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Large Animal Surgery > Equine Wound Management > Flashcards

Equine Wound Management Flashcards

1
Q

What is examined for initial physical exams for wounds?

A
  • abbreviated TPR
  • observe wound from afar - closeness to synovial surfaces, freshness, contamination, fracture
  • blood loss
  • severe tachycardia
  • lameness
  • colic - horse may have injured itself while rolling to relieve pain
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2
Q

What 3 sedatives are recommended to allow a deeper exam of wounds?

A
  1. Xylazine
  2. Detomidine
  3. Butorphanol
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3
Q

What is used to aid in clipping around the wound without introducing new pathogens?

A

sterile lube or pack with wet gauze —> catches hair!

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4
Q

What 2 products are used to clean wounds? How are they lavaged?

A
  1. Betadine (0.1%)
  2. chlorhexadine (0.05%) - can use scrub in severe cases, but can be cytotoxic

lavage with saline in a 35-60 mL syringe with a 18/19 g needle —> reaches 15 PSI to wash away bacteria/debris without packing them in further

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5
Q

What are 2 options for local anesthesia for wound mangement?

A
  1. nerve blocks
  2. local infiltration - along cut skin edge, circumferential away from wound
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6
Q

What are indications of superficial digital flexors, deep digital flexors, and suspensory tendon involvement?

A

dropped fetlock

raised toe

90 degree flexion

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7
Q

What tendons are likely involved in this wound?

A

dropped fetlock = superficial digital flexor tendon

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8
Q

What tendons are likely involved in this wound?

A

dropped fetlock + raised toe = superficial digital flexor and deep digital flexor tendons

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9
Q

What tendons are likely involved in this wound?

A

dropped fetlock + raised toe + flexion = superficial digital flexor, deep digital flexor, and suspensory tendons

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10
Q

What is indicative of extensor involvement in wounds?

A

insert of P3 —> knuckling, able to bear weight (unlike flexors!)

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11
Q

What 4 treatments are indicated for wounds involving flexors? What is commonly not indicated?

A
  1. wound lavage
  2. coaptation
  3. physical therapy
  4. therapeutic shoeing

sx - apposition is difficult due to inability to take wide bites and increased tension

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12
Q

How does prognosis of flexor and extensor damage compare?

A
  • superficial/deep - fair to good, 8-12 months healing
  • suspensory - poor, likely all tendons severed, depends on vascular involvement
  • extensors - good, able to bear weight, horse learns

(decreased prognosis if synovial and vessel involvement)

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13
Q

What adjacent structures are of concern in cases of cervical wounds? What commonly results?

A
  • treachea
  • veins, arteries, nerves

SQ emphysema - self-limiting, will resorb

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14
Q

What sequelae are associated with thoracic and abdominal wounds?

A

THORACIC - pneumothorax, septic pleuritis

ABDOMINAL - septic peritonitis, punctured viscera (likely need to euthanize on table)

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15
Q

What must be done to ensure proper healing of wounds in highly mobile areas? What is avoided?

A

immobilization

full distal limb casts = pressure sores common, increased maintenance necessary and commonly stay in hospital ($$$)

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16
Q

How are casts properly put on limbs?

A
  • cast over bandage
  • leave out toe to allow weight bearing

good TGH, decreased instance of pressure sores

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17
Q

What 3 things does tension at wound edges cause?

A
  1. vascular damage
  2. tissue necrosis
  3. dehiscence
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18
Q

How do the tension lines in horses lie? How does this affect wound closure planning?

A

vertical - proximal to distal

  • wounds perpendicular to Langer’s lines have high tension and appear gaping on presentation
  • wounds parallel to Langer’s lines have minimal gaping and can be closed with more normal appositional patterns
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19
Q

What are 3 options for relieving tension when closing wounds?

A
  1. everting suture patterns
  2. reduce edema - tack and pressure bandage prior to closing, tourniquet
  3. quills or stents
20
Q

What are 3 options of tension relieving suture patterns? What is avoided?

A
  1. NFFN/FNNF - pulley action provides +++ tension relief, commonly use larger suture to avoid sawing of the skin
  2. vertical mattress - everts tissue edges for ++ tension relief
  3. (inverted) cruciate - interrupted, + tension relief

horizontal mattress - impedes blood supply, resulting in ischemia

21
Q

What is the best way to approach skin flaps?

A

use split thickness bites turn the flap into more of a Y, which relieves tension

22
Q

What are the 3 most common methods of wound debridement? What are 2 other options?

A
  1. sharp - scalpel
  2. mechanical - lavage at 15 PSI, wet to dry bandage + hypertonic saline
  3. autolytic - moist wound healing

+ chemical - enzyme-based
+ biological - sterile maggots

23
Q

What are 2 indications for primary closure of wounds?

A
  1. apposition possible with minimal tension
  2. minimal contamination
24
Q

What are 2 benefits to primary closure?

A
  1. decreased contamination, healing time, scarring, and aftercare —> less cost!
  2. improved cosmesis
25
Q

What is delayed primary closure? What are 3 indications?

A

wound initially treated medically and closed within 3-5 days before granulation tissue is present

  1. mild/moderate contamination
  2. minimal tissue loss
  3. minimal tension
26
Q

What is secondary closure? What are 2 indications?

A

treating a wound medically first and closing after granulation tissue develops

  1. chronic, gross contamination or infected tissue
  2. granulation tissue present
27
Q

What is second intention healing? What are 3 indications?

A

leaving a wound open to heal + bandaging and medical therapy

  1. significant tissue loss
  2. contraction and epithelialization
  3. primary closure failed and dehisced
28
Q

What location of wounds are most commonly left to second intention healing?

A

trunk/neck —> decreased elasticity, increased arterial supply

29
Q

What are the 3 phases of second intention healing?

A
  1. INFLAMMATORY - stopping blood loss, preventing infection, substrate/cell signaling for further healing
  2. PROLIFERATIVE - angiogenesis, fibroplasia, granulation tissue, epithelialization, contraction
  3. REMODELING - collagen accumulation
30
Q

How do edema and cellulitis compare?

A

EDEMA = swelling, not typically painful

CELLULITIS - infection of SQ tissues causing horse to become febrile, painful, and lame

31
Q

What are the 5 most common signs of cellulitis? What are the 2 most common bacterial causes?

A
  1. significant swelling in one limb
  2. severe lameness (Grade 4-5/5)
  3. febrile
  4. no visible wound
  5. may weep fluid from skin or have skin sloughing

Staph + Srept (G- or anaerobes possible)

32
Q

What 4 treatments are recommended for cellulitis?

A
  1. broad-spectrum antibiotics - SMZ, Doxycycline, Gentamicin, Enrofloxacin (refractory cases), Ceftiofur/Penicillin
  2. NSAIDs - Flunixin meglumine, Phenylbutazone
  3. hydrotherapy
  4. sweat bandage - Epsom salt, Nitrofurazone, DMSO + Seran wrap keeps a warm/moist environment for treatment (kept <24 hours)
33
Q

What is indicative of chronic cellulitis? What is associated with decreased survival?

A

chronically thick leg (horses prone to recurrence!)

laminitis

34
Q

What additional treatment is especially important for wounds? What may be associated with this treatment?

A

tetanus toxoid booster - given when vaccine was given more than 6 months from occurence

tetanus antitoxin associated with Theiler’s Disease

35
Q

What are the 5 most common causes of non-healing wounds?

A
  1. infection
  2. FB
  3. necrotic tissue
  4. exuberant granulation tissue
  5. tissue transformation
36
Q

How does infection cause non-healing wounds? What are the 4 most common causes?

A

arrests healing process

  1. Staph —> Botriomycosis
  2. Pseudomonas
  3. E. coli
  4. Enterobacter
37
Q

What are the most common fungal and parasitic infections that cause non-healing wounds?

A

Pythius spp

Habronema - “Summer sores”

38
Q

Non-healing wound:

A

necrotic tissue!

39
Q

What kind of wounds most likely cause bone sequestrum? What are the 2 most common signs?

A

lacerations with exposed bone

  1. draining tract
  2. no healing over exposed bone
40
Q

What causes formation of bone sequestrum in wounds?

A

periosteal damage from the wound causes a loss of blood supply to the affected bone, resulting in necrosis of the outer coretex

41
Q

When is evidence of bone sequestrum seen on radiographs? How are they prevented and treated?

A

2-3 weeks post-injury

  • PREVENTION = suture wound and cover bone, curette exposed bone
  • TREATMENT = surgical removal of bone
42
Q

What is proud flesh? What causes its formation at wounds?

A

exuberant granulation tissue in wounds

prolonged inflammation causes the proliferation phase to remain longer than usual, resulting in delayed contraction and prevention of epithelialization

43
Q

What are 3 risk factors that lead to increased chances of proud flesh formation?

A
  1. distal limb - decreased tissue coverage and oxygen tension
  2. high movement areas
  3. large, open wounds
44
Q

Healthy granulation tissue:

A
  • pink
  • bumps
45
Q

What are 4 options for treating proud flesh? What should be avoided?

A
  1. sharp debridement - very vascular, no nerve endings, recommended if greater than the thickness of a dime (from bottom up)
  2. topical corticosteroids
  3. skin grafting
  4. equine amnion dressings

damage to healthy cells

46
Q

Proud flesh:

A
47
Q

What 2 skin transformations result in non-healing wounds?

A
  1. sarcoid
  2. SCC

Large Animal Surgery (32 decks)

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