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Wound healing phase characterized by PMN�s and macrophages, lasting day 1-10 post-insult
Inflammation
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Wound healing phase characterized by fibroblasts, collagen production, and granulation tissue, lasting 5days-3weeks post-insult
Proliferation phase
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Wound healing phase characterized by replacement of type III with type I collagen
Remodeling
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Order of cell arrival in wound (5 total)
- Platelets
- PMNs
- Macrophages
- Fibroblasts
- Lymphocytes
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Cells essential for wound healing, that release growth factors and cytokines
Macrophages
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Cells that replace fibronectin with collagen
Fibroblasts
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Material that acts as chemotactic for macrophages and anchors fibroblasts
Fibronectin
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Predominant cell type in wound on day 0-2
PMNs
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Predominant cell type in wound on day 3-4
Macrophages
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Predominant cell type in wound on day 5+
Macrophages
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Platelets + fibrin
Platelet plug
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Platelets + fibrin + fibronectin
Provisional matrix
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Platelet granules that cause aggregation
Platelet factor 4
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Platelet granules that bind thrombin
Beta-thrombomodulin
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Platelet chemoattractant
PDGF
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Platelet aggregation factors (3)
TXA2, thrombin, platelet factor 4
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Vasodilators released from platelets (2)
PGE2 and PGI1
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Most important factor in healing open wounds
Epithelial integrity
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Most important factor in healing cloased incisions
Tensile strength
-
Strength layer of bowel
Submucosa
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Weakest time point for small bowel anastamosis
3-5 days
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cells involved in wound contraction and healing by secondary intention
myofibroblasts
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most common type of collagen; skin, bone and tendons
type I
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collagen type found in basement membranes
type IV
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collagen type increased in healing wounds, blood vessels and skin
type III
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collagen type found in cartilate
type II
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co-factors required for hydroxylation and cross-linking of protein and collagen formation (4)
alpha-ketoglutarate, vitamin C, oxygen, and iron
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point where a wound reaches maximal tensile strength
8 weeks
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point where a wound is at 80% of final strength and 60% of original strength
6 weeks
-
drug that inhibits collagen cross-linking
d-penicillamine
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point in wound healing where type III collagen is replaced by type I
3 weeks
-
essentials for wound healing (4)
moisture, oxygen, no edema, no necrotic tissue
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impediments to wound healing (7)
bacteria >10^5, devitalized tissue, foreign bodies, cytotoxic drugs, diabetes, low albumin, steroids
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counteracts effects of steroids on wound healing
Vitamin A
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Cytotoxic drugs that impair wound healing (4)
5FU, methotrexate, cyclosporine, FK-506
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disorder with a type I collagen defect
osteogenesis imperfecta
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collagen disorders creating hyperelastic defects
Ehlers-Danlos syndrome
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Disorder in fibrillin collagen creation
Marfans
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Disorder of excess fibroblast production
Epidermolysis bullosa
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Treatment of epidermolysis bullosa
Phenytoin
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Cause of 90% of leg ulcers
Venous insufficiency
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Predominant makeup of scar tissue (3)
Proteoglycans, hyaluronic acid, water
-
Tissue type containing no blood vessels
Cartilage
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Wound healing disorder where collagen goes beyond the original scar
Keloid
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Treatment of keloids
XRT, steroids, silicone, pressure garments
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Wound healing disorder where collagen stays within the confines of the scar
Hypertrophic scar tissue
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Treatment of hypertrophic scar tissue
Steroids, silicone, pressure garments
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