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54 Cards in this Set
- Front
- Back
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Healing of Vascularized Tissue
3 major phases |
inflammation
proliferation maturation |
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Healing of Vascularized Tissue
inflammation phase- main idea? |
Inflammation phase prepares the wound for healing
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Healing of Vascularized Tissue
proliferation phase- main idea? |
The proliferation phase rebuilds the damaged structures and strengthens the wound
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Healing of Vascularized Tissue
maturation phase- main idea? |
Maturation phase modifies the scar tissue into its mature form
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Inflammation
duration/main idea? |
Inflammation phase- Days 1-6. The immediate protective response attempts to destroy, dilute, or isolate the cells or agents that may be at fault. It is a normal and necessary prerequisite to healing
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Cardinal Signs of Inflammation
4 main indications |
Redness
Warmth Swelling Pain and loss of function |
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Responses of the Inflammatory Phase
Hemostatic Phase- key points? |
Stop the bleeding!
The injured vessels initially vasoconstrict and platelets begin to seal the vessels. |
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Responses of the Inflammatory Phase
Vascular Response- key points |
Vasodilation with increased permeability for white blood cells (leukocytes) to leave the blood vessels and be attracted by chemotaxis by histamines to the wound.
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Responses of the Inflammatory Phase
4 main divisions |
Hemostatic response
Vascular Response Cellular Response Immune Response |
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Responses of the Inflammatory Phase
Cellular Response- key points |
Phagocytosis by the leukocytes to rid the area of debris
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Responses of the Inflammatory Phase
Immune Response- key points? |
Antibodies bind with bacteria and viruses to clear them from the area
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Local Edema Occurs
edema- what is it? |
Edema is an accumulation of fluid within the extravascular space and interstitial tissues
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Local Edema Occurs
edema- what is it the result of? |
Edema is the result of vasodilation, increased vascular permeability, increased capillary hydrostatic pressure, increased interstitial osmotic pressure, and an overwhelmed lymphatic system that is unable to accommodate this increase in fluid and plasma proteins
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Local Edema Occurs
edema- why painful? |
Pain results from the pressure of this edema & from irritation from chemicals released from damaged cells
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Edema
TRANSUDATE- definition? |
Transudate- The fluid that first forms edema during inflammation. It has few cells and very little protein
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Edema
EXUDATE- definition? |
Exudate- The cloudy extravascular fluid that is more viscous. It has a high content of lipids and cellular debris
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Edema
what happens when the exudate concentration increases? |
When the exudates’ concentration of leukocytes increases, it is known as pus or suppurative exudate. This fluid often harbors bacteria.
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Is inflammation good???
prostaglandin and the use of anti-inflammatory drugs... |
Steroids and nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis
Prostaglandins (PGEs) are produced by most all cells in the body and are released in response to any cell membrane damage. They facilitate the inflammatory process and increase sensitivity of pain receptors |
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Proliferation Phase of Healing
average duration and purpose? |
Days 3-20
The purpose of proliferation is to cover the wound and impart strength to the injury site and involves both epithelial cells and connective tissues. |
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Proliferation Phase of Healing
what are the 4 simultaneous processes that are occurring? |
There are 4 simultaneous processes occurring during proliferation phase to help the wound close: epithelialization, collagen production, wound contraction, and neovascularization
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Epithelialization
definition? |
Epithelialization is defined as re-establishment of the dermis.
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Epithelialization
what does it provide? |
Provides a protective barrier to prevent fluid and electrolyte loss and to decrease the risk of infection.
Burns |
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Collagen Production
what does it provide/ what is it made by |
Collagen provides tensile strength to the new covering.
Collagen is made by Fibroblasts Provides tissue strength |
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Collagen Production
where does FIBROBLAST GROWTH take place? |
Fibroblast growth takes place in connective tissue from undifferentiated cells in the area
They migrate to the injured area along fibrin strands. |
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Granulation Tissue
what is it? |
Granulation Tissue- Tissue containing newly formed capillaries, fibroblasts, and myofibroblasts starts filling in, hopefully from the bottom up.
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Granulation Tissue
what happens as the amount of granulation tissue increases? |
As the amount of granulation tissue increases, there is a concurrent decrease in the size of the fibrin clot, allowing for the formation of a more permanent support
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Proliferation Phase
Approximately what percent of tensile strength does the wound have during the proliferation phase? |
~ 15%
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Proliferation Phase
what does the cross linking of collagen molecules allow for? |
Cross linking of collagen molecules allows for early, controlled movement without disruption
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Proliferation Phase
What can lead to further inflammation and additional deposition of collagen? |
want SOME collagen to come in
if chronic inflammatory response, too much scar tissue will be laid down creating non functional/non stretchy areas on the skin. |
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Wound Contraction
what is responsible for wound contraction? |
Highly contractile myofibroblasts are responsible for wound contraction just below the epidermis
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Wound Contraction
picture frame theory... |
linear wounds with one narrow dimension contract rapidly due to ring of myofibroblasts moving inwards from the wound margin. square or rectangular wounds with no close edges progress at a moderate pace and circular wounds contract most slowly.
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Contractions
main idea |
Contractions— If wound contraction is uncontrolled or it has a huge space to cover, it can result in the formation of contractions. These are result in high resistance to passive stretch. Importance of stitching/grafts.
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Contractions
what may they result from? |
Contractions may results from fibrosis of tissues surrounding a joint, adhesions, muscle shortening, or tissue damage
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Neovascularization
main idea |
Neovascularization is the development of a new blood supply to the injured area, and occurs as a result of angiogenesis, the growth of new blood vessels
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How do I know when tissue is in the Proliferation Phase?
how will the scar appear? |
During this time frame, the scar will appear red and swollen from the increase in vascularization and fluid.
The wound is still weak and is susceptible to damage from excessive pressure or tension. |
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Maturation
what is the time frame of this phase? |
The longest phase in the healing process.
Day 9 up to 24 months. |
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Maturation
what is being balanced? what collagen type replaces earlier collagen? |
Balance of synthesis and lysis of collagen.
Type I collagen, which is strong, replaces Type III. |
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Synthesis vs. Lysis
sythesis- definition |
building up of
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Synthesis vs. Lysis
lysis- definition |
breaking down of
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Collagen
what type predominates in the MATURATION PHASE? |
Although there are >27 types of collagen, the type that predominates in the maturation phase is type 1
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Collagen
What happens if the rate of collagen production is much greater than the rate of lysis? |
can lead to the development of a hypertrophic scar
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Keloid scars
main idea? |
Genetic defect
Scarring extends beyond original wound Poor success of limiting with pressure garments, surgery or meds |
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Hypertrophic scars
where do they end up? |
Remain within the margins of the original wound
Raised |
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Hypertrophic scars
how do they respond to an oxygen deficient environment? |
Because synthesis is oxygen dependent and lysis is not, these scars respond to decreasing oxygenation through pressure garments and elastomer.
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Hypertrophic scars
as long as scar is still red, what is still occurring? |
As long as scar tissue is red, remodeling is still occurring.
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Scars
Factors that affect collagen structure |
Muscle tension
Joint movement Fascial gliding Temperature Mobilization |
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Chronic Inflammation
2 major causes... |
Can be due to persistence of the injurious agent. (cumulative trauma or infection)
Can be due to an immune response to a foreign material such as a suture or an autoimmune response such as rheumatoid arthritis. |
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Systemic Factors that affect Inflammation
4 major categories... |
Age
Disease- PVD, diabetes, etc. Medications- antibiotics, corticosteroids Nutrition- lack of protein, amino acids, vitamins, minerals |
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Cartilage
reason for its limited ability to heal? |
Limited ability to heal because it lacks lymphatics, blood vessels and nerves.
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Cartilage
how can healing be improved? |
Healing improves if sustained with a subchondral bone injury allowing formation of granulation tissue
This newly formed cartilage however is prone to degenerative changes. |
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Tendons & Ligaments
when injured, what can PROM of tendons promote? |
Studies show PROM of tendons accelerate and enhance strength of a tendon repair.
BUT active contraction at less than 3 weeks post op generally results in a poor outcome. – shoulder Intracapsular vs. extracapsular ligaments. Muscle and bone heal well and predictably. |
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Muscle
does this tissue heal well? |
Heals well secondary to good blood flow
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Muscle
when injured, what must be looked out for? |
Be careful of myositis ossificans
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Bone
does bone heal in a predictable fashion? |
Predictable healing
3 weeks to 4 months depending on specific bone and patient age |
