Complications of wound healing Flashcards Preview

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Flashcards in Complications of wound healing Deck (35)
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1
Q

Esmarch’s principals of wound management

A
non-introduction of anything harmful
tissue rest
wound drainage
avoidance of venous stasis
cleanliness
2
Q

swelling at the incision site - causes

A
acute haemorrhage + haematoma
incisional swelling + oedema
acute infection
seroma
abscess
scarring + contracture
draining tracts
exposed bone
non-healing wounds
3
Q

swelling at the incision site - evaluation

A

body wall integrity - palpation, ultrasound etc.

4
Q

swelling at the incision site - treatment

A

massage
support dressing
remove constricting sutures

5
Q

acute haemorrhage + haematoma treatment

A

apply pressure dressing

6
Q

mature haematoma treatment

A

resolve over time

warm compress

7
Q

acute haemorrhage + haematoma

A

separation of wound edges
prevention of adherence of grafts + flaps
barrier to leucocyte migration
growth medium for bacterial growth

8
Q

infection - treatment

A

asses wound
culture any discharge
antibiotic therapy

9
Q

seroma -causes

A

skin seperation
skin flaps + grafts
interferences with blood supply + WBC migration

10
Q

seroma - contributing factors

A
inflammation
lymphatic injury
poor haemostasis
traumatic surgery/implants
movement
dead space
11
Q

seroma - therapy

A

control dead space
drain
remove sutures - 2nd intention healing
surgery if dehiscence or infection

12
Q

dehiscence

A

breakdown of surgical wounds
rarely caused by inability of tissue to heal
usually seen 3-5 days post-op
serosanguinous discharge, swelling, necrosis, bruising, discharge

13
Q

dehiscence - causes

A

excessive force on incision - activity level, skin tension, trauma
poor wound holding strength - suture selection, knot security, wound edges compromised, wound infection, neoplastic tissue in wound

14
Q

dehiscence - treatment

A

dependant on tissue layer affected
if exposes vital structures then should be closed
in skin + is infected the wound should be treated as open

15
Q

wound infection

A

dependant on many factors - contamination at time of surgery, degree of damage/disection, surgeon exp, use + timing of antibiotics, presence of systemic disease

16
Q

wound infection - treatment

A

for superficial wound infection - open wound management, removal of sutures if needed, debridement of devitalised tissue, lavage + drainage.
deep wound infection may need exploration + drain implantation
samples taken + cultured
bacterial infection can cause systemic infection + septicaemia

17
Q

delayed wound infection

A

commonly caused with implants + non-absorbable suture material
failure of adequate debridement initially
may present with local signs of wound infection + eventual draining tract development

18
Q

tissue necrosis/sequestration

A

debridement of the wound needed

increased risk of infection, abscesses, continuing infl, additional metabolic load, delayed wound healing

19
Q

excessive scarring

A

excessive collagen deposition
may limit mobility in joints
cause closure or functional incompetence near natural body orifices

20
Q

scarring reduction

A

atraumatic technique
control of infection
early wound closure

21
Q

wound contracture

A

loss of a body part due to excess scarring
placing limb in more comfortable position like flexion to avoid weight bearing can cause this
early recognition of wounds at risk needed
larger wounds healing by 2nd intention at greater risk
wounds more than half circumference of limb unlikely to heal by 2nd intention

22
Q

treating contracture after it has occured

A
z-plasties
scar excision with reconstruction
partial myotomies 
temp splintage
physiotherapy + return to normal funtion
23
Q

adhesions

A

adhesions in the abdomen + involving entrapment of parts of the GIT uncommon in small animals
occur when equilibrium between normal fibrin deposition + fibrinolysis is disrupted
causative factors - ischaemia, haemorrhage, foreign bodies + infection

24
Q

reducing adhesions

A

atraumatic tissue handling
keeping tissues moist
strict asepsis

25
Q

sinus - define

A

blind ending tract than extends from an epithelial surface

26
Q

fistula - define

A

communcating tract that extends from one epithelial surface to another

27
Q

draining tracts

A

associated with - pockets of necrotic tissue, resistant bacteria/fungi, underlying osteomyelitis/sequestrum, foreign bodies + neoplasia

28
Q

draining tracts - diagnosis

A

radiography for foreign bodies

ultrasonography to identify tract + foreign bodies

29
Q

draining tracts - treatments

A

surgical exploration, debridement + tissue biopsy for culture
if possible each tract should be excised
if not possible to excise, explore + lavarge then by open wound management or closure

30
Q

granulation tissue formation imparement

A
necrosis
devitalised tissue
wound infection
poor blood supply
movement
31
Q

failure of wound contraction

A

peripheral countertension due to lack of loose skin around the wound
restrictive fibrosis - mechanically impairs skin advancement from wound edges
if wound contraction limited - wound healing more dependant on epilthelialisation

32
Q

failure of epithelialisation - causes

A

necrotic tissue, infection, fibrotic scar tissue, poor quality chronic granulation tissue, repeated surface trauma to the wound, loose bandages causing abrasion, tissue desiccation + movement at wound site

33
Q

failure of epithelialisation - treatment

A

debridement + lavage, antibiotics, excision of chronic wound bed + re-establishment of new granulation tissue, immobilisation of affected area, physical protection of wound

34
Q

indolent pocket wound

A

granulation tissue forms with pliable skin around wound
surrounding skin becomes elevated from wound bed + doesnt stick to margins of defect
cavity forms in hypodermal space
epithelial cells from skin edge migrate to line dermal surface + edges curl under
granulation tissue becomes chronic with increase in amount of fibrous tissue + reduction in vascular tissue + may get infected
most common in inguinal, axillary + flank regions, esp in cats

35
Q

indolent pocket wound - treatment

A

control infection, excise scar border + restrictive dermal scar, closure of wound, anchor skin edges to underlying granulation tissue bed, manage dead space with drains, use skin flaps for closure, use omentalisation if vascular supply compromised