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13 Cards in this Set
- Front
- Back
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Three phases of healing
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inflammatory response phase
repair/graulation/proliferation phase remodeling phase |
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inflammatory response phase specifics
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acute injury, up to 10 days
3 different response phases: vasucalar response - vasoconstriction followed by vasodilation hemostatic response(5 details): control blood loss blood vessels retract platelet aggregation clot formation (hematoma) tenderness, pain, loss of function cellular response - the different cells that come to respond to injury |
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repair/granulation/proliferation phase
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can go by any of those three names - tissue repair
3-20 days granulation tissue formation-scaffolding tissue repair fibroplasia- angiogenesis-blood vessel formation moist environment needed for cell migration-exibate, keep a moist wound bed wound area is revascularized - blood vessels come back in how would you know your pt is in tissue repair phase- scab, tenderness to palpation, pain with movement |
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remodeling phase
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matrix remodeling
3 weeks - months - 1 year can last a long time and is highly variable collagen coversion wound contraction scar formation |
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causes of inflammation
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anything that causes damage
diminished blood suppy - can be caused by a vascular disease/diabetes - blood supply doesn't get to area so it can't heal trauma fracture foreign bodies bacteria diminished blood supply auto-immune disorder (chronic disease) |
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signs & symptoms of acute inflammation
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redness (rubor)
swelling (edema) - visual, or special measuring tapes to track swelling heat pain - 0-10 scale loss of function |
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collagen conversion (step 1 in remodeling phase - last phase of healing)
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collagen conversion from type 3 to type 1
type 3 is formed 2-14 days from repair(during repair phase), then converted to type 1 (which is stronger) could take up to a year to be complete --collagn fibers align to a pos. of max efficiency parallel to lines of tension -- therefore we can influence this and this makes getting a pt up and moving and working important --ongoing processes tensile max strength at maturity is always <=80% of normal collagen -- so it is imp. to know of previous injuries to get a true sense of where pt strength is oxygen is required for collagen cross-linking -- this becomes imp. in pt who smoke or have a chronic oxygen defiet disease |
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wound contraction (step 2 in remodeling phase - last phase of healing)
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wound contraction - closure - myofibroblasts(orchestrate the whole contracture)
a great time for interventions (heat, cold, ultrasounds, etc) -full thickness wounds may contract 40% and show more scarring than partial thickness wounds --a good time to promote well developed scar tissue, line up scar tissues more parallel versus criss-crossed tissue skin growth occurs from bottom of wound up, and from sides in to the wound center smaller the wound the quicker the healing |
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scar formation (step 3 in remodeling phase - last phase of healing)
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4 stages:
1) initial scar forms - 2-4 days post injury with type 3 collagen. no remodeling b/ it is painful, swollen and too fragile 2) 5-21 days - repair and remodeling (best time for interventions - heat stretch, positioning, massage, mobilizations) - stimulate scar remodeling 3) 21-60 days - consolidation - dec. remodeling more fibrous, increased tensile strength 4) 60-360 days - scar maturation; rel. unresponsive to treatment(very little you can do -- you want to address the problem in stage 2 and 3) *the older a scar gets, the stronger the collagen the stronger the collagen, the harder it is to manipulate |
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hypertrophic scarring
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abnormal scar formation
the balance is off between fibroblastic and fibroclastic activity thickened but does not exceed wound bed boundaries, overproduction of TGF-beta |
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keloid scarring
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abnormal scar formation
the balance is off between fibroblastic and fibroclastic activity scar does exceed wound bed boundaries - excesses in hyalaronic acid which stim. fibroplasia pt is more likely to have this if they have other ones like it |
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local factors influencing healing
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-type, size, location of injury
distal takes longer -infection, retained foreign body -vascular supply -movement/immobilization, pressure (bed sores) blood supply is lessened, movement influences it by getting blood to injury -temp deviation -topical meds -physical agents |
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systemic factors influencing healing (know these)
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age
metabolic disorders - ex. diabetes infection - ex. MERSA medication immobilization nutrition - ex. a can of soup a day in elderly (aka poor nut) hormones - ex. thyroid can effect fever oxygen |
