Wound Healing Complications Flashcards
(29 cards)
What are the key types of traumatic/open wound?
Abrasion Shear/degloving Laceration Puncture Crushing Burns
What is an abrasion?
Partial thickness skin wound
Through epidermis and part of dermis
What is a laceration?
A tear resulting in a full thickness irregular skin wound
Variable amount of damage to underlying tissue
What are puncture and crushing wounds?
Small surface wound can have deeper effects e.g. crushing muscle, FBs etc
What are the stages of wound healing?
Coagulation
Inflammation
Migration/proliferation
Remodelling
What is the progression of cell types in wound healing?
Platelets Neutrophils Macrophages Fibroblasts Lymphocytes
What is healing by secondary intension?
A clean wound that will heal by itself
What is healing by primary intention?
A clean wound that can be closed surgically
What are the principles of open wound management?
1) Assess and stabilise the whole patient
2) Initial in depth wound assessment - wound cleansing and debridement
3) Wound closure/reconstruction
What should you do to assess and stabilise the patient?
1) cover wound with sterile dressing to parent nosocomial (hospital acquired) infection (get nurse to - focus of vet is what is life threatening)
2) Stabilise the patient - deal with any potentially life threatening conditions
3) Sedate or ideally anaesthetise the patient for in depth wound assessment
How do you perform an initial in depth wound assessment ?
Cover the wound surface
Clip and clean around the wound as for aseptic surgery
Lavage wound
Debride wound
Close wound or continued wound debridement and care
Why should you cover the wound surface before cleaning the surrounding skin?
Protect the open wound from hair etc being clipped and other surface debris
What is the best solution to use for lavage?
0.9% ringer - lactated solution
What should you use to debride a wound?
Scalpel
How should you debride a wound if it is more than 6 hours old and significant ?
Consider staged debridement
When should you close the wound?
Less than 6h old No remaining necrotic tissue No remaining gross swelling/bruising All contaminated tissues debride Healthy wound
When should you consider continued debridement?
More than 6h old Concern of ongoing necrosis Appears infected Significant skin/tissue loss Simple closure over a penrose drain not possible
What is the goal of continued wound debridement?
Healthy granulation tissue
What are the features of healthy granulation tissue?
Macrophages - naturally antibacterial
Fibroblasts - Lay down collagen to strengthen the wound and act as a scaffold for angiogenesis
Endothelial cells - creating capillary loops to bring nutrition to the wound
Epithelial cells migrating from wound edges into the wound
What are the types of debriding dressings?
Wet-to-dry dressing
Hydrogel
Honey/sugar
Negative pressure wound therapy
How does a wet-to-dry dressing work?
Moist sterile gauze applied to wound
Dry sterile gauze applied on top and held securely onto wound
Draws exudate out of wound into the moist then dry
Gauze adjacent to wound dries
Bacteria and necrotic tissue dry out and adhere to gauze
Mechanical wound debridement as dressing is removed
What are the benefits of wet-to-dry dressings?
Inexpensive
Available
Easy to apply
Effective
What are the disadvantages of wet-to-dry dressings?
Must be changed every 12-24h or as soon as moisture penetrates the outer layer (strike through)
Pain on removal - requires sedation and/or anaesthesia
How do hydrogels work?
Gives up water to the wound and maintains moist wound
Wound exudate remains in contact with the wound
-endogenous GFs and cytokines promote healing
- Endogenous enzymes break up necrotic tissue
- Attracts white blood cells - phagocytosis of tissue debris and bacteria
