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Treatment of Large Animal Wounds Flashcards

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1
Q

Wound healing has 3 overlapping stages…. what are they?

A

Inflammatory phase
Proliferative phase
Remodeling phase

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2
Q

What occurs during the inflammatory phase of healing?

A

Vasoconstriction for hemostasis
Vasodilation
Formation of provisional wound matrix
Cellular response

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3
Q

how long does the inflammatory stage last for?

A

0-3 days

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4
Q

How long does the proliferative phase last for?

A

2-14 days, usually active by day 3

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5
Q

What is the main objective of the proliferative phase?

A

protection of the wound surface by formation of granulation tissue & new epithelium

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6
Q

What is the purpose of angiogenesis?

A

To restore oxygenation & supply nutrients to granulation tissue

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7
Q

What is important to remember about granulation tissue?

A

It does NOT have nervous innervation

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8
Q

When does the remodeling phase begin?

A

Around day 7+

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9
Q

What percentage of final wound strength is achieved in the first 3 weeks?

A
  • 20%
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10
Q

How long can scar formation take?

A

up to 2 years

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11
Q

Which heals better, ponies or horses? Why?

A

ponies - due to the differences in local inflammatory response & functional capacity of leukocytes

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12
Q

What are the 4 ways of classifying a wound based on contamination?

A
  • Clean
  • Clean-contaminated
  • contaminated
  • dirty or infected
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13
Q

What is a clean wound?

A
  • surgical incisions made under aseptic conditions
  • primary closures
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14
Q

What is a clean-contaminated wound?

A

Surgical incisions made to involve the respiratory, GI, or urogenital tracts entered under controlled conditions

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15
Q

What are contaminated wounds?

A

open wounds
Traumatic wounds
Sx incisions w/ major breaks in asepsis

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16
Q

What are dirty or infected wounds?

A

Exudative
Traumatic wound w/ delayed txt
Obvious contamination
Devitalized tissue present

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17
Q

What are examples of open wounds classified by type?

A

incisions, erosions, lacerations, burns, abrasions, punctures

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18
Q

What are examples of closed wounds classified by type?

A

bruises, hematomas, contusions

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19
Q

When classifying a wound based on bacteria, what are the options?

A

clean, clean-contaminated, contaminated
Dirty or infected

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20
Q

When classifying a wound based on time, what are the options?

A

Class 1 - < 6 hrs w/ minimal contamination
Class 2 - 6-12 hrs w/ significant contamination
Class 3 - >12 hrs w/ gross contamination

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21
Q

What sedative would you use when trying to assess wounds?

A

alpha-2 agonist & opioids

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22
Q

When do you take a swab for culture & sensitivity for wound management?

A

before you clean OR if its very contaminated, clean the outer aspect of the wound then lavage w/ sterile saline before swabbing deep

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23
Q

Determine the extent of wound by…

A
  • probing/sterile gloved finger
  • assess for damage to vital structures
  • assess for foreign bodies, sequestrate, etc
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24
Q

What are some general considerations during wound management?

A
  • Owner’s goals
  • treat or refer?
  • wound closure
  • antibiotics, anti-inflammatories, TAT, or toxoid
  • what type of dressing or bandage?
  • box rest?
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25
What type of local anesthetic can be used?
distant perineural nerve blocks ring or splash blocks
26
What is the duration of action of lidocaine?
90-180 mins
27
What is the duration of action of mepivacaine?
120-180 mins
28
What is the duration of action of bupivicaine?
180-500 mins
29
What are the aims of debridement?
- reduce bacterial load & remove necrotic tissue - more rapid & cosmetic healing - minimise trauma to the wound bed
30
What are the main types of debridement?
sharp, mechanical, chemical, biological, and autolytic
31
What are the most common types of debridement in equines?
sharp and autolytic
32
What are some benefits to sharp debridement?
- one of the least traumatic - cost effective - allows assessment of tissue viability - minimal equipment required
33
What are the 3 main forms of mechanical debridement?
woven gauze Lavage Versajet
34
When doing mechanical debridement with lavage, what is the appropriate pressure & volume?
10-15 psi by using a 35 ml syringe & 19 g needle with non-cytotoxic solution like sterile saline
35
What does versajet do?
uses water to debride mechanically
36
What are the types of autolytic debridement?
- hydrogels - manuka honey - chemical debridement
37
What are the three types of wound closure?
primary closure delayed primary closure second-intention healing
38
What are some considerations that have to be made when closing wounds?
- vascularity & tissue health - debridement - management of dead space/debridement - facilities available - box rest or not - bandaging
39
What are some indications for mechanical debridement?
- surgical incisions - minimal tissue loss - minimal bacterial contamination - minimal tension on wound edges - exposed vital structures
40
What are examples of appositional suture patterns?
simple interrupted cruciate interrupted vertical mattress
41
What are examples of tension-relieving or everting suture patterns?
interrupted horizontal mattress near-far-far-near far-near-near-far walking suture
42
What is the aim of drains?
to channel unwanted fluids & air from tissues or body cavities
43
What are some reasons to use a drain?
- eliminate dead space - allow drainage of fluid/gas from the wound cavity - prevent anticipated build-up of fluid
44
what makes an ideal drain?
inert, soft, non-reactive, radiopaque
45
what are some complications with drains?
foreign body response ascending infection delayed healing
46
What are some examples of passive drains?
gauze, penrose, sheet, tube
47
What are some active drains that can be used (closed-suction systems)?
infected joints under full thickness skin grafts large deep wounds evacuating pleural space
48
When should a primary wound closure being used?
whenever possible
49
Why is primary wound closure ideal?
- reduced healing time - improved cosmesis - less aftercare & subsequently expense - earlier return to function
50
What are some indications for delayed primary closure?
- initial treatment to allow debridement & reduce contamination - mild/moderate bacterial contamination - minimal tissue loss - minimal tissue tension
51
When is second intention healing used?
- when neither primary or delayed primary closure is possible
52
What are some indications for second intention healing?
- primary/delayed primary closure not possible - unmanageable contamination - established infection - excessive tissue loss
53
Granulation tissue is...
- very vascular - devoid of nervous tissue
54
What are some indications of skin grafting?
- defects that exceed the ability of epithelialization or conventional closing techniques - where cosmesis is important in large, slow-healing wounds - where rapid healing is required
55
What are some common topical treatments?
- fucidic acid 'Isaderm' - Silver sulphadiazine 'Flamazine' - Manuka Honey - Vulketan Gel - Aloe Vera - Corticosteroids
56
What is normal synovial fluid?
- translucent, pale yellow - viscous - TP = <10-20 g/L - WBCs = 0.2 x 10^9 g/L
57
What is abnormal synovial fluid?
- increased volume - lowered viscosity - abnormal appearance
58
Cloudy, turbid, amber synovial fluid is a sure sign of...
septic arthritis
59
Haemorrhagic synovial fluid is a sure sign of...
traumatic arthritis
60
When looking at synovial fluid, what are sure signs of definitive sepsis?
WBC >100 x 10^9 g/L TP >40 g/L Neutrophils >90%
61
synovial contamination is an...
emergency
62
if there is exposed bone, what should you do on Day 1
Take radiographs
63
What is special about exuberant granulation tissue (EGT)?
it has no nerves but is increased blood supply - unique to horses
64
What is bandaging used for?
- protection - pressure - support/immobilisation - absorption - optimal healing environment
65
Contact/primary layer of bandaging is a ... layer and is either... or ...
Sterile layer adherent or nonadherent
66
What is the second layer of bandaging?
padding or conforming bandage
67
What is the outer layer of bandaging?
cohesive bandage for compression and support
68
What is adhesive tape for in bandaging?
to prevent slipping and debris tracking in or can be applied over length of bandage for extra compression & support
69
Splinting of limb fractures depends on...
location and have been divided into 4 levels for fore & hindlimbs
70
An effective splint must...
provide rigid support to neutralize the distracting forces acting at the fracture site
71
An inappropriate splint can make...
a fracture worse
72
Splints should extend one joint ...
above and below a fracture splint

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