Tobias Everything > Open Wounds > Flashcards

Open Wounds Flashcards

(36 cards)

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1
Q

What are the 4 phases of wound healing?

A
  • Inflammation
  • Debridement
  • Repair
  • Maturation
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2
Q

What are the four ‘steps’ of wound healing

A
  • Formation of fibrin-platelet plug
  • Recruitment of WBCs to protect from infection
  • Neovascularisation and cellular proliferation
  • Tissue remodeling
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3
Q

What are the most common locations of a decubital ulcer?

A
  • Greater trochanter
  • Lateral elbow
  • Lateral hock
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4
Q

Define contamination, colonisation and infection

A
  • Contamination - The presence of microbes on a surface
  • Colonisation - Surface microorganisms are replicating
  • Infection - Invasion and replication of microorganisms within the tissue
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5
Q

What microbial burden has been associated with a higher rate of infection? What time does it typically take to reach this level?

A

10^5 CFU/g
Within 6 hours

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6
Q

What is a more relevant calculation of microbial burden?

A

Microbial burden = (Number of microorganisms x Virulence) / Host Resistance

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7
Q

How does the production of granulation tissue of cats differ to that of dogs?

A
  • Open wounds in cats produce significantly less granulation tissue and is more likely to have a peripheral, rather than central, distribution
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8
Q

At 21 days after wounding, how does epithelialisation and total healing differ in dogs anc cats?

A

Dogs: epithelialisation 89%, total healing 98%
Cats: epithelialisation 34%, total healing 84%

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9
Q

What are some potential causes of open wounds which fail to progress towards healing?

A
  • Systemic disease (uraemia, herpatic dz, DM, cushings, FIV)
  • Malnutrition
  • Local tissue hypoxia and ischaemia (Normovolaemia must be maintained, blood transfusin if anaemic)
  • Bacterial colonisation
  • Altered cellular and stress response
  • Repetitive trauma
  • Presence of necrotic tissue
  • Tension
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10
Q

What are some options to improve wounds which are incapable of forming granulation tissue?

A
  • Omental flaps
  • Muscular flaps
  • Vascular skin flap for closure
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11
Q

Is tap water hyper-, iso-, or hypotonic?

A

Hypotonic

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12
Q

What pressure is generally recommended for high pressure irrigation?
How is this best achieved?

A

16-22g needle onto a fluid administration set of a 1L bag of fluids under pressure of 300mmHg

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13
Q

List hyperosmotic wound dressings

A
  • Hypertonic saline (20%)
  • Honey
  • Sugar
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14
Q

List some hydrophilic dressings

A
  • Hydrogel
  • Hydrocolloid
  • Alginate
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15
Q

Is saline or a balance electrolyte preparation recommended for initial wound preparation? Why?

A

Balanced electrolyte prep
- Saline is slightly hypoosmolar and is cytotoxic to fibroblasts

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16
Q

What antiseptics can be used in the wound?

Study These Flashcards
A
  • 0.05-0.1% chlorhexidine
  • 0.1 - 0.01% povidone-iodine

No detergents! (Cytotoxic)

17
Q

Why is debridement important?

Study These Flashcards
A

Presence of contaminants causes inflammation and devitalised tissue acts as a medium for microbial growth

18
Q

What are the 2 braod categories of wound debridement?

Study These Flashcards
A
  • En Bloc Debridement (and then primary closure)
  • Layered debridement
19
Q

What tissues are not well vascularised? How is this overcome?

Study These Flashcards
A
  • Cortical bone - forage
  • Excess fat - removed
  • Intact fascia - debrided to expose underlying muscle
20
Q

What substances do most enzymatic debridement agents contain?

Study These Flashcards
A
  • Trypsin
  • Collagenase
  • Papain
  • Urea
21
Q

How do nonenzymatic debridement dressings work?
What are some examples?

Study These Flashcards
A
  • Draw exudate and accompanying debris out of the wound
  • Dehydrate microorganisms and have a cidal and inhibitory effect

Hypertonic saline dressings. Sugar-, Honey- and Dextran-soaked dressings

22
Q

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

Study These Flashcards
A
  • Hydrogen peroxide is produced by the action of glucose peroxidase (within the honey) on glucose.
  • Forms at a very low concentration of 0.003%
23
Q

What antimicrobial effects are provided by Honey?
What is the inhibin number of medical grade Honey?

Study These Flashcards
A
  • 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

24
Q

Other than is antimicrobia properties, what other effects of Honet may enhance wound healing?

Study These Flashcards
A
  • 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
25
What type of maggots are used for wound debridement?
Maggots of the green blow fly *Lucilia Sericata* Can destroy healthy epithelium - MUST be protected
26
What is the underlying prinicple of moist wound healing?
Application of a hydrophilic (moisture retentive) dressing to maintain the cellular and cytokine-rich exudate at the wound surface
27
What is typically included in a triple antibiotic ointment?
- Bacitracin zinc - Neomycin sulphate - Polymixin B sulphate
28
How does incorporation of silver into alginate dressing effect its function?
- Increased antimicrobial activity - Improved binding affinity for elastase, MMP-2, TNF-a, and IL-8 - Further inhibited production of free radicals
29
How do bioscaffolds work? What wounds are they recommended for?
- 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
30
What is chitosan? What are its reported functions?
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
31
List 2 growth factor-containing agents which coulf be used in wound management?
- rhPDGD-BB - Autologous PRP
32
What is the recommended porosity of the foam and recommended pressures for negative pressure wound management in small animals?
- 400 - 600 mcm pore foam - Recommended -125mmHg for foam-based or -80mmHg for gauze based systems
33
What are the purported benefits of negative pressure wound therapy?
- Improve wound perfusion - Reduce oedema - Stimulat granulation tissue formation - Decrease bacterial colonisation - Remove exudate
34
Expression of which growth factors/cytokines may be increases in negative pressure wound therapy?
- VEGF and FGF-2 (experiment on rats) - IL-8 and VEGF (humans)
35
How may NPWT be beneficial for skin grafting? Used at what pressure?
Benefits: - Stibilisation of the graft - Reduce fluid accumulation under the graft - Prevent dessication - Possibly prevent bacterial contaminations Pressure -65 to -75mmHg
36
What are the effects of NPWT on bacterial burden?
Unclear.... - Upregulation of IL-8 and IL-1B may trigger accumulation of neutrophils and thus accelerate bacterial clearance
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