What signs are suggestive of EGT?
Heavily vascularised (granular appearance) Fibroblasts (major cell type) Collagen 3 --> collagen 1 Endothelium White margins
What is proud flesh?
What happens in the proliferative phase of wound healing?
fibroplasia and angiogenesis
What is second intention healing?
where you leave the wounds open to undergo inflammation --> proliferation --> maturation
What happens in the remodelling/maturation phase?
epithelialisation and contraction
Why does tension cause a problem in wound healing?
The fibroblasts are sensitive to this (specifically the myofibroblasts)
Why does healing over bone/tendon take longer in the distal limb?
poor mucocutaneous blood supply
What is a sequestrum?
a piece of bone that has lost its blood supply and is infected (it may be because of a fracture or because periosteum has been stripped away - most commonly). If you ID this you must remove it.
Why are ponies wounds usually faster to heal than equivalent wound on a horse?
ponies have a more robust acute inflammatory process - this prevents excess EGT (i.e. proud flesh) forming and hence poor wound healing. Also ponies have more pronounced and faster wound contraction than horses.
How might you minimise inflammation?
Anti-inflammatory durgs - corticosterouds - single application of a topical corticosteroid for a short amount of time (otherwise healing is impaired)
How can you encourage wounds to heal?
Minimise inflammation Do nothing and educate owners not to interfere Minimise movement (box rest, cast immobilisation) ID underlying issues - necrosis, exposed bone etc. Skin graft Treat infection Debridement and lavage (repeat) Wet-dry dressing
What are characteristics of epithelialisation?
ring of epithelium migrating in (not bringing edges closer together), hairless, scaly (lacks sebaceous glands), thin and fragile, less strong than normal skin.
What is the difference between contracture and contraction?
CONTRACTURE = stiffness in a muscle, tendon, ligament around a joint that restricts its movement. If you get a lot of CONTRACTION --> contracture
What are the DDx for this condition?
Abscess Infected proud flesh FB ****NEOPLASIA**** - most likely, sarcoid high on differentials list. Treat (debridement, submit sample, warn owners of likely future complications)