Principle of Body Function

FMS 3 -2020

Week 5: Cell Injury - Acute and Chronic Inflammation

Student Case
Tutorial 1
Page 1
Lucky is a 28 years old forest worker in east Kalimantan. Three days ago he was falling a tree
when a dead branch fell off and struck his right thigh causing a deep penetrating wound. He
was taken to the local company clinic where some wood fragments were moved. Two sutures
were used to close the skin and he was placed on amoxicillin 500 mg 4 x daily and
acetaminophen 500 mg 3x/day.
He arrives at Siloam hospital after coming to Jakarta by company boat.
On examination, his BP is 120 / 80 mmHg. Pulse 80 times/minute and temperature 380C. His
right thigh is swollen, tender, red and warm. He is generally otherwise normal

What are Mr. Lucky's problems? 

What mechanisms can explain the findings?

What are the stages of the inflammatory response to injury?

Tutorial 1
Page 2
A decision is made to admit him to the hospital and continue the antibiotics and analgesics
for another 4 days. Re-examination at that time showed the wound looking much
better. Although it was still tender, the redness had improved and the thigh was less tender.
He was afebrile. The sutures were removed. The wound had not fully closed and a small
amount of pus was seen at one end of the wound. A swab was sent for bacterial culture. The
antibiotics are discontinued and Lucky is discharged to his home.

What are the problems now?

What basic mechanism might explain the findings?
What do you recommend to do next?
Tutorial 2
Page 3
After 15 days Lucky returns to the outpatient clinic. He says that the leg is less painful but
that it has not yet healed and that it drains a yellowish fluid. He also says that it feels like
there is still something in the wound. The cultures have returned “no growth”.

What is happening to Lucky?

What are the possible mechanisms?
What do you recommend to do now?
Tutorial 2
Page 4

On examination, the wound is still draining a yellowish fluid is no longer tender. The tissues of the
thigh are very firm and the skin is felt as thick and leathery.
The wood fragments that come out of the wound are 3 (three) pieces of 0.5 x 0.5 cm size from the
branch that struck Mr. Lucky.

What are the problems now?

How are granulomas classified?
What are the mechanism of this case at this stage?
Tutorial 3
Page 5
Lucky underwent exploration of the wound under general anesthesia. Several fragments of
wooden material were found and removed. The wound was flushed clean and
closed with sutures.
Lucky was seen in follow up 6 months later. His leg had now healed well with no further
drainage. He had no pain and the wound was not tender. However, the scar was quite thick,
raised and firm.

What process has occurred?

What basic mechanism might explain his problem?