Wound Healing
| A | Thin continuous epithelial cover appears | |
| B |
Fibroblasts lay down collagen fiber |
|
| C |
Granulation tissue fills the wound |
|
| D |
Neutrophils line the wound edge |
Which occurs first in wound healing –
| A |
Thin continuous epithelial cover appears |
|
| B |
Fibroblasts lay down collagen fiber |
|
| C |
Granulation tissue fills the wound |
|
| D |
Neutrophils line the wound edge |
Ans. is ‘d’ i.e., Neutrophils line the wound edge
Wound healing is the summation of following processes except –
| A |
Coagulation |
|
| B |
Matrix synthesis |
|
| C |
Angiogenesis |
|
| D |
Fibrolysis |
Ans. is ‘d’ i.e., Fibrolysis
Wound healing is affected by:
| A |
Age |
|
| B |
Nutrition |
|
| C |
Dryness or wetness of wound |
|
| D |
a and b |
Ans. is ‘ a ‘ , ‘ b ‘
|
Factors that adversely affect wound healing |
|
• Local |
|
• Abnormal blood supply (ischemia due to arterial disease or impaired venous drainage, e.g. |
|
arteriosclerosis, varicose veins) |
|
• Infection |
|
• Presence of foreign material, necrotic tissue or excessive blood (hematoma) |
|
• Movement in injured area |
|
• Tension in injured area |
|
• Irradiation (decreases the viability of cells) |
|
• Denervation |
|
• Systemic |
|
• Advanced age |
|
• Failure of collagen synthesis d/t |
|
– vitamin C deficiency |
|
– protein deficiency |
|
– zinc deficiency |
|
– Ehlers-Danlos syndrome (disorder characterized by defective collagen formation, |
|
hyperextensible joints, fragile tissues and impaired wound healing) |
|
• Diabetes mellitus |
|
• Corticosteroid excess (administration of exogenous corticosteroids or Cushing’s syndrome) |
|
• Malnutrition |
|
• Anemia |
|
• Obesity |
|
• Drugs (steroids, cytotoxic medication, intensive antibiotic therapy) |
|
• Genetic disorders (osteogenesis imperfecta, Ehler-Danlos syndrome, Marfan syndrome) |
|
• Systemic infection |
|
• Malignant disease |
|
• Temperature |
|
• Trauma, hypovolemia and hypoxia |
|
• Uremia |
|
• Bleeding disorder |
| A | Zinc | |
| B |
Copper |
|
| C |
Vitamin C |
|
| D |
None |
Ans. is ‘None’
Delayed wound healing is seen in all except‑
| A |
Malignancy |
|
| B |
Hypertension |
|
| C |
Diabetes |
|
| D |
Infection |
Ans. is ‘b’ i.e., Hypertension
The Vitamin which has inhibitory effect on wound healing is –
| A |
Vitamin -A |
|
| B |
Vitamin – E |
|
| C |
Vitamin -C |
|
| D |
Vitamin B-complex |
Ans. is ‘b’ i.e., Vitamin-E.
- Systemic vitamin E and glucocorticoids inhibit the inflammatory response and collagen synthesis, thereby possibly impeding the healing process.
| A |
Selenium |
|
| B |
Copper |
|
| C |
Zinc |
|
| D |
Iron |
Ans. C: Zinc
Symptoms of Zinc Deficiency
- Poor Immune system
- Weight loss
- Intercurrent infections
- Hypogonadism in males
- Lack of sexual development in females
- Growth retardation
- Dwarfism
- Delayed puberty in adolescents
- Rough skin
- Poor appetite
- Mental lethargy
- Delayed wound healing
- Short stature
- Diarrhea
Congenital abnormalities causing zinc deficiency may lead to a disease called acrodermatitis enteropathica.
March 2013 (a, e, f)
| A | Malignancy | |
| B |
Diabetes |
|
| C |
Hypertension |
|
| D |
Infection |
Ans. C i.e. Hypertension
Wounds & tissue repair
Healing by primary/ 1st intention:
– Closed wounds,
– Edges approximated
– e.g. clean skin incision closed with sutures
Factors delaying wound healing:
– Vitamin C deficiency,
– Presence of vitamin E (inhibitory role),
– Deficiency of trace metals (zinc, copper etc.),
– Absence of oxygen (reduced perfusion),
– Anemia,
– Infection etc.
| A | Vitamin C | |
| B |
Vitamin D |
|
| C |
Vitamin A |
|
| D |
Niacin |
- Vitamin C is required for collagen synthesis.
- Due to its important role in collagen synthesis, vitamin C is required for adequate wound healing.
| A |
Wound is clean |
|
| B |
Scanty granulation tissue |
|
| C |
Sutures are not used |
|
| D |
Outcome is neat linear scar |
Ans:C.)Sutures are not used
Image shows:’A’:Healing by primary intention,’B’:Healing by secondary intention.
False about wound healing ‑
| A |
Inhibited by infection |
|
| B |
Inhibited by DM |
|
| C |
Inhibited by hematoma |
|
| D |
Inhibited by foreign body |
Ans. is ‘c’ i.e., Inhibited by hematoma
Factors causing impairment of wound healing
A. Systemic factors
- Poor nutrition (protein deficiency, vitamin C deficiency).
- Metabolic abnormalities (Diabetes mellitus).
- Poor circulatory status (Inadequate blood supply).
- Hormones, e.g. glucocorticoids.
B. Local factors
- Infection is the single most important factor.
- Mechanical factors, e.g. early mobilization.
- Foreign bodies (unnecessary sutures, fragments of steel or glass).
- Wound in poorly vacularized area, e.g. foot.
| A | Frenkel white line | |
| B |
Wimberger sign |
|
| C |
Pelken Spur |
|
| D |
Bowing of legs |
Ans:B.)Wimberger sign
The patient in question is suffering from Scurvy
SCURVY
• Scurvy: first disease identified due to dietary deficiency.
• Primary metabolic bone disorder in scurvy is decreased osteoid matrix formation.
Clinical features
- Swollen gums which bleed easily
- Perifollicular and petechial hemorrhages
- Ecchymoses, Hemarthrosis
- GI bleeding
- Anemia
- Poor wound healing
- Coiled hairs
- Bowing of legs
- Pseudoparalysis.
- Hyperkeratosis
Radiological features
- Most commonly around knee
- Pencil thin cortex
- Trummer field zone(metaphyseal lucency)
- Frenkel white line
- Pelkan spur(lateral extension of white line)
- Wimberger sign(ringed epiphysis): Definitive sign.
- Zone of rarefaction below white line
- Cortical spur
- Epiphyseal separation
- Metaphyseal porosis
- Metaphyseal infarction
- Metaphyseal calcification
