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Equine Surgery and Medicine > Surgery > Flashcards

Surgery Flashcards

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1
Q

X-ray production

A

Electrons with high potential from cathode to anode, when they reach the anode an x-ray is produced
Variability in tissues absorption of X-rays- contrast and 2-D image
If more radiation absorbed- whiter– RADIOPAQUE
If more radiation just passed through- darker – RADIOLUCENT
Best quality image if the x-ray beam is perpendicular to the plate

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2
Q

Most radiopaque to most radioluscent

A

Metal
Bone
Soft tissue, fat, water
gas

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3
Q

KV

A

Energy of electrons

penetrating ability

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4
Q

mAs

A

amount of radiation produced over a set time i.e the number of electrons
Contrast

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5
Q

Types of x-rays

A

Conventional
Computed- phosphor plate
Digital/direct

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6
Q

Indications for taking x-rays

A

orthopedic:
Lameness
Obvious lesions e.g when there is swelling
Pre-purchase

Non-orthopedic:
Head- teeth and sinuses
Thorax
Abdomen

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7
Q

Basic principles of interpretation- orientate the radiographs in a standard fashion

A

Dorsal/cranial to the left on laterals
Medial to the left on DP’s (dorsoproximalis)
Left side to the right for head DP’s

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8
Q

What are pyhses?

A

usually in young horses, separate centres of ossification

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9
Q

Describing lesions

A

Active: smooth, regular and well-defined

benign, long-standing lesions usually

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10
Q

Estimating how long the lesion has been present

A

Osteophyte formation- 3 weeks

Incomplete fissure fractures- may take weeks to appear

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11
Q

Bone growth

A

Wolff’s law- bone models due to the stress applied to it

X-rays detect changes in mineralization- but not the early stages

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12
Q

Increased bone production-

A

more radiopaque

cortical thickening- e.g bucked shin in race

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13
Q

New bone

A

Periosteum- on the outside of the bone
Endosteum- on the inside of the bone
From infection, inflamm, neoplasia etc

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14
Q

Sclerosis

A

Densification– more radiopaque
Often within trabecular pattern
stress- osteomyelitis
protect a weakened area- OCLL

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15
Q

Focal new bone formation

A

Osteophyte- at edges of articular cartilage and periarticular new bone
Entheseophyte- where tendons, ligaments and joint capsules attach

Sometimes hard to differentiate the 2

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16
Q

Demineralization– general

A

Thinning of cortices and more obvious trabecular pattern
Radiographic overexposure
Disuse osteopenia- healing of fractured

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17
Q

Demineralization- focal

A

Chronic prolif synovitis

cysts: subchondral bone cyst, osseous cyst like lesion

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18
Q

Fractures

A

Location
Complete/incomplete
Displaced/non-displaced
Articular/non-articular

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19
Q

Physitis

A

growing horses
irregularity between the epiphyseal and metaphyseal margins of growth plate
Soft tissue swelling
(separate centres of ossification)

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20
Q

OCD= osteochondrosis dessecans

A

developmental disease
stifle and hock
osteochondral fragments
irregular joint surface (flattening) e.g in the fetlock the sagittal ridge of the canon bone
subchondral bone luscent but may be surrounded by increased opacity
secondary remodelling of joint surfaces

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21
Q

Osteoarhtritis

A

Not to be mixed up with synovitis- no bone involvement, here the bone is involved
Periarticular osteophyte formation, and soft tissue swelling
Subchondral bone lysis/sclerosis– more luscent
Narrowing of joint space
Capsule distension
Osseous cyst like lesions

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22
Q

Contrast radiography

A

Radiodense material

To check if a wound has travelled to synovia or to check communication between synovial cavities

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23
Q

Standard views for lameness diagnosis

A

1.LM
Straight limb, beam parallel with heel bulbs, at region of the navicular bone
2.Dpa
Foot on block, pulled forward, horizontal beam at right angle to heel bulbs
3.DPrPaDiO of pedal phalanx
Upright pedal view- hoof wall is vertical on the block
Standing on a block
4. DPrPaDiO of navicular bone
foot slightly pulled forward on the block
5.PaPrPaDiO= skyline of the navicular bone

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24
Q

Standard view for laminitis

A

LM

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25
Problems associated withe the navicular bone
Along the distal border there are radiolusecnt zones- if these are more pronounced- this is clinically more significant Modelling at insertion of the CSL Periarticular new bone formation Flexor cortex defect
26
What structures does navicular disease involve
``` Navicular bursa DDF Distal sesamoidean impar ligament Collateral ligaments of the navicular bone Chondrosesamoidean ligaments ```
27
Abnormalities of the distal phalanx
``` Sagital fracture Parasagital fracture OCLL Keratoma Infectious osteitis ```
28
Laminitis
The distal phalanx should be parallel with the dorsal hoof wall There is rotation/ sinking Dorsal hoof wall thickness- less than 20mm Radioluscent line- serum/necrotic tissue
29
Fractures of the fetlock
1. Traumatic/stress: proximal phalanx- short incomplete or sagittal 2. Condylar: race and endurance, usually medially 3. Prox sesamoid bones: race 4. Sesamoiditis- abnormal thickening of vascuclar channels
30
Problems occurring at the carpus
Sclerosis/ fractures: third carpal bone usually Osteoarthritis Osteochondroma
31
Elbow
Olecranon fracture | Osseous cyst like lesions of the radius
32
Shoulder
Fracture of greater tubercle of humerus Fracture of supraglenoid tubercle Osteoarthritis
33
Technique for radiographing the neck
From occipital to T1/T2 Rope headcollar Sedation Horse standing square, neck has to be 100% straight Lateral lateral images, take at least 4 Oblique-articular processes of the joints
34
Common findings of the neck
Caudal cerv vertebra- enlargement of the articular processes Pain- nerve root compression ataxia- SC compression- abnormal sagittal diameter ratios C5-C6 and C6-C7 is very common
35
Myelography of the neck
Contrast medium into the vertebral canal at the atlantooccipial fissure Latero-latero and dorso-ventral images
36
Abnormalities of the fetlock (hindlimb)
``` OCD Osteoarthritis Deformed sesamoid bone Superchondylar lysis Very low position of the proximal sesamoid bones ```
37
Abnormalities of the metatarsal region | normal- almost uniform opacity
Patchy opacity Marked entheseous reaction Splint bones are very susceptible- especially IV- kicks! Sequestrum (piece of bone separated due to necrosis)
38
Abnormalities of the hock
Frequent cause of hindlimb lameness Osteoarthritis in distal tarsal joints and tarscocrural joint Trauma- kicks- especially of lat malleolus OCD: -distal intermediate ridge of tibia -trochlear ridges of tallus (lat>med) -med malleolus At sustentaculum tali: septic tenosynovitis of tarsal sheath- new bone formation and sequester formation
39
Abnormalities of the stifle
OCD- lateral trochlear ridge of the femur Osteoarthritis- osteophytes Calcinosis circumseptica
40
Radiography of the back
Use portable machine, DR system to get the spinous processes Take 9-11 images Latero-latero for DSP's and vertebral bodies Ventral to dorsal oblique views for articular process joints
41
What is the most common cause of backpain in the horse?
Impinging "kissing" dorsal spinous processes
42
Open magnet for the adult horse (MRI)
``` 0.27 tesla where the horse can walk in Bony and soft tissue structures Thin slices in 3D Differences in signal intensity- hypo/hyperintense T1 weighted T2 weighted Fat-supressed ``` Very time consuming- usually done on the foot
43
Computer tomography (CT)
"3-D x-ray" uses x-rays to build cross sectional images Good for neck Marked based on HU scale (Hounsfield unit) which measures radiodensity Low density is hypoattenuating: -air, water-- edema and necrosis High density is hyperattenuating: -bone, hyperaemia, recent bleeding, contrast
44
Contrast enhanced CT-
iodine based used to enhance soft tissue lesions and to assess angiogenesis Contrast arthrography- used because there is such little contrast between soft tissue and cartilage
45
Scintigraphy
Detection of gamma rays Tc99m methylene diphosphanate (radiopharmaceutical) binds to hydroxyapatite of the bone but its uptake depends on osteoblastic activity and perfusion Most NB indication: when suspect stress fractures in racehorses, also exertional rhabdomyolysis Interpretation: when there is increased uptake it appears dark
46
Orthopedic US
Lameness Stronger returning echo- brighter Weaker returning echo- darker Linear abdominal macroconvex probes Clip horse- air
47
PRP-Platelet rich plasma
Autograft Centrifuge 2 fractions Over: thrombocyte and WBC rich Under: RBC rich Centrifuge to activate the alphagranules in the thrombocytes- release of growth factors
48
US of the shoulder
Cranial to caudal scanning Weightbearing position 5-10MHz
49
Radiology of the head- techniques
``` Use tranquilizers Large size cassettes and imaging plates Right and left laterolateral Dorsoventral and ventrodorsal (similar to neck and back) Obliques Collimation, cassetteholder Ropehalter ```
50
Radio of cranium
LL: 5cm caud to the orbit VD: beam centred at the larynx Obliques: TMJ
51
Cranium of mature vs young horses
Young still have sutures and a more domed cranium Mature: ventrally: TMJs. proc. coronoideus, zygomatic arch petrous temporal bones attachment of the nuchal ligament rostral to the cranial cavity: ethmoid turbinate where the caud part is more opaque, and rostral part is superimposed over the maxillary sinus dorsal to ethmoid is the frontal sinus ventral to the ethmoid is the guttural puch, larynx and pharynx Dentigerous cyst: fluid btw reduced enamel epitherlium and crown of an unerupted tooth
52
Radio of paranasal sinuses and maxilla
LL: beam halfway btw orbit and opening of infraorbital canal VD: beam btw ventral rami of mandible, at level of caud border DV: beam sagittal plane, btw orbit and for. infraorbitale
53
Significant pathologies of the head
Sinusitis PEH- proliferative ethmoid hematoma Cyst Trauma- fractures
54
Radio of thorax
``` High output x-ray unit Leave gap between patient and casette Short exposure Full INspiration LL views: fields- dorsocaud, ventrocaud, dorsocran, ventrocran ```
55
Patterns of lung disease
``` Interstitial Vascular Bronchial Alveolar Cavitary pulmonary lesions Pulmonary masses Pleuropneumonia Pneumothorax Pneumomediastinum Tracheal collapse/ stenosis RAO Pneumonia- eosinophilic, bacterial and aspiration ```
56
Vascular lung disease
vessels within the interstitium changes the shape of pulmonary arteries and veins congenital heart disease or inflamm lung disease
57
Radio of the abdomen
US more useful small- high output portable units adult- stationary abd width needs to be 70cm Foals: LL and VD- because can be in recumbency Adults: LL in standing: cranioventral, mid-ventral, mid-dorsal and dorsocaud
58
Diseases of the GIT | that show up on radiograph
``` SI or LI obstruction Atresia coli Rupture of hollow viscus Sand impaction Enterolithiasis ```
59
Radio of the bladder: pneumocystography
- where air is introduced to see if there is air getting into the abdomen sedation, standing or dorsal recumbency 7mm diameter 5L in adult thoroughbred
60
Radio of bladder: positive contrast cystography
12ml/kgbw of contrast material LL and VD's Asses the size and position of the bladder
61
Chemicals causing injuries
Acid- coagulation necrosis Alkali- colliquation necrosis also- chemicals
62
Thermal open injuries: burns
1st degree: erythmetosa 2nd degree: bullosa 3rd degree: escharctica 4th degree: carbonisatio
63
Thermal injuries: forstbite/congelation
1st degree: ischaemia 2nd degree: thrombus, stasis 3rd degree: cell degen, stopping of circulation, necrosis
64
Electricity caused injuries
Above 50mA- critical Above 100mA- always death Cell degen and coag inlet and outelt shock
65
Depth of wounds
Supf: graze, erosion, abrasion, 2nd healing intention | Deep
66
Healing stadium of wounds
Regular or irregular Infected with complication
67
Types of wounds
``` Incised Lacerated Contused Puncture Bite Gunshot ```
68
Incised wounds
``` Sharp objects Minimal tissue damage Edges are linear and smooth Damage to the underlying tissue is only in the incision line Good prognosis, easy to fix ```
69
Lacerated wounds
``` Irregular objects Extensive tissue damage, even loss Edges are irregular Underlying tissue is damaged Poor prognosis On eye- need to make sure that they eye can close--- myiasis ```
70
Contused wounds
``` Dull objects Extensive tissue damage Edges are irregular V painful Extensive damage to underlying tissue Poor prognosis (quite similar to lacerations) ```
71
Puncture wounds
``` Sharp object Supf- point like Deep- channel Can be penetrating or perforating Anaerobe infections!!! Be careful of shoe nails ```
72
Bite wounds
Car- puncture | Herb- contused
73
Gunshot wounds
``` Inlet- primary necrotisation Channel- necrobiotical zone Outlet- molecular commotional zone Direct effect-bullet wandering Indirect effect- bullet capsulation ```
74
Conc dependent antibiotics
aminoglycosides and fluoroquinolones | Ratio of peak plasma conc to MIC should be 10:1 or 12:1
75
Time dependent antibiotics
Beta-lactams and macrolides | Keep conc above the MIC for a longer period of time
76
When would we use antibiotics prophylactically
To improve surgical outcome Should be: - bactericidal - produce effective tissue conc at the time of surgery - should be able to maintain tissue levels
77
RLP= regional limb perfusion
Distal to tourniquet apply a high conc of AB For distal limb 30ml, for more prox use a smaller volume Amikacin often used
78
Wound healing: regeneration
Replacement with normal cells of the lost tissue Cells need to then replicate (mitosis) Epithelium, bone, liver
79
Wound healing: repair
must re-establish the continuity of the interrupted tissues SCAR tissue 2nd best option to heal
80
Wound healing: partial thickness wounds
abrasion, erosion underlying epithelium migrates and proliferates Minimal input by inflamm or mesenchymal cells
81
Wound healing: full thickness wounds
acute inflamm cellular prolif matrix formation remodelling with scar formation
82
What does the acute inflamm stage consist of
``` Inflamm stage Debridement stage Cellular prolif: -connective tissue -granulation tissue -wound contraction Matrix synth and remodelling ```
83
Acute inflamm: inflamm stage
Initial vasoC Then vasoD and incr permeability- hist, bradykinin etc.-- form inflamm exudate Complement: fibrocellular clot PMNS die- release enzymes- pus Clot dehydrates- scab- protection Heat, pain, swelling, redness, functio leasa- 6-12 hrs Neutrophils: protease, phagocytosis, lysosoma, secretion into the EC matrix Monocytes Lymphocytes Complement Ig
84
Acute inflamm: Debridement stage
Starts 6hrs after injury Removal of damaged and necrotic tissue and infection Duration depends on amount of necrotic tissue and contamination PMN leucocytes- breakdown IgG's and complement- opsonins Monocytes and macrophages- phagocytosis and attract fibroblasts If wound is uninfected- macrophages should be sufficient but if contaminated will need vet intervention
85
Acute inflamm: Cellular prolif
Fibroblasts Epithelization GrRANUlation tissue Contraction of wound ``` Epithelization 12 hrs Fibroblasts- collagen synth- 3-5 days Granulation tissue- vascular loops Wound contraction- by myofibroblasts Tensile strength (tropocollagen)- 5-15 days ```
86
Cellular prolif: Connective tissue
Collagen fibres and ECM production
87
Cellular prolif: Granulation tissue
Hallmark capillaries, macrophages, fibroblasts, mast cells resistant to infection so no need for more AB's
88
Cellular prolif: wound contraction
By myofibroblasts- the contractile properties of smooth muscle
89
Acute inflamm: matrix synth and remodelling
Maturation of collagen scar Decr vasularity Decr number of fibroblasts and macrophages Tensile strength from collagen cross-linking
90
Factors affecting wound healing
1. anaemia- hypoxia- 1st phases 2. uremia 3. protein deficit 4. Zn deficit 5. Cu deficit- collagen synth 6. Vitamins- C, K, A 7. NSAID's 8. SAID's 9. Trauma 10. Infection 11. Local cleaning 12. Local anaesthetics- less leucocyte adhesion 13. Suture materials and techniques 14. Hematoma and serotoma- delay 15. Local insulin- overall positive impact 16. Bandages- can cause immobilization! Silicone dressing- nonadherent and fully occlusive. Amnion dressing is species specific 17. Magnetic field therapy- positive 18. Dehydration and edema- decreased perfusion-delayed 19. Temp and pH- healing better at higher temp and low pH
91
Primary wound healing 10-14 days
``` Space fills up with blood and the clot Ne acc at 24 hrs Macrophages on 3rd day Angiogenesis 5th day Collagen and fibroblast on the 2nd week No inflamm after 1 mnth- there may be an avascularized scab ```
92
Disorders of primary wound healing
1.Hematoma soft tissue swelling lots of clots needs to be opened and thrombotised 2. Seroma 3. Resorption fever 4. Signs of sepsis 5. Wound disjunction- colic surgery
93
Secondary wound healing
Loss of materials Open lacerated edges (granulation tissue) or Can be closed but infected The cleaning of the wound (by the body) is regressive Lots of granulation tissue Constriction of granulation tissue- scar tissue Epithelization
94
Disorders of Second intention wound healing
Longer regressive processes Quantitative problems of gran tissue formation Quality probs- breaking up, keloid formation Problems with constriction phase Problems during epithelization
95
Healing of bone fractures
Fractura= dislocation
96
Periosteal rupture often leads to callus formation
1. Hematoma 2. Acute inflamm- ne, monocytes, histiocytes 3. Granulation tissue forms from the periosteum and endosteum-- 4. Temp callous: fibroblasts diff into osteoblasts 5. Temporary osteoid, cartilage callous 6. Temporary bone callous- irregular structure 7. Regular lamellar bone callus
97
Lamellar bone callus
1. Intermediate callus lamellar bone Haver's ducts compact substance 2. Endocallus bone marrow area 3. Ectocallus extra bone formation around the fractured area- disorganisation
98
Wound infections
Always delay the wound healing reduce vasc supply increase cellular response collagenolysis
99
Clinical signs of wound infections
General: 3-6 days high fever depression decreased appetite Local: same as for inflamm! red, swelling etc
100
Bacteria causing wound infections
``` Aerobe: staph strep entrobact pseudomonas ``` Anaerobe: clostridium
101
Fungal infections
Pythius sp
102
Other factors that may cause wound infections
High conc of disinfection- decr Ne migration Bone sequester - no bs therefore necrosis- fistule channel Suture material- esp non-absorbable Talcum from gloves- septic peritonitis Metal implants
103
Antiseptics
Povidone iodine Chlorhexidine H2O2 Acetic acid- but we don't really use
104
Types of infection
Primary Secondary Exogenic- aerogenic, contact Endogenic- by the blood
105
Clean
Non-traumatic surgical wounds Hollow viscus not entered The incision does not pass through the infected tissue
106
Clean-contaminated
Surgical wound that enters the alimentary, urogenital or resp tract Minimal invasiveness eg colic
107
Contaminated
Traumatic inflamm Surgical wounds that contain "spill" from other organs
108
Dirty and infected
Old traumatic wounds (3-5days) Pus Preoperative entry into viscera e.g EINSCHUSS PHLEGMONE
109
Pyogenic infection: bacteria that can cause
``` PUS! strep rhodococcus corynebact pseudomonas E.coli ```
110
Pyogenic infection: 6-8hrs after wound
Endo and exotoxins: Thrombotisation of vessels Necrosis and neutrophils producing pus Leucocytosis Local and general signs the same as above
111
Pyogenic infection in a sutured wound
``` Swelling Tension of material and tissue Pus discharge Opening of edges 2nd intention healing ``` ``` Tx: first US the size and content open some of the suturing ABx Open if its fluctuating Drain and bandage ```
112
Erysipelas
Pyogenic usually strep and staph Fast! Forms pustules, phlegmone and gangrene Tx: ABx, sulphonamides
113
What is phlegmone
Septic or aseptic inflamm of the CT 3 main forms: subcutan, subfascial or intermuscular Special form in Eq- Einschuss Phlegmone Localized or diffuse
114
Clinical signs of phlegmone
Pain Swelling sharply demarcated and doughy Functional limitation Fever
115
Subfascial and intermuscular phlegmone
Most painful when skin over the swelling is movable Swelling is smooth and tight Not weight bearing Later pustula and gangrene Strong functional limitation and gangrene Tx: ABx, rest, hyperaemisation, warm bandage
116
Abscess
Cavity filled with pus Empyema: pus in natural body cavity e.g colic after surgery Sequester: abscess in bone
117
Causes of abscesses
``` Hematoma due to kicks Seroma Phlegmone FB infection Poor disinfection of skin Non-sterile instruments High conc of antiseptic fluids Necrotic tissue IM inj Vaccination ```
118
Signs of abscesses
Well-localized, fluctuating, painful swelling Centhesis- 18 gauge needle e.g teeth problems with fistula channels
119
Process of abscesses
Absorption Abscesses Fistula formation
120
What is pus
Serum and necrotic tissue Dead leucocytes and bacteria Is species specific
121
Where are abscesses very common
Cranial part of hoof solar surface Warm Arteries are pulsating No weight bearing
122
Putrid bacteria
ROTTEN! Clostridium Proteus Pseudomonas
123
Result of pyogenic infection
General: Toxemia Septicemia Pyemia Local: Fistulation-- use methylene blue as contrast
124
Anaerobic: gas phlegmone
``` Clostridium within 1-4 hrs due to toxins emphysematous gas production can be from gas IM injections ``` Tx: surgery, ABx, H2O2
125
Anaerobic tetanus
Clostridium tetani Punctuated deep wound Or after surgical procedures e.g castration after 10-14 days
126
Signs of anaerobic tetanus
Muscle rigidity Open nostrils Trismus- clenched jaw Prolapse of membrane nicititans Immediate therapy?: active vaccination or passive with tetanus serum For clin signs: ABx, diazepam, tetanus serum IM/IV, infusion, ear plugs, darkness, clean wound if able to find it
127
Wound treatment- surgical wounds
Goal is primary intention healing No suturing- secondary intention with contamination and lack of tissue?? Preventative ABx 15-30 mins before surgey IV Postop ABx Cleaning of site to remove microbes Removal of suture after 10-14 days
128
Wound management of a fresh injury
Not universal- depends on injury Start: patient exam or shock therapy Prompt and thorough exam- determine exact site, depth and direction of wound Which anatomical structures involved- tendons, joints, nerves, arteries
129
Local management of wounds
``` Local anesthesia- perineural Clip hair- do not shave!! could cause more damage Disinfection Excision Closing ```
130
Disinfection of wounds
Povidone iodine 0.1-0.2% Chlorhexidine 0.05% H2O2 3% Acetic acid soln- dont really use this
131
Excision of wound
``` Depends on tissue, depth of wound and contamination within 24hrs removal of all dead tissue necrotomy - bone reduce haemorrhage with ligation ```
132
Closing of wounds
Primary closing or suturing Open for draining Open wound management- when not enough skin to cover Anaerobe-- v sensitive to clostridium tetani Give vaccination but not booster vaccine give serum at around 5-10 days ABx
133
Suture material
Absorbable- jejunum and subcutan Non-absorbable- skin, laryngoplasty Monofil/ polyfil/ pseudomonofil Natural/ synthetic- mostly synthetic
134
Types of sutures
``` Simple interrupted Simple continuous Forward overlooking (continuous) suture Horizontal mattress sutures Vertical mattress sutures Subcuticular sutures Supported quill sutures Walking sutures Staples ```
135
Simple interrupted sutures
Advantage: if one stitch disrupted- doesn't affect the others- easy to remove Can be used in combo with horizontal mattress 8-figure has better tension relief Disadvantage: too slow to close, poor tension relief Not good cosmetically
136
Simple continuous sutures
Advantage: simple and tension evenly distributed Disadvantage: if one breaks the whole stitch loosened Types: Intracutaneous for abd colic surgeries with absorbable Cushing
137
Forward overlooking (continuous) suture
Advantage: rapid closure, even tension along length Disadvantage: not good cosmetically , can pucker. Slow removal
138
Horizontal mattress sutures
Advantage: high tension relief, strong, dont break down Disadvantage: slow to insert, may cause necrosis of skin if too tight. Wound edges not brought into opposition
139
Vertical mattress sutures
Advantage: good tension relief and wound edges are brought into opposition Disadvantage: Careful placement of stitches, double needle penetration
140
Subcuticular stitches
Advantages: Needs careful placement but excellent cosmetically Disadvantage: Difficult on tight skin- tension not evenly distributed Need to suture at least 2 levels- subcutis and skin
141
Supported quill sutures
Advantages: tension relief for wound margins Disadvantages: slow to insert, excessive tension. Maybe necrosis
142
Walking sutures
Advantages: minimize fluid acc in subcutaneous, reduce tension, minimize contraction of the skin Disadvantages: FB
143
Staples
Advantages: rapid, holds margins of the wound with no skin trauma Disadvantages: skin needs to be positioned manually- removal needs a special tool
144
Drain indications and types
``` Indications: Foreign material Contamination Reduce acc of blood, serum Abscess cavity ``` Types: Bandage Tubular- semi-rigid, fenestrated Penrose- soft and lumen is collapsible
145
Stents
``` Support the margins of the wound and coverage! useful when can't apply a bandage. For 2-5 days Advantages: reduces fluid acc prevent bacterial contam pressure Disadvantages: too much tension on wound wound site is difficult to examine- need to remove the stent to drain the fluid ``` e.g ulnar Fx used on the head and neck
146
How to treat an incised wound
Clean up Excision Primary suturing
147
How to treat a lacerated wound
Examine the circ of the flap and DO NOT REMOVE if the circ is good... but remember, it can necrotize after surgery Cleaning Excision- but not too much because the tissue is already tight Take special care with tendons- try to suture also.. remember hindlimb when the fetlock is flexed the hock is also because of the apparatus
148
How to treat a contused wound
Radical excision Necrotomy Suturing over drain Open management if it's too big
149
How to treat a puncture wound
Needs a thorough exam Look for foreign objects Supf: excision and suturing over a drain Body cavities: explore the opening and close afterwards Nail tread is common: flush and clean, give ABx to prevent septic bursitis and infection of the tendon sheath etc
150
How treat bite wounds
NB!! Bacterial contam! Deep: cleaning and open management Supf: excision and suturing over drain Body cavities: open, explore and close afterwards
151
Gun-shot wounds
Body cavities: open, explore and close afterwards | Removal of the bullet is not so important from a clinical point of view
152
Open joint injuries
Joint surface visible Yellow discharge and foamy discharge during motion Needs diagnostic intraarticular puncture Use of probe not advised
153
Septic joint injuries
``` Effusion Swelling Warm Painful palpation Lameness ```
154
Therapy for joint wounds
emergency- needs to be within 6 hrs before bacteria propogate Pre and postop ABx: gentamicin IM Penicillin and amoxiclav Joint lavage: the most NB! Arthroscopic- debridement of fibrin clot (remove the bacteria) Puncture away from the injured site Lots of sterile fluid needed Intraarticular ABx or regional limb perfusion with ABx (tourniquet) Then local debridement and close the wound with a drain DO NOT LEAVE THE WOUND OPEN
155
Wound management in standing position
``` Sedation Local and perineural anaesthesia Disinfection Debridement Wound lavage Suturing ```
156
Wound management in standing position: Sedation
Xylazine Detomidine Romifidine Butimidor- combo! longer, 15-30 mins
157
Wound management in standing position: Local and perineural anaesthesia
Lidocain Marcain Mepivacaine Mupivacaine
158
Wound management in standing position: Disinfection
Same as before
159
Wound management in standing position: Debridement
Removal of the injured and necrotic tissue | maybe also small pieces of bone
160
Wound management in standing position: Wound lavage
Removes debris and reduces bacterial numbers Stim microcirc Be careful not to push the contaminants deeper
161
Wound management during general anaethesia
Tendon suturing always requires! IV or Inhalational (usually longer) - premed: alpha2, combo with opioids: - induction: ketamine and diazepam - maint: myolaxin IV infusion-- can combo with xylazine and ketamine Lateral or dorsal recumbency
162
Reasons for bandaging
``` Reduce edema Prevent haemorrhage Protect the surgical sites from contam Immobilization Protection from dessication ```
163
Primary wound dressing
Applied in the surgical site or wound Sterile, semiocclusive, non-adherent Position with sterile conformational gauze
164
Secondary dressing
Applied over the primary Sheet or roll cotton 1-2cm
165
Materials needed for bandages
Padding- cotton Elastic bandage Elastic adhesive bandage

Equine Surgery and Medicine (10 decks)

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