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Small Animal Surgery > Management of Traumatic Wounds > Flashcards

Management of Traumatic Wounds Flashcards

1
Q

How does the healing of superficial wounds differ in dogs and cats?

A

If SQ tissue is removed in cats, granulation and healing take much longer. In dogs, removal of SQ tissue doesn’t make much difference.

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2
Q

What are 3 things to consider with bite wounds?

A
  • Size and number of animals involved (eg. cat + cat vs. big dog + small dog/cat; one-on-one vs. pack-on-one)
  • Location of wound (eg, limbs vs. neck/trunk)
  • Clinical assessment of severity of trauma
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3
Q

What suture material would be best for a deep wound?

A

Absorbable monofilament, with antimicrobial would be best.

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4
Q

What is a degloving injury?

A

Shearing force which severs cutaneous vessels supplying the skin

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5
Q

What is the difference between a physiologic and anatomic degloving injury?

A 
Physiologic = Skin devitalized, but still in palce
Anatomic = Skin avulsed from underlying tissue
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6
Q

What do you commonly see combined with degloving in dogs and cats?

A

Crush injury

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7
Q

With impalement, what should you tell the owner if they call in?

A

DO NOT REMOVE

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8
Q

With a gunshot wound, do you need to get all the fragments?

A

Not really unless it’s close to or in a joint.

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9
Q

What 4 things do we assess in a burn patient?

A

Cause
Concurrent injury (smoke inhalation in a house fire)
Extent (% TBSA)
Depth

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10
Q

What is a major issue with burn patients?

A

Hypovolemia

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11
Q

What is really important with burn wound management?

A

Nutritional support

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12
Q

Whata 4 things make up your initial burn management?

A

Cool injured tissue
Topical treatment
Analgesics
Fluid resuscitation

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13
Q

What are the 3 general burn wound outcomes?

A

<15% TBSA - Usually easily managed
15-50% TBSA - May require extensive treatment
>50% - Significant complications and prolonged treatment

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14
Q

What are 2 classifications of traumatic wounds?

A

Penetrating - Open
Non-penetrating - Closed (eg. sterile abscess)

NOTE: Open traumatic wounds should be considered contaminated at best

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15
Q

What are 2 common topical treatments for burns?

A

Aloe (anti-inflammatory)
Silver sulfadiazine

NOTE: These two work synergistically

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16
Q

When do you need to really worry about fluid resuscitation in a burn patient?

A

When burns >15% TBSA

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17
Q

When can you use hydrotherapy for burn patients?

A

With partial thickness burns

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18
Q

How can you easily tell if a burn is partial or full thickness?

A

If the fur doesn’t epilate easily, tissue is probably still healthy

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19
Q

What are 6 possible causes for a nonhealing wound?

A 
FB
Immunodeficiency
Pathogens (hard to culture organisms)
Concurrent dx
Nutritional status
Drugs
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20
Q

What types of FBs, if any, can usually be well tolerated?

A

Non-porous FBs

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21
Q

What is the most common FB?

A

Plant-based

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22
Q

What is common to see with a sinus tract?

A

Will “pseudo” heal, but reappears when Abx are fnished

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23
Q

Define sinus tract.

A

Communication between mesothelial surface and skin.

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24
Q

Define fistula.

A

Communication between two epithelial surfaces, lined by epithelium.

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25
Q

What diagnostics can you do to find a FB in a wound?

A

RADs (most plant materials are NOT radio opaque)

U/S

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26
Q

What can you use to help visualize the wound tract?

A

Dilute methylene blue

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27
Q

What do you need to be careful of when removing FBs from wound tracts?

A

The longer the FB has in the body, the more friable it becomes.

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28
Q

What do you do with a wound tract if you don’t have U/S or CT?

A

Remove all abnormal tissue and look for FB

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29
Q

What is the most common source of contamination for a traumatic wound?

A

Endogenous flora

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30
Q

What are 3 sources of contamination for a traumatic wound?

A 
Endogenous flora
Accident site (usually pretty wimpy bacteria)
Hospital (nosocomial, tougher bugs)
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31
Q

What 3 factors influence bacterial development?

A 
Number and type
Host defense
Exogenous factors (FBs, soil)
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32
Q

What is the “Golden period”?

A

Time from contamination until bacteria reach 10^6/g of tissue

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33
Q

What is the trouble with infection potentiating factors?

A

Can reduce the number of bacteria needed for infection to as low as 100 (from 10^6)

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34
Q

What must you do with all wound patients?

A

Assess the entire patient!

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35
Q

If not ready to deal with wound, what should you do?

A

Protect it to prevent further contamination.

If comes in bandaged, DO NOT take a peek until you’re ready to deal with it.

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36
Q

What are the 3 steps to initial management of traumatic wounds?

A

Thorough exam of wound (look for fx, explore penetrating wounds and consider what might be underneath)
Debridement
Wound Lavage

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37
Q

Wat 4 minimum precautions should you take in evaluating the wound?

A

Temporarily close or pack the wound
Clip and prep surrounding skin (don’t be afraid to go wide)
Cap, mask and gloves
Ideally aseptic technique

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38
Q

How much bacteria can be removed with wound lavage?

A

Up to 90%

39
Q

What do you normally use as wound lavage solution?

A

Saline or balanced electrolyte solution

Can have antiseptics, but difficult to dose

40
Q

What is the easiest way to lavage a wound?

A

Large syringe with 18G or 20G needle on the end is best.

41
Q

What is the most tissue friendly wound lavage solution?

A

BES

Good for wounds that are not overly contaminated

42
Q

What is the best antiseptic to use?

A

Povidone-Iodine

43
Q

Why should you dilute Iodine?

A

Increases free Iodine

44
Q

What is the residual activity of Iodine?

A

4-6 hours

NOTE: If colour changes to a light yellow, all iodine has been used up

45
Q

What are 2 disadvantages of Iodine?

A 
Forms inactive complexes with organic matter
Systemic absorption (toxicity and metabolic acidosis)
46
Q

What are 3 advantages to using Chlorhexidine?

A

Activity less affected by organic matter
Long residual action
Side-effects uncommon (usually hypersensitivity)

47
Q

T/F: Residual activity of Chlorhex increases with repeated applications.

A

True

48
Q

What happens to Chlorhex if mixed with a poly ionic solution?

A

It forms a precipitate

NOTE: Antibacterial activity is maintained for 2 weeks, and precipitate doesn’t seem ti interfere with wound healing.

49
Q

What is debridement?

A

Removal of devitalized tissue and foreign bodies

50
Q

What are 5 methods of debridement?

A 
Surgical
Autolytic (moisture retentive bandage)
Chemical (enzymes)
Mechanical (adherent primary bandage)
Biosurgical
51
Q

What is the most commonly used method of surgical debridement?

A

Layered, but will still have some contamination at the end

52
Q

What is “en bloc” debridement?

A

Surgical debridement where the wound is packed, sutured closed and then you dissect around the mass from the packing.

53
Q

What is another term for chemical debridement?

A

Enzymatic debridement

54
Q

What are the indications for chemical debridement (4 ways)?

A

Poor anesthetic risk
Minimal debridement necessary
Surgical debridement may damage important structures
Adjunct to other methods

55
Q

What is a cheap and readily available enzymatic debridement agent?

A

Granulex

56
Q

What are the 3 components of Granulex?

A

Trypsin (debriding agent)
Castor oil (minimize dessication)
Balsam of Peru (stimulates capillary formation)

57
Q

What are the 2 primary parts of granulation tissue?

A

Fibroblasts

Blood vessels

58
Q

Define mechanical debridement.

A

Devitalized tissue and FB are trapped in primary bandage layer

59
Q

What are indications for mechanical debridement?

A

Wound in lag phase with heavy contamination or thick viscous exudate.

60
Q

What sort of dressings are used in mechanical debridement?

A

Wet-to-dry or dry-to-dry dressings with wide mesh gauze

DON’T FORGET TO COUNT YOUR GAUZE!!!

NOTE: Antiseptics often used to wet dressings in contaminated/infected wounds.

61
Q

If you have a wound that is inappropriate for closure after the initial lavage and debridement, what do you do next?

A

Stabilize patient

62
Q

When using an adherent dressing on a wound not yet ready for closure, when should you discontinue?

A

When the wound bed is healthy, then switch to non-adherent dressings until wound closure.

63
Q

What is negative pressure therapy?

A

Vacuum assisted closure with constant or intermittent suction applied to wound (constant is best)

64
Q

When does negative pressure/vacuum therapy work best?

A

Wound in late lag or early proliferative phase.

65
Q

How does vaccum/negative pressure therapy help?

A

Promotes more rapid granulation tissue formation in acute wounds.

Improves the local environment to enhance second intention healing of chronic wounds.

66
Q

What is important to remember with negative pressure/vacuum therapy?

A

Accelerated granulation tissue formation (within 48hrs) may incorporate sponges so need to be careful.

67
Q

What is calcium alginate?

A

A non-woven felt from seaweed

68
Q

What 3 functions does calcium alginate have?

A 
Fluid absorption (Extremely hydrophillic)
Promotes autolytic wound debridement
Aids in hemostasis
69
Q

What are 2 indications for calcium alginate?

A

Moderate to heavily exudative wounds

Wound adequately debrided, but not good for closure

70
Q

What is a benefit to calcium alginate over gauze?

A

Less painful to change than gauze.

71
Q

What are 4 benefits of using honey?

A

Cleanses wound
Hygroscopic (attracts and holds water from surroundings)
Promotes granulation tissue
Antibacterial/antifungal

72
Q

How does honey work as an antibacterial/antifungal (3 ways)?

A

Osmotic effect
Low pH
Produces inhibine which produces H2O2 and phenolic acids

73
Q

What is sugar’s primary effect?

A

Antibacterial due to osmolality, also helps lower pH.

74
Q

What other beneficial effect does sugar have within a wound?

A

Promotes granulation tissue by attracting macrophages

75
Q

What 4 actions does Maltodextrin (Intracell) have?

A

Chemotactic (PMNs, Lymphos and Macros)
Energy for cells
Stimulates rapid granulation and epithelialization
Antibacterial properties

76
Q

Does all the shot have to come out of a gun shot wound?

A

No, some can stay UNLESS it’s in or near a joint.

77
Q

What are the two types of adherent dressing?

A

Wet-to-dry

Dry-to-dry

78
Q

In what 2 situation is a wet-to-dry bandage indicated?

A

Necrotic tissue +/- FBs

High viscosity exudate

79
Q

What is the benefit to a wet-to-dry bandage?

A

It liquefies viscous exudate enhancing entrapment in dressing

80
Q

When are dry-to-dry bandages indicated?

A

In highly exudative wounds to aid in wound debridement

81
Q

What makes Kerlix AMD (dry-to-dry dressing) so great?

A

Broad spectrum antibacterial activity

82
Q

What are 4 indicatinos for a dry-to-dry bandage?

A

Degloving injury
Bite wounds
Lacerations
Deep “cavity” wounds

83
Q

What are 3 disadvantages of adherent dressings?

A

Bacteria can flourish
Wet dressings can cause maceration
Bacterial strike-through

84
Q

What are 2 common uses of non-adherent dressings?

A

Protect a sutured wound

Cover wounds in a reparative stage

85
Q

What are 3 advantages of non-adherent dressings?

A

Keeps wound moist
Allows excess fluid to drain
Doesn’t damage newly formed reparative tissue

86
Q

What are the 2 classifications of Moisture retentive dressing?

A

Semi-occlusive

Occlusive

87
Q

When is it better to use moisture retentive dressings?

A

Wounds in late debridment because optimize body’s inherent healing ability

88
Q

What do you need to be careful of with moisture retentive dressings?

A

If the wound has too much exudate, it will separate the bandage from the wound.

89
Q

What are 3 types of biological dressing?

A

Equine amnion
Xenografts and allografts
Extracellular matrix-derived

90
Q

Why do we not often use xenografts and allografts in veterinary medicine?

A

Because they’re often rejected

91
Q

What are 3 types of extraccellular matrix-derived biological dressings?

A

Collagen
Porcine small intestinal submucosa (PSIS)
Porcine urinary bladder submucosa (PUBS)

92
Q

What is so nice about porcine small intestine submucosa (PSIS)?

A

It is a “smart tissue” that takes on the characteristics of the tissue it is placed in.

93
Q

What are 3 indications for use of PSIS?

A

Deglovng injuries and other large skin defects
Biological dressing until definitive reconstruction
Dermal substitute to “guide” wound repair

94
Q

How do you apply PSIS?

A

Put rough side in contact with the wound surface, suture into wound bed, under the wound edge

Small Animal Surgery (13 decks)

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