Ch 76 open wounds Flashcards

Question

How is hydrogen peroxide produced by honey? At what concentration?

Answer 1

Hydrogen peroxide is produced by the action of glucose peroxidase (within the honey) on glucose. Forms at a very low concentration of 0.003%

Answer 2

Hydrogen peroxide production Oxygen-derived free radicals Phytochemicals (phenols and organic acids) Acidic pH (3.2 - 4.5) The inhibin number is the amount of dilution to which the honey will retain its antibacterial activity

Answer 3

Reduction of inflammation due to anti-oxidant content Stimulation of B- and T-lymphocyte proliferation Stimulation of phagocytic activity Stimulation of cytokine release from monocytes

Answer 4

Maggots of the green blow fly Lucilia Sericata Can destroy healthy epithelium - MUST be protected

Answer 5

- fostering a moist wound environment to facilitate debridement, granulation tissue formation, and epithelialization - facilitates autolytic wound debridement - Dry to minimally exudative > hydrogel dressing - Mild to moderately exudative > hydrocolloid sheet, polyurethane foam dressing - Heavily exudative > colloidal dressings (alginate) or hypertonic saline

Answer 6

Application of a hydrophilic (moisture retentive) dressing to maintain the cellular and cytokine-rich exudate at the wound surface

Answer 7

Bacitracin zinc Neomycin sulphate Polymixin B sulphate

Answer 8

- Increased antimicrobial activity - Improved binding affinity for elastase, MMP-2, TNF-a, and IL-8 - Further inhibited production of free radicals

Answer 9

- Use of 1% silver sulfadiazine is fast being replaced by newer nanoparticle slow-release, silver-impregnated dressings - silver dressings may result in a surface exudate > similar to that seen with Pseudomonas infections. - After the exudate has been removed with wound irrigation, the true color of the underlying wound bed can be evaluated.

Answer 10

Provides a substrate for extracellular matrix formation Stimulates matrix deposition, angiogenesis and epithelialisation due to collagenous and growth factor content Recommended for use with chronic, indolent ulcers

Answer 11

Chitosan is a lineal copolymer of linked Beta glucosamine and N-acetly-D-glucosamine Reported functions: - ENhance the action of inflammatory cells - Increase production of granulation tissue through upregulation of TGF-B, PDGF, fibroblast production and IL-8 production

Answer 12

rhPDGD-BB Autologous PRP

Answer 13

400 - 600 mcm pore foam Recommended -125mmHg for foam-based or -80mmHg for gauze based systems

Answer 14

Improve wound perfusion Reduce oedema Stimulat granulation tissue formation Decrease bacterial colonisation Remove exudate

Answer 15

VEGF and FGF-2 (experiment on rats) IL-8 and VEGF (humans)

Answer 16

Benefits: - Stibilisation of the graft - Reduce fluid accumulation under the graft - Prevent dessication - Possibly prevent bacterial contaminations Pressure -65 to -75mmHg

Answer 17

Unclear…. - Upregulation of IL-8 and IL-1B may trigger accumulation of neutrophils and thus accelerate bacterial clearance

Answer 18

- local application of subatmospheric pressure across a wound - occlusive dressing, mechanical unit that applies constant negative pressure (suction). - Controlled experimental studies in dogs show positive and negative effects - alter the interstitial fluid gradient reduce edema, potentially increasing dermal perfusion (how this exactly acheved is unclear) - tissue perfusion can decrease with increasing suction and increased tissue pressure - STUDY: pressures from −75 to −100 mm Hg might effectively stimulate blood flow while minimizing marginal hypoperfusion - granulation tissue formation thought to result from stress and strain created in the extracellular matrix, altering the proliferative response > likely modulated by molecular mechanism (VEGF, IL8, FGF). - Intermittent suction appeared to have a greater effect than continuous suction and may promote vascular proliferation within the wound

Answer 19

A commercial NPWT device (control) and three homemade-NPWT devices (wall suction) commercial NPWT device produced an average pressure variance of 3.02 mmHg, and the h-NPWT produced average variances of 4.38 The h-NPWT system achieved negative pressures that were comparable to those of a commercial control NPWT device

Answer 20

Pathophys - in one case report, bacterial biofilm was shown to be present upon - presence of foreign material - poor local blood supply in the area leads to poor granulation - high mobility - tension histopathological analysis of a chronic non-healing pressure wound in a dog - For long-term resolution of an axillary wound, antimicrobial therapy is important (infection is one of the most common complications observed) - tissue sample recommended for ab stewradship - wound management first (irrigation, debride, tie-over) definitive TX - simple closure: complications after initial wound closure leading to suboptimal outcomes and further treatment have frequently been reported in the literature - omental pedical graft: before primary closure,blood supply and lymphatic tissue, as this assists with controlling infection achieved positive results in 70% of the wounds presented, and the average healing time was 24 days. - elbow skin flap: can function as an axial pattern flap, is created by detaching the skin from the trunk to allow cranial advancement - APF: thoracodorsal and lateral thoracic artery axial pattern flaps and the omocervical flap, provide full-thickness skin coverage, resistance to infection and early immobilisation and neovascularisation, - complications associated with skin flaps is seroma formation, which may lead to infection > active suction drains - in one study combining omentalisation and a thoracodorsal axial pattern flap, 100% of the wounds had healed within 14 days and only 20% required minor revision surger

Answer 21

- these showed no clear advantage of one technique over the other. - the Levine technique, where a swab is pressed on 1 cm2 of healthy tissue in the wound until fluid is obtained, is suitable - One advantage of tissue biopsy is that the resulting sample can also be sent for histopathological analysi

Answer 22

Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin–clavulanic acid. Amoxicillin–clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland.

Answer 23

- electroceutical → bacterial inhibition by interrupting bacterial adhesion, generation of hypochlorous acid + may stimulate angiogenesis, keratinocyte proliferation and migration - reduction in wounds in treated cases that previously failed other treatments

Answer 24

- only two studies are available that have investigated the effect of different dressings in cats. The rest are mainly case-reports - consdier using NPWT in cats

Answer 25

acute, full-thickness wounds in dogs. Study design: Prospective, controlled, randomized, experimental study no difference of infection rate between the two groups (superficial, did not require Tx, 17%) This study did not provide evidence to support the application of HoneyCure® in small, acute wounds in healthy dogs > wounds in both groups healed in the same amount of time. However, application may be beneficial in the early proliferative stage of wound healing and in wounds that would benefit from early, robust epithelialization.

Answer 26

52 client-owned dogs Culture results of swab and tissue biopsy specimens were identical in 11/52 (21.2%) cases. Tissue biopsy specimen and swab cultures yielded positive results for 44 (84.6%) and 40 (76.9%) wounds, respectively In 7/52 (13%) wounds, the observers would have treated the patient differently on the basis of the results of the 2 cultures swab collected by the Levine technique is an appropriate noninvasive alternative to culture of a tissue biopsy specimen. A negative result obtained from culture of a swab is likely to be reliable. Disagreement between the results of swab and tissue biopsy specimen cultures is likely of low clinical importance

Answer 27

could improve short- and long-term outcomes in complicated wounds.prospective studies for the various clinical situations described due to lack of compelling data from well-designed studies in the veterinary peer-reviewed literature best applied in situations where healing is impaired, such as with severe swelling, infection, crush injury, radiation scars and hypoxic tissue > chronic oxygen deficiency and the local oxygen tension is not optimal for healing patient breathes 100% oxygen while inside a pressurised chamber, benefits - Vasoconstriction and reduced inflammation - HBOT enhances the function of leukocytes - antibacterial and antifungal effects of HBOT - Reduction of ROS in ischemia/reperfusion injury - Neovascularisation indicated for: reperfusion injury (spinal), graft, necrotizing wounds, burns

Answer 28

Prospective. 64. Pretreatment swab cultures to predict infection in acute open traumatic wounds Fewer bacteria were cultured from postlavage than from prelavage Postoperative infection was subsequently diagnosed in 14 of 64 (22%) dogs; 13 of these dogs had positive culture results. Bacterial species present in the initial wound swab did not correlate with those subsequently cultured Routine bacterial culturing of acute wounds is not likely to help predict subsequent wound infection, nor is it likely to accurately guide early selection of antimicrobials to treat wounds that become infected.

Answer 29

Prospective randomized clinical study Materials and Methods Dogs (n = 26) **shorter time to closure (14.2d) vs foam dressing (28.6d) - greater reduction in total wound area at all time points - less progression of local infection** As the wounds were ultimately surgically closed whenever possible, the exact duration of open treatment is notwithout bias. One potential drawback is the increased time of hospitalization,

Answer 30

acellular fish skin grafts for wounds in 11 dogs, 4 cats A cellular fish skin grafts 13 dogs and 4 cats with complex wounds no control group, it was difficult to determine the impact that FSGs had on wound healing treated FSG maintains omega-3 fatty acids, collagen, elastin, laminin, lipids, fibrin, proteoglycans and glycosaminoglycans - omega-3 → anti-viral, anti-bacterial and anti-inflammatory properties - anti-bacterial for up to 24-72 hours in human wounds - 3D microporous structure homologous to mammalian extracellular matrix - incorporated into would within 7-10 days - closure by second-intention by median 71 days (26-145) in 10/11 dogs, 3/4 cats - failure to heal in 1 dog, 1 cat

Ch 76 open wounds Flashcards

(56 cards)