Wound Management

Question 1

Why is US used for wound diagnostics?

Answer 1

To ensure that there are no foreign bodies

Question 2

What diagnostic tool measures depth of a wound?

Answer 2

Probe

Question 3

What percentage of a horses body weight is blood?

Answer 3

8%

Question 4

What should you do if a horse has unknown vaccination status vs. if a horse is unvaccinated?

Answer 4

Vaccination status unknown: booster w/ tetanus toxoid

Unvaccinated: give tetanus toxoid + tetanus antitoxin

Question 5

What is the Golden Period?

Answer 5

Period of time before which there is less than 10^5 bacteria/g of tissue

This does NOT exist in equine wound management- environment is always dirty so there is never a “clean cut”

Question 6

What is primary intention closure?

Answer 6

Debride at time of presentation then appose w/ sutures
Immediate closure
Clean and clean-contaminated wounds w/ minimal tissue loss

Question 7

What is delayed primary closure?

Answer 7

Close wound 2-5 days after injury, before granulation tissue production
Typically wounds that have questionable viability

Question 8

What is secondary closure?

Answer 8

Closure > 5 days after injury

Contaminated/infected wounds

Question 9

What is second intention healing?

Answer 9

Body heals on its own, leaves bigger scar this way

Granulation tissue present, wound contracture and epithelialization

Question 10

What is the goal for wound closure?

Answer 10

Return damaged tissue to best possible function and appearance via manipulation of healing process

Question 11

What are the three phases of wound healing?

Answer 11

Inflammation/Lag
Proliferative
Remodeling

Question 12

What occurs in the inflammation/lag phase?

Answer 12

Hemostasis and acute inflammation

Question 13

What occurs during hemostasis of the inflammatory stage of wound healing?

Answer 13

Platelet aggregation- seals vessels, release growth factors, fibrin deposition
Responsive vasoconstriction then vasodilation
Fibrin deposition

Question 14

What is the first cell on site of wounds?

Answer 14

Neutrophils

Question 15

What cells come to wounds to clean up the area?

Answer 15

Monocytes –> macrophages

Question 16

How long are macrophages present for in wounds?

Answer 16

Days to weeks

Question 17

What processes makes up the proliferative phase of wound healing?

Answer 17

Angiogenesis
Fibroplasia and granulation tissue formation
Collagen deposition
Epithelialization
Wound contraction

Question 18

What is angiogenesis initiated by?

Answer 18

Decreased O2 tension, increase lactate, decrease pH in wound

Question 19

When does collagen deposition occur post wound formation?

Answer 19

2-3 days after wounding

Initially type III collagen deposited –> shifts to type I as wound remodels

Question 20

When does epithelialization occur post-wound?

Answer 20

Immediately after wounding

Question 21

What component of wound healing most commonly results in a disaster with distal limb wounds?

Answer 21

Wound contraction (begins 2nd week after injury)

Question 22

What percentage of the original wound is reduced by contraction?

Answer 22

40-80%

Question 23

What phase is when the wound is regaining strength?

Answer 23

Remodeling

Question 24

When does the remodeling phase start and how long does it last?

Answer 24

Begins 2nd week and lasts 1-2 years

Question 25

The final scar is ____ weaker than original skin

Answer 25

15-50%

Question 26

What pain management is used for wound care?

Answer 26

Alpha-2 agonists, NSAIDs, +/- opioids

Question 27

What is the most common drug used for analgesia in wounds?

Answer 27

Phenylbutazone- IV only | Can lead to severe sloughing of skin if extravasation

Question 28

What are three common antibiotics that are used for wounds?

Answer 28

Penicillin Gentamicin Amikacin

Question 29

What is the single most important factor in success of wound healing?

Answer 29

Debridement

Question 30

What type of debridement is best in equine patients?

Answer 30

Sharp and autolytic debridement

Question 31

What is the best choice of material for irrigation of wounds in equine?

Answer 31

35 cc syringe + 19g needle

Question 32

What is the solution that is most commonly used for wound lavage?

Answer 32

Non-toxic solution- Saline

Question 33

What solutions are not effective and cytotoxic to the flesh?

Answer 33

Dilute antiseptics- Betadine & Chlorhex

Question 34

What are some "potions" that are bad for wounds?

Answer 34

Scarlet oil (increase granulation tissue formation) White lotion (used to have lead) Panalog (steroid and Ab in this which can reduce the rate of healing) Nitrofurazone (carcinogen)

Question 35

What are two safe wound agents that can be applied topically?

Answer 35

Silver sulfadiazine | Triple antibiotic ointment

Question 36

What are some different wound dressings that can be used?

Answer 36

``` Hypertonic saline Honey Antimicrobial dressing Hydrogels Calcium alginate Growth factors Semi-occlusive foam Negative pressure therapy Steroids Antiseptics ```

Question 37

What is the most common wound dressing used?

Answer 37

Hypertonic saline dressing: curasalt/20% hypertonic saline on Kerlix Used for exudative or necrotic wounds

Question 38

What is the best antimicrobial dressing used?

Answer 38

Kerlix AMD

Question 39

What active antimicrobial agent is good for post-op wounds to prevent infections?

Answer 39

Polyhexamethylene biguanide

Question 40

T/F: Corticosteroids can be used to help increase the rate of wound healing.

Answer 40

FALSE- this will decrease the rate of wound healing

Question 41

What is the most common anatomical location for wounds?

Answer 41

Distal limb