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Test Taking Tips

  • Questions tend to revolve around the physiology of how wounds heal, that is, secondary intention, myofibroblasts, and which cells are involved in wound healing.

  • The strength layer of bowel and skin is also commonly tested. One should also be familiar with which organs lack certain tissue layers, such as the esophagus with no serosa, and where the posterior rectus sheath starts and stops.

Name the 3 phases of wound healing:

  • Inflammation (1–6 days), proliferation (3 days–3 weeks), maturation (3 weeks–1 year)

Name several factors that can inhibit wound healing:

  • Diabetes, infection, ischemia, malnutrition, radiation, steroids, neoplasia, anemia

What are the optimal nutrition parameters?

  • Albumin >3 g/dL and prealbumin >16 mg/dL

What is primary wound closure (primary intention)?

  • Immediate closure of a wound with suture or staples

Most important factor in healing closed wounds by primary intention:

  • Tensile strength

What is the most important layer to close for strength in skin lacerations?

  • Dermis

How long does it take a surgical incision to become “watertight”?

  • 24 to 48 hours

What is secondary wound closure?

  • Leaving a wound open and allowing it to heal by granulation, contraction, and epithelialization over time

Most important factor in the healing of open wounds by secondary intention:

  • Epithelial integrity

What causes contraction in wounds healing by secondary intention?

  • Myofibroblasts

What is delayed primary closure?

  • Closing a wound several days (3–5 days) after incision

Rate of regeneration of a peripheral nerve:

  • 1 mm/d or 1 in./mo

Rate of epithelialization:

  • 1 to 2 mm/d

The strongest layer of the bowel:

  • Submucosa

The time period that a small-bowel anastomosis is at its weakest:

  • 3 to 5 days

Name the 2 major events in the process of epithelialization:

  • Migration and mitosis

Name the process by which keratinocytes pile up on top of each other at the leading edge of a migration and tumble forward over the top of the heap:

  • Epiboly

What cell is the most essential for wound healing?

  • Macrophage

This cell is responsible for the movement and contraction of wound edges:

  • Myofibroblast

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