Factors Affecting Surgical Infections and Wound Healing, Exams of General Surgery

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Surgical Principles Final Exam The potential for postoperative infection depends on all of the following except: a) Pathogeniciy of the bacteria b) ≤ 10^5 bacteria c) Immune status of the patient d) > 10^6 bacteria e) Number of bacteria - d) > 10^6 bacteria Which of the following factors is the most important regarding the potential for development of a post surgical infection? a) Antibiotic prophylaxis b) Operating room design c) Virulence and quantity of bacterial inoculum d) Size of wound e) Length of time of the surgical procedure - c) Virulence and quantity of bacterial inoculum Surgical infections depend of all the following factors except: a) The type of bacteria in the wound b) Operating room temperature c) Bacterial virulence d) Number of bacteria in the wound e) Patient resistance - e) Patient resistance The number and virulence of bacterial contaminants are important when considering: a) Systemic prophylaxis b) Topical prophylaxis c) How long surgery should take d) Development of infection e) Treating a patient's immune system - d) Development of infection An acceptable post-operative infection rate goal should average: a) 5-10% b) 10-15% c) 15-20% d) <2% e) None of the above - d) <2% Practically and realistically, the goal of a veterinary surgeon is to aim for an infection rate less than: a) 1-2% b) 3-11% c) 10-17% d) 27-40% e) varies widely - a) 1-2% All of the following are techniques to reduce the surgical infection rate EXCEPT: a) Treat remote infections perioperatively b) Minimize the hospital stay c) Handle tissues as if they were your own d) Shave the wound the night before the surgical procedure e) Debride completely - d) Shave the wound the night before the surgical procedure Surgical infection is reduced by which one of the following: a) Adding epinephrine to local anesthetics b) Evacuating hematomas c) Calming incisional wound edges with hemostats d) Selecting braided suture material for wound closure e) Shaving the wound - b) Evacuating hematomas Which of the following is an example of good surgical technique used to reduce infection? a) Shave the surgical site 24 hours in advance of scheduled surgery b) Admit the surgery patient 24-48 hours ahead to allow for acclimatization c) Use a drug like epinephrine to reduce skin bleeding d) A closed suction drain for evacuation of hematomas and seromas e) Braided suture is preferred because it is stronger - d) A closed suction drain for evacuation of hematomas and seromas Removing a hematoma/seroma from the wound a) Can reduce the chance of a post operative infection b) Will have no benefits in surgical wounds c) Is rarely used in large animal surgery d) Always contributes to infection e) Is used in the management of refined, clean wounds - a) Can reduce the chance of a post-operative infection All of the following are useful in reducing surgical infections EXCEPT: a) Minimize post operative hospital stay b) Minimize the use of local anesthetics containing epinephrine c) Minimize irrigation to the surgical wound d) Minimize the number of sutures used in the wound e) Minimize the operative time - c) Minimize irrigation to the surgical wound Wound classification terminology, based on the probability of bacterial contamination, includes all of the following except: a) Exceptionally clean a) Clean/contaminated wounds b) Clean wounds with implant placement c) Diabetes d) Geriatric patient e) Refined clean wounds - e) Refined clean wounds Systemic prophylaxis should be administered: 0.5 to 1 hour before surgery. You would likely recommend the use of systemic prophylactic antibiotics in all the following situations EXCEPT: a) A young patient b) Refined cleaned wound c) Diabetic patient d) Clean-contaminated wound e) Patient with remote infection present - b) Refined cleaned wound Systemic prophylaxis includes all of the following EXCEPT: a) IM antibiotics 60 min before planned surgery b) IV antibiotics 30 min before planned surgery c) IM or IV antibiotics one hour after beginning surgery d) Additional doses during procedures > 3 hours e) Discontinue Antibiotics within 24 hours of the surgery - c) IM or IV antibiotics one hour after beginning surgery Systemic prophylaxis should be administered at what time to be effective? a) Intravenously at the time of catheter placement b) Anytime around the start of surgery c) Orally the morning of surgery d) SubQ 3 hours before surgery e) When the skin incision is made - a) Intravenously at the time of catheter placement Reducing bacterial adherence: a) Disadvantage of using topical antibiotics b) A disadvantage of using systemic antibiotics c) An advantage of using topical antibiotics d) An advantage of using systemic antibiotics e) An advantage of using both systemic and topical antibiotic - c) An advantage of using topical antibiotics You have chosen to use topical antibiotics prophylaxis: which of the following statements describes the recommended technique? a) It varies with the antibiotic chosen b) Whenever you think about it during sx c) Every 10-20 miin during surgical procedure d) Depends on the procedure being done e) Frequently, esp as you open each tissue plane - e) Frequently, esp as you open each tissue plane Wound infections are commonly caused by all of the following organisms EXCEPT: a) Staphylococcus aureus b) Staphylococcus epidermis c) Pseudomonas aeruginosa d) Peprosteptococcus oralis e) Proteus mirabilis - b) Staphylococcus epidermis Diagnosis of wound infection can be made with the finding of: a) A dry appearance of a wound b) Swelling one day post-op c) An intact suture line d) Cool feeling around wound e) Exudation - e) Exudation A postoperative wound infection reveals an exudate with a sweet musky smell. While awaiting culture comfirmation you believe its most likely: a) E. coli b) Bacteroides fragilis c) Pseudomonas aeruginosa d) Staphylococcus epidermis e) Streptococcus faecalis - c) Pseudomonas aeruginosa A green-blue exudate in a wound subjectively supports an infection caused by: a) E. coli b) Staphylococcus c) Pseudomonas d) Anerobes infection e) Streptococcus - c) Pseudomonas Anaerobic bacteria have a characteristic: a) Foul smelling bacteria b) Green-blue exudate c) Thick and purulent exudate d) Watery exudate - a) Foul smelling bacteria Characteristics of surgical wound exudates can aid in the diagnosis of a wound infection with all of the following bacteria EXCEPT: a) Bacillus spp b) E.coli c) Staphylococcus d) Pseudomonas e) Anaerobic bacteria - a) Bacillus spp (E.coli: fecal smell, serous to purulent exudate Staphylococcus: thick, purulent exudate Pseudomonas: Green-blue exudate Anaerobic bacteria: foul smelling, possible gas, sulfur granules) What is the goal of cryosurgery? - Destruction of tissue The phenomenon of large crystal formation is termed: - Recrystallization The term that best describes the process of conversion of small crystals into large crystals during cryosurgery: a) Reformation b) Rectification c) Recrement d) Reconstitution e) Recrystallization - e) Recrystallization The following clinical problems could be targeted for treatment using cryosurgery EXCEPT: a) Anorectal fistulas b) Dermatological lesions c) Ophthalmic lesions involving conjunctiva d) Osteosarcoma e) Oral squamous cell carcinoma - d) Osteosarcoma (cells have low H20 content) The following can be managed using cryosurgery except: a) Anorectal tumors b) Oral tumors c) Bone tumors d) Skin tumors e) Ophthalmologic tumors - c) Bone tumors Which of the following agents is the preferred cryogen? a) Dry ice b) Nitrous oxide c) Liquid nitrogen d) Freon e) H20 in a gaseous state - c) Liquid nitrogen Regarding cryosurgery, all of the following are correct EXCEPT: a) Recrystallization occurs b) Used for dermatological lesions c) Direct injury to the tissue d) Destroys tissue d) Delayed wound healing e) Operating room fires - a) Decreased rate of wound infection A chemical for cauterizing small vessels is: a) Silver nitriate b) Ferrous sulfite c) Sodium subsulfate d) HCL e) None of the above - a) Silver nitriate Which of the following is NOT important for skin graft survival? a) Age & breed of the animal b) Plasmatic imbibition c) Inosculation d) Vascular ingrowth of vessels e) Health of the recipient wound bed surface - a) Age & breed of the animal From where do axial pattern flaps derive their blood supply? - A direct cutaneous artery and vein Which axial pattern flap would be best to use to close a wound on the caudal aspect of the thigh? - Caudal superficial epigastric What axial pattern flap would would work best for a skin defect on the upper thigh? - Caudal superficial epigastric Which axial pattern flap is like doing a mastectomy? - Caudal superficial epigastric Which of the following concerning axial pattern flaps is INCORRECT? a) Axial pattern flaps are typically named after the origin of their blood supply b) A caudal superficial epigastric axial pattern flap includes the last 3 or 4 mammary glands in the dog. c) A reverse saphenous conduit flap gets its name due to the 180 degree transposition of the flap to cover defects below the hock d) Drains & bandages may be required post-op to prevent possible seroma complications e) A flank fold flap takes advantage of the loose extra skin in the fold of skin cranial to the thigh - c) A reverse saphenous conduit flap gets its name due to the 180 degree transposition of the flap to cover defects below the hock Which two types of reconstructive technique could you use to close a wound over the metatarsal bones of a Labrador? - Reverse medial saphenous axial pattern flap/Free skin graft What is the most commonly used type of free skin graft? - Mesh Which of the following concerning free skin grafts is incorrect? a) Graft failure due to seroma/hematoma formation can be reduced by using "mesh" grafts b) Graft motion is a major risk factor for graft failure as it impairs graft revascularization c) Recipient bed infections can contribute to graft failure so careful preparation of the site to be grafted is critical. d) Full thickness grafts are used rather than split thickness grafts because they take more readily e) Free skin grafts are most frequently used for wounds at distant sites. - d) Full thickness grafts are used rather than split thickness grafts because they take more readily Which of the following concerning free skin grafts is CORRECT? a) Free graft failure due to seroma/hematoma formation can be reduced by using mesh grafts b) Free skin grafts are transposed into wounds that are adjacent to the donor site c) Free skin grafts contain the subdermal plexus d) Punch grafts are the easiest and therefore most commonly used type of free skin graft e) Ingrowth of new vessels occurs first in the process of free graft survival - a) Free graft failure due to seroma/hematoma formation can be reduced by using mesh grafts The blood supply from free skin grafts comes from: - Plasmatic imbibition, inoculation, and ingrowth of new vessels (in that order) Which of the following concerning skin flaps and axial pattern flaps is FALSE? a) For skin flaps, the skin should always be undermined in the fascial plane beneath the cutaneous musculature to preserve the integrity of the subdermal plexus b) A caudal superficial epigastric axial pattern flap includes the last 3 or 4 mammary glands in the dog c) During creation of a reverse saphenous conduit flap, division of vascular connections to the femoral artery and vein result in reversal of blood flow which is maintained by distal anastomotic connections to plantar vessels d) Drains are avoided with skin flaps as they reportedly increase the complication rate (drains are placed as needed to control dead space and ↓ seroma formation) e) A flank fold flap is made up of thin, elastic skin that can conform readily - d) Drains are avoided with skin flaps as they reportedly increase the complication rate (drains are placed as needed to control dead space and ↓ seroma formation) T/F: Skin grafts require protection with bandages and even splints that should stay on for the first 3 days after surgery without changing - True Though shock results from multiple causes, what is the common feature of all forms of shock? - Tissue hypoxia A common clinical feature of the response to all forms of shock is: a) Fever b) Anemia c) Tachycardia d) Rapid CRT e) Pale mucous membranes - c) Tachycardia What is the fastest physiologic response to increase cardiac output in the face of shock? a) Increase respiratory rate b) Erythropoesis c) Tachycardia d) Anti-diuretic hormone release e) Increase thirst - c) Tachycardia Which of the following does NOT lead to an increase in cardiac output? a) Increased respiratory rate b) Splenic contraction in dogs c) Tachycardia d) Anti-diuretic hormone e) Fluid resuscitation - a) Increased respiratory rate Increasing heart rate is an effective mechanism to acutely increase cardiac output and oxygen delivery. Identify one "cost" of prolonged increases in the heart rate. a) Decreased coronary perfusion b) Increased glucose consumption c) Pulmonary edema d) Decreased blood pressure e) Prolongation of diastole - a) Decreased coronary perfusion Carotid body chemoreceptors are important in sensing: a) Hypotension b) Hypernatremia c) Acidosis d) Hypertension e) Hyperthermia - c) Acidosis In the clinical presentation of severe sepsis, which species is most likely to be bradycardic, hypoglycemic and hypothermic? - Cats The difference between cats & dogs in their typical response to sepsis is: a) Cats have late hyperglycemia b) Cats are tachypnea c) Cats develop acidosis d) Cats are bradycardic e) Cats bite - d) Cats are bradycardic The classic presentation of septic shock in a cat includes which of the following: a) Tachycardia, pale MMs, hyperglycemia b) Tachypnea, hypothermia, tachycardia Regarding fluid administration in shock, in which form of shock are fluids potentially contraindicated? - Cardiogenic shock What would represent an "endpoint of resuscitation" (when you know you have bolused sufficient fluid to restore perfusion)? - Normalization of heart rate Regarding fluid administration in shock, a difference between cats & dogs is: a) Dogs have a bigger spleen and therefore need more fluid b) Cats have a lower PCV than dogs and therefore blood is always the first choice for resuscitation c) Dogs are more prone to trauma and therefore require hypertonic saline d) Cats are more likely to have asthma, therefore Hetastarch should be avoided d) Cats are more susceptible to fluid overload and therefore resuscitation volumes should be lower than in dogs. - d) Cats are more susceptible to fluid overload and therefore resuscitation volumes should be lower than in dogs. Fluid administration for shock in cats requires _______ volumes than in dogs. - lower Regarding fluid administration in shock, which type of fluids are potentially contraindicated? a) Blood b) Balanced electrolyte solution c) 5% dextrose d) Hypertonic saline e) Hetastarch - c) 5% dextrose A reduction in oxygen at the cellular level leads to all of the following EXCEPT: a) Anaerobic metabolism b) Altered gene expression c) Lactic acid accumulation d) Mitosis e) Reduction in ATP - d) Mitosis What are the two main determinants of O2 delivery? a. Stroke volume and systemic vascular resistance b. Cardiac output and total oxygen content c. Heart rate and stroke volume d. Cardiac output and hemoglobin saturation e. Heart rate and stroke volume - d. Cardiac output and hemoglobin saturation A 12 week old male dog is admitted on an emergency basis with a 2 day history of vomiting and bloody diarrhea. On physical examination, his rectal temperature is 98F, his MM are pale pink and tacky, his CRT is 4 seconds, his heart rate is 180, no murmurs or arrhythmias are asculted, his extremities are cold and his pulses are weak, he has a slightly increased RR at 50 per minute, but normal effort and no abnormalities are ausculted in his lungs. 1. Based on this initial triage exam and clinical history, you believe that this dog is suffering from which form of shock? a. Hypovolemic shock b. Cardiogenic shock c. Distributive shock d. Hypoxic shock e. Not enough information 2. In the puppy above, you would expect the venous lactate concentration to be: a. Normal b. Low c. Elevated d. Lactate would not give any additional information. e. None of the above - a. Hypovolemic shockc. Elevated Laser light is different from typical room lighting because laser light is: a. Coherent, nondivergent, multichromatic b. Incoherent, non-divergent, multichromatic c. Coherent, monochromatic, nondivergent d. Monochromatic, divergent, incoherent e. Multichromatic, divergent, incoherent - c. Coherent, monochromatic, nondivergent Which statement is INCORRECT? a. Equine laparoscopy can be performed in the standing or recumbent animal b. Bipolar cautery can be dangerous when used during laparoscopy in the standing, sedated horse c. The cannulas have a diaphragm that maintains an airtight seal while the instrument passes through the cannula d. Cannulas are different diameters and lengths for different size instruments and different body wall thickness e. Laparoscopic cryptorchidectomy has less potential complications than standard cryptorchidectomy - b. Bipolar cautery can be dangerous when used during laparoscopy in the standing, sedated horse If you want to use a laser to ablade neoplasia deep to clear fluid (therefore transmit through the fluid), what characteristic of the laser is most critical to having the energy absorbed just by the neoplastic laser? a. Power of the laser b. The wavelength of the laser c. The spot size of the laser d. The energy density e. Distance of tissue from the laser fiber - b. The wavelength of the laser Laparoscopic portals typically require different types of trocars and cannulas, but they all must have which components in common? a. A sharp trocar tip point to enter the abdomen and a flip valve to maintain insufflation b. A diaphragm to accommodate a single instrument size and a blunt tipped trocar tip c. A blunt cannula and trocar with a retracting blade to protect viscera d. A diaphragm that will maintain insufflation when the instrument is out e. A valve that is manually opened and closed and a blunt tipped, sharp sided trocar blade - d. A diaphragm that will maintain insufflation when the instrument is out Which statement about equine laparoscopic surgery is true? a. It is typically less expensive that conventional surgery because equipment costs are less b. It is always better for the patient because it requires only small skin incisions c. Laparoscopic cryptorchidectomy can be performed in either standing or recumbent anesthetized horses d. Gastrointestinal laparoscopic surgery is the most common laparoscopic surgery e. Hemostasis cannot be performed with cautery instruments in the standing awake horse - c. Laparoscopic cryptorchidectomy can be performed in either standing or recumbent anesthetized horses Which statement is true? a. Most standard surgical instrumentation is used for laparoscopy b. Equine laparoscopy can be performed in horses under general anesthesia but insufflation causes too much discomfort to perform in the standing horse c. No other training is required for minimally invasive surgery since the incisions are smaller d. Electrocautery can be used during equine laparoscopy e. Pneumoperitoneum is created for laparoscopy with helium - d. Electrocautery can be used during equine laparoscopy Laser is an acronym for: a. Light amplification by the stimulated emission of radiation b. Light attenuated to the simultaneous emitted radiation c. Light action by simultaneous emulsified radioactivity d. Light action to synchronous emission of radioactivity e. Light amplified to synchronous emission of radiation - a. Light amplification by the stimulated emission of radiation Procedures commonly performed in the horse via laparoscopy include a. Ovariectomy, gastropexy, nephrectomy b. Cryptorchidectomy, inguinal hernia repair, adhesiolysis c. Colotomy, nephrosplenic ablation, ovariectomy d. Osteotomy, cryptorchidectomy, nephrectomy e. Cystotomy, ileostomy, splenic resection - b. Cryptorchidectomy, inguinal hernia repair, adhesiolysis Which statement about equine laparoscopy is TRUE a. Better visualization is achieved in the recumbent animal b. Hemostasis without collateral damage can only be achieved with bipolar cautery c. The cannulas have a diaphragm that maintains an airtight seal while the instrument passes through the cannula a. In dogs and cats, the hypodermis is made of two distinct layers (a superficial fat and a deeper muscular layer) b. The middle and superficial plexus lie within the dermis c. Capillary loops of the subpapillary/superficial plexus are better developed in pigs and humans than in dogs and cats d. the hypodermis is considered the deepest layer of skin but does not contribute significantly to skin function e. In areas of the body, where the panniculus is present, the surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus - d. the hypodermis is considered the deepest layer of skin but does not contribute significantly to skin function Which one of the following statements is INCORRECT regarding the inflammatory/debridement phase of wound repair a. Occurs after granulation tissue has filled the wound bed b. Corresponds to the lag phase of wound repair c. Macrophages, platelets, mast cells and eosinophils are all cells that migrate into the wound bed during this phase and secrete substances which promote later angiogenesis during the repair process d. Vasodilation follows initial vasoconstriction during the vascular phase e. Macrophages play a central role in mediating cellular and biochemical responses in wound - a. Occurs after granulation tissue has filled the wound bed Which one of the following is INCORRECT regarding angiogenesis during wound repair? a. The earliest phase involves endothelial cell migration rather than cell division b. Is initially stimulated by low oxygen tension c. Occurs in the epithelial layer d. Is stimulated by a variety of cytokines including basic FGF and VEG-F e. Capillary loops are initially open but are replaced by closed arcades - c. Occurs in the epithelial layer With regard to wound debridement, which one of the following is incorrect? a. Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin b. One benefit of biosurgical debridement is that it does not require any special conditions for efficacy c. Autolytic wound debridement is accomplished by providing a moist wound environment which allows wound fluid to remain in contact with the wound d. A significant distadvantage of mechanical (bandage) debridement is that it traumatizes healthy tissue (non-selective) e. The use of a scalpel is preferred to scissors during surgical debridement - b. One benefit of biosurgical debridement is that it does not require any special conditions for efficacy All of the following except one are important surgical principles used to avoid impaired wound repair. Select the incorrect action/technique. When debriding a wound: a. Perform a throrough debridement and remove all foreign material b. Be meticulous with hemostasis to avoid hematoma and sarcoma formation c. Flushing with antiseptics may be used as a substitute for thorough debridement of the wound d. Minimize tension (mechanical stress) on wound edges e. Minimize dead space - c. Flushing with antiseptics may be used as a substitute for thorough debridement of the wound With respect to hypodermis and cutaneous circulation, which of the following statements is true? a. The cutaneous circulation in the dog is identical to that found in people b. The middle and superficial plexus lie within the epidermis c. Capillary loops of the subpapillary/superficial plexus are better developed in cats and dogs compared to primates and pigs d. The hypodermis is considered the deepest layer of skin but does not contribute significantly to skin function e. In areas of the body where panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus - e. In areas of the body where panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus Identify the TRUE statement regarding the inflammatory/debridement phase of wound repair: a. Occurs after granulation tissue has filled the wound bed b. Macrophages play a central role in mediating cellular and biochemical responses in wound repair c. Corresponds to the log phase of wound repair because of the significant increase in wound strength attained during this phase d. Vasoconstriction follows initial vasodilation during the vascular phase e. None of the above - b. Macrophages play a central role in mediating cellular and biochemical responses in wound repair Which of the following statements regarding granulation tissue is FALSE? a. It protects the wound bed (provides coverage) b. It provides a barrier for infection c. It typically begins to appear 3-5 days post wounding d. It appears a thin, pale tan tissue in the wound e. It provides a scaffold for epithelial cell (keratinocyte) migration - d. It appears a thin, pale tan tissue in the wound Which of the following is FALSE regarding epithelialization of wounds? a. In partial thickness wounds, re-epithelialization may occur from both the wound edges as well from existing epidermal appendages b. Re-epithelialization is dependent on contraction c. Epithelialization may occur along suture tracks with subsequent keratinization (this may incite an inflammatory reaction at suture sites d. Keratinocyte migration ceases due to contact inhibition (when the migrating epithelial edges from each side of the wound meet) e. Re-epithelialization may be incomplete in large wounds - b. Re-epithelialization is dependent on contraction Which of the following is TRUE regarding the development of wound healing complications? a. Any degree of contamination with microorganisms will lead the development of a chronic wound b. Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management c. Wound contraction never leads to contracture. The elastic nature of skin prevents contraction from limiting joint movements or body orifice opening d. Geriatric patients and young puppies are equally susceptible to wound healing complications e. Bandages and splints should always be avoided due to the concern that they may compromise vascular supply - b. Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management With regard to wound debridement, which of the following is FALSE? a. Autolytic wound debridement is accomplished by providing a moist wound environment, which allows wound fluid containing endogenous enzymes and growth factors to remain in contact with the wound b. An advantage of biosurgical debridement (medicinal maggot application) is that when used appropriately it is capable of both removing necrotic tissue and stimulating granulation tissue formation c. The use of scissors is preferred to scalpel during surgical debridement d. Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin e. A significant disadvantage of mechanical (bandage) debridement is that it traumatizes healthy tissue (is non-selective) - c. The use of scissors is preferred to scalpel during surgical debridement With respect to the hypodermis and cutaneous circulation, which of the following statements is correct? a. The cutaneous circulation in the dog is identical to that found in people b. The middle and superficial plexus lie within the epidermis c. Capillary loops of the subpapillary/superficial plexus are better developed in dogs and cats compared to primates and pigs d. The hypodermis is considered the deepest layer of skin but does not contribute substantially to skin function e. In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus - e. In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus Identify the CORRECT statement regarding the inflammatory/debridement phase of wound repair a. Occurs after granulation tissue has filled the wound bed b. Macrophages play a central role in mediating cellular and biochemical responses in wound repair c. Corresponds to the lag phase of wound repair because of the significant increase in wound strength attained during this phase d. Vasoconstriction follows initial vasodilation during the vascular phase e. None of the above - b. Macrophages play a central role in mediating cellular and biochemical responses in wound repair Which of the following statements regarding granulation tissue is INCORRECT? a. It protects the wound bed (provides coverage) b. It provides a barrier for infection c. Healthy granulation tissue appears as a thin, pale tan tissue in the wound d. It provides a scaffold for epithelial cell (keratinocyte) migration e. It typically begins to appear approximately 3-5 days post wounding -