w/ enterotomy; acute cholecystitis w/ pus; infection rate < 15%
Wound: Dirty/Infected: heavily contaminated wounds, traumatic wounds greater than 6 hours old, grossly infected wounds; ex: pelvic abscess, gangrene of extremity, perf viscus, perirectal abscess, leg ulcer; infection rate 30%
Factors that Influence Healing: Infection/ contam; Nutrition; DM; Jaundice; Uremia; Steroids; CT/radiation; Hypoxia (smoking); edema
Created by: Adam Barnard Adam Barnard