Complications of wound healing Flashcards Preview

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

Esmarch's principals of wound management

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

2

swelling at the incision site - causes

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

3

swelling at the incision site - evaluation

body wall integrity - palpation, ultrasound etc.

4

swelling at the incision site - treatment

massage
support dressing
remove constricting sutures

5

acute haemorrhage + haematoma treatment

apply pressure dressing

6

mature haematoma treatment

resolve over time
warm compress

7

acute haemorrhage + haematoma

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

8

infection - treatment

asses wound
culture any discharge
antibiotic therapy

9

seroma -causes

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

10

seroma - contributing factors

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

11

seroma - therapy

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

12

dehiscence

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

dehiscence - causes

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

dehiscence - treatment

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

wound infection

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

16

wound infection - treatment

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

delayed wound infection

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

tissue necrosis/sequestration

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

19

excessive scarring

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

20

scarring reduction

atraumatic technique
control of infection
early wound closure

21

wound contracture

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

treating contracture after it has occured

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

23

adhesions

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

reducing adhesions

atraumatic tissue handling
keeping tissues moist
strict asepsis

25

sinus - define

blind ending tract than extends from an epithelial surface

26

fistula - define

communcating tract that extends from one epithelial surface to another

27

draining tracts

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

28

draining tracts - diagnosis

radiography for foreign bodies
ultrasonography to identify tract + foreign bodies

29

draining tracts - treatments

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

granulation tissue formation imparement

necrosis
devitalised tissue
wound infection
poor blood supply
movement

31

failure of wound contraction

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

failure of epithelialisation - causes

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

failure of epithelialisation - treatment

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

34

indolent pocket wound

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

indolent pocket wound - treatment

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