PA: Healing
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| What is regeneration? | Restoring tissue; new tissue is IDENTICAL to old tissue in structure and function
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| What is repair? | Fibrous scar formation; normal structure, BUT function is altered
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| What is ideal healing? | New tissue identical to old
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| What is acceptable healing? | Almost normal structure, but less than optimal function
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| What is minimal healing? | Minimal normal structure and partial function
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| What is failed healing? | Abnormal structure and function
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| What is an example of failed healing? | Articular cartilage (once it's gone, it's gone)
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| What are the four key successive phases of healing? | Hemostasis
Inflammatory
Proliferative
Remodeling/maturation
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| What is the hemostasis phase? | Stopping of bleeding, body's emergency response to form blood clots, lasts seconds to minutes, may form hematoma
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| What is the inflammatory phase? | Wound cleaned of debris
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| What are the 5 signs of inflammation? | Redness
Swelling
Increased temperature
Pain/tenderness
LOF
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| What are the two categories of the proliferative phase? | Fibroplasia
Angiogenesis
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| What is fibroplasia? | Formation of new scar tissue
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| What is angiogenesis? | Formation of new blood vessels
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| What is the remodeling/maturation phase? | Fibers align correctly and increase in strength (~300 days)
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| What is the initial response after injury? | Vasoconstriction followed by vasodilation
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| What are some positive edema consequences? | Dilute harmful substances
Bring in O2 and other nutrients
Lets clotting proteins in
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| What are some negative edema consequences? | Compression in the vicinity, which then pushes on nerves eliciting pain
Compression further disallow venous and lymphatic drainage
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| What is margination? | Leukocytes come in contact with endothelium and adheres to it
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| What is diapedesis? | Passage of leukocytes through capillary walls
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| What is chemotaxis? | Calling neutrophils to the area
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| When do neutrophils arrive after an injury? | Appear within one hour of injury, secondary to injured cells releasing leukocytosis inducing factors
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| When do monocytes appear? | 2-4 days after injury
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| What do monocytes transform into? | Dendritic cells and macrophages
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| What do macrophages do? | Remove dead cells and debris
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| When do lymphocytes appear? | ~5 days post injury
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| What is different about chronic inflammation compared to acute inflammation? | Chronic inflammation does not present with the cardinal signs of inflammation
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| What are 4 important things regarding inflammatory chemicals | Histamine
Kinin
Prostagladin
Complement system
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| What does histamine do? | Vasodilation
Increases capillary permeability
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| What do kinins do? | Vasodilation
Major pain causing chemicals
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| What do prostagladins do? | Sends danger message
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| What does the complement system do? | Enhances defense
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| What are the components of repair phase of wound healing? | Granulation
Fibroplasia
Angiogenesis
Re-epithelialization
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| What does granulation tissue do? | Reduced edema
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| What type of tissue is indicative of normal healing? | Granulation tissue
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| How soon does type III collagen start forming after an injury? | 2 days
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| What type of collagen (I or III) is unorganized and has poor strength? | Collagen (Type III)
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| What are the three stages of the remodeling phase? | Collagen conversion
Wound contraction
Scar formation
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| What is the tissue breaking strength when compared to pre-wound values? | Never throught to exceed 80%
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| What is necessary for collagen cross-linking to occur? | Oxygen
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| What is wound contraction? | Process that closes wound after tissue loss
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| What are the main effector cells for wound contraction? | Myofibroblasts
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| What is scar formation associated with? | Wound contraction
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| How many stages make up scar formation? | 4 stages
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| Characteristics of Stage I of scar formation | 2-4 days post injury
Type III collagen
Prone to tear
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| Characteristics of Stage II of scar formation | 5-21 days post injury
Type III converted to type I collagen
Less likely to tear
MOST receptive to intervention
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| Characteristics of Stage III of scar formation | 21-60 days post injury
More fibrous and strong
Decreased response to intervention
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| Characteristics of Stage IV of scar formation | 60 days post injury
Scar maturation
Final appearance
Unresponsive to treatment, surgical intervention considered
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| What is the difference between hypertrophic and keloid scars? | Hypertrophic scars do not extend outside of the wound bed
Keloid scars typically extend outside of the wound bed and are typically seen in Asian and African populations
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