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SA Sx > Wound Stuff (Cav)-Exam 1 > Flashcards

Wound Stuff (Cav)-Exam 1 Flashcards

1
Q

What type of wound has no infection and asepsis was maintained?

A

Clean wound

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2
Q

What type of wound deals with a hollow organ but no bacteria contamination involved or there was a minor break in asepsis?

A

Clean-contaminated

Ex: foreign body retrieval

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3
Q

What type of wound deals with a hollow organ that has open and spilled or a major asepsis break occurred?

A

Contaminated

Ex- BITE WOUND

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4
Q

What type of wound contains pus or contents of perforated organ implying infection?

A

Dirty

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5
Q

Define asepsis

A

minimize incidence of sx wound infection

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6
Q

What is the relationship of time and risk in surgery?

A

Risk doubles every hour in sx- TIME IS TRAUMA

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7
Q

What are the three risk factors for infection?

A
  1. duration of sx
  2. increasing number of persons operating
  3. dirty sx site
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8
Q

What are the six risk factors contributing to infection/inflammation?

A
  1. duration of anesthesia
  2. duration of postop stay
  3. wound drainage
  4. Increased patient weight
  5. dirty sx site
  6. antimicrobial prophylaxis
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9
Q

What is the most common source of operating wound infections?

A

Patients’ endogenous flora- GI/skin

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10
Q

What is the difference of prophylactic and therapeutic antibiotic use?

A

Prophylactic: administration of Ab PRIOR to wound contamination/creation of wound
Therapeutic: infection already present

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11
Q

What is the minimum time that Ab should be administered prior to sx?

A

30 minutes before (not longer than24 hrs.)

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12
Q

How can postoperative infections be minimized?

A

Good nursing care- incision lines protected, wash hands/glove up between patients, remove catheters and drains in a timely manner

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13
Q

What is the lag phase of wound healing and when does it occur?

A

First 3-5 days

Inflammation & debridement predominate and wounds have not gained much strength

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14
Q

What are the four phases of wound healing?

A
  1. Inflammatory phase
  2. Debridement phase
  3. Repair
  4. maturation/Remodeling phase
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15
Q

When does the inflammatory phase occur?

A

Within minutes of injury

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16
Q

inflammation is a positive response that is initiated by what?

A

Tissue damage

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17
Q

What are some examples of cellular response in the inflammatory phase?

A

Increased permeability of blood vessels, recruitment of circulatory cells, release of growth factors & cytokines and activation of WBC

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18
Q

What is the first response to injury?

A

Hemorrhage

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19
Q

What process controls hemorrhage with a fibrin clot (glues edges of wound together)

A

Vasoconstriction

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20
Q

What process dissolved plug in lymphatics turning clot into a scab?

A

Fibrinolysis

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21
Q

What process increases permeability causing a release of inflammatory mediators

A

Vasodilation

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22
Q

What initiates the debridement phase?

A

Leakage of WBC into wound

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23
Q

Where does the debridement phase occur?

A

In the wound bed when neutrophils and monocytes arrived

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24
Q

What prevents infections and phagocytize organisms and debris?

A

Neutrophils

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25
Q

What cell is ESSENTIAL for wound healing?

A

Monocytes

Lymphocytes/neutrophils are NOT essential

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26
Q

What do macrophages secrete?

A

Collagenases- removes necrotic tissue, bacteria, and foreign material
Chemotactic factors- direct macrophages to injured tissue
Growth factors- initiate, maintain & coordinate formation of granulation tissue

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27
Q

What occurs in the repair phase?

A

Macrophages stimulate fibroblast & DNA proliferation

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28
Q

What type of environment do fibroblasts prefer?

A

Acidic and oxygen rich environment

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29
Q

What is angiogenesis?

A

Capillaries infiltrate wound under fibroblasts- relies on interaction of extracellular matrix w/ cytokines

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30
Q

What is formed with the combination of fibroblasts, new capillaries and fibrous tissue development 3-5 days post wound?

A

Granulation tissue

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31
Q

What are the functions of granulation tissue?

A

Barrier to infection
External source of special fibroblasts
Surface for epithelial migration

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32
Q

What is epithelialization?

A

Mobilization, proliferation & differentiation of epithelial cells

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33
Q

What is the time period of epithelialization for sutured wounds vs. opened wounds?

A

Sutured wounds: 24-48 hrs

Open wounds: 4-5 days

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34
Q

T/F: Migration of epithelial cells is random but guided by collagen fibers

A

TRUE

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35
Q

What is the term for when there is contact on all sides w/ other epithelial cells inhibiting further cell migration?

A

Contact inhibition

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36
Q

What environment does fast epithelialization occur in?

A

Moist

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37
Q

T/F: Oxygen rich environment prevents epithelial migration and mitosis

A

FALSE- anoxic environment

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38
Q

What type of bandages delay re-epithelialization?

A

wet-to-dry bandage

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39
Q

What is wound contraction?

A

size of wound reduced from fibroblasts, reorganizing collagen in granulation tissue & myofibroblast contraction at the wound edge

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40
Q

What does wound contraction occur simultaneously with?

A

Granulation & epithelialization

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41
Q

What is necessary for initiation of contraction?

A

Fibroblastic invasion

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42
Q

What is contraction inhibited by?

A

skin around wound being fixed, inelastic, under tension or when myofibroblasts are inadequate

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43
Q

When does the maturation phase begin?

A

Once adequate levels of collagen are reached (17-20 days post injury)

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44
Q

What type of collagen fibers increase vs. decrease?

A

Increase- Type I

Decrease- Type III

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45
Q

When does the most rapid gain in wound strength occur?

A

Between 7-14 days post injury b/c of rapid collagen accumulation

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46
Q

T/F: Normal tissue strength is regained months after inury

A

FALSE- never regained. Only about 80% strength is regained

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47
Q

What class of wound has minimal contamination or tissue damage?

A

Class I- 0-6 hrs. post wound

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48
Q

What is the golden period?

A

insufficient microbial replication to cause infection and can manage with primary closure

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49
Q

What class has microbial replication to critical level possible and at what time frame is this seen?

A

Class II- 6-12 hrs. post wounding

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50
Q

What class does microbial replication at critical level allow for infection?

A

Class III- >12 hrs. post wounding

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51
Q

What type of wounds will receive primary closure?

A

Class 1 & some 2 wounds

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52
Q

What is delayed primary closure and what class is associated with this?

A 
Appositional closure before granulation tissue develops 
Good for class 2 wounds
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53
Q

What is secondary closure?

A

Appositional closure after granulation tissue has developed

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54
Q

What is second intention healing?

A

Healing by contraction/epithelialization or open wound management

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55
Q

What are the 8 fundamentals of wound management?

A
  1. Assess patient
  2. Prevent nosocomial infections
  3. Aseptically clip/scrub area
  4. Lavage
  5. Procure culture of wound
  6. Debridement
  7. Select appropriate surgical closure method
  8. Provide drainage if necessary
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56
Q

T/F: Scrub the area around and the wound itself

A

FALSE-only scrub around the wound- can cause irritation, toxicity, pain and potentiate wound infection if scrubbed inside wound

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57
Q

Why should alcohol never be used on open wounds?

A

Damages open tissue

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58
Q

How does lavage reduce bacterial numbers?

A

loosening and flushing bacteria and associated necrotic debris away

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59
Q

What is the preferred lavage solution?

A

Sterile isotonic saline or balanced electrolyte solution

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60
Q

T/F: Antiseptics have little effect on established infection

A

TRUE

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61
Q

What should be used for initial cleaning of heavily contaminated wounds?

A

Running, luke worm tap water

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62
Q

What is a potential disadvantage of tap water when dealing with wound cleaning?

A

Causes hypotonic tissue damage

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63
Q

What is the goal of lavage?

A

Remove particulate debris/bacteria w/ mechanical contact, inertial force and exudate infected wounds and remove toxins associated with infection

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64
Q

What is the ideal lavage pressure?

A

7-8 psi

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65
Q

When should your wound culture be taken?

A

initial debridement- preferred

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66
Q

What are the most common organisms that cause infection?

A

Staph and E. coli

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67
Q

What type of cultures should be requested in heavily contaminated wounds?

A

Aerobic/anaerobic

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68
Q

What type of wounds is topical antimicrobials use?

A

Open wounds-applied in 1-3 hrs. of contamination infection is prevented

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69
Q

What route of antimicrobials would be used for heavily contaminated wounds?

A

Topical/systemic antimicrobial therapy

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70
Q

What prevents topical Ab from reaching effective levels in tissues deep in the wound and prevents systemic antibiotics from reaching superficial bacteria?

A

Wound coagulation

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71
Q

What must be performed to allow Ab access to bacteria in wound?

A

Wound debridement

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72
Q

Which topical antimicrobials are used for superficial skin wounds?

A

Bacitracin, neomycin & polymyxin

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73
Q

Which bacteria do topical antimicrobials have poor efficacy against?

A

Pseudomonas spp.

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74
Q

Which topical antimicrobial can retard wound contraction?

A

Zinc bacitracin

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75
Q

What topical antimicrobial is effective against most gram +/- and fungi?

A

Silver sulfadiazine

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76
Q

What is the drug of choice used to treat burn wounds?

A

Silver sulfadiazine

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77
Q

What is the process of removing dead/damaged tissue, foreign material & microorganisms from wound?

A

Debridement

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78
Q

What are the two types of surgical debridement?

A

Layered and En bloc

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79
Q

What is the difference of layered vs. en bloc debridement?

A

Layered: devitalized tissue sx excised in layers beginning from surface and progressing into wound
En bloc: entire wound can be excised if sufficient healthy tissue surrounds the wound & vital structures can be preserved

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80
Q

What is the advantage of en bloc debridement?

A

Wound care greatly accelerated

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81
Q

What must you be careful of in terms of cats and debridement?

A

Don’t take extensive SQ in cats as it may delay wound healing

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82
Q

What is the difference of autolytic and biosurgical debridement?

A

Autolytic: creation of a moist environment to allow endogenous enzymes to dissolve nonviable tissue
Biosurgical: maggot therapy using greenbottle fly larvaeas the maggots secrete proteolytic digestive enzymes into wound

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83
Q

What is autolytic debridement highly selective for?

A

Devitalized tissue ONLY

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84
Q

Why is fluid accumulation detrimental to wounds?

A

Acts as a growth medium for bacteria, separates tissue planes that should be healing together, creates pressure leading to pain and decreased blood flow

85
Q

What are the two classifications of drains?

A

Active and Passive

86
Q

How does a penrose drain operate?

A

Relies on gravity dependent flow of fluid in dead space

87
Q

T/F: Fluid travels through a penrose drain?

A

FALSE- flows on either side of it, no need to fenestrate the drain

88
Q

How long should a drain be left in typically?

A

5-7 days-longer risks infection

89
Q

Where should drain exit sites be placed?

A

most dependent area of dead space at least 1 cm from wound

90
Q

Why shouldn’t the drain exit through the primary incision line?

A

increases risk ofwound dehiscence

91
Q

Why should cold compress be avoided in the wound?

A

Freezes fluid in wound

92
Q

What is the gold standard active drain?

A

Jakson pratt

93
Q

How does the jackson pratt drain work?

A

Relies on concept of active removal of wound fluid w/ negative suction-complete seal needed to create suction

94
Q

T/F: No need to make fenestrations with a Jackson Pratt drain

A

FALSE- fluid travels in the drain-relies on fenestrations

95
Q

What is the difference of the exit site of a Jackson Pratt drain as opposed to a penrose drain?

A

Jackson pratt drains exit dorsal to wound in NON-DEPENDENT portion of wound

96
Q

What is a major advantage of the Jackson Pratt tube?

A

quantification of drain production at home

97
Q

How much fluid does the body produce as a reaction from the drain?

A

1-2 mL/kg/day

98
Q

At what rate of drainage should you remove the drain?

A

Decreased below 5 mL/kg/day= < 0.2 mL/kg/hr

99
Q

What is the most common problem of active drains?

A

Loss of suction during healing- make sure grenade is securely attached to tube and evacuation port is closed (common problem)

100
Q

What is the first step of open wound management?

A

Debridement-removes all contaminants

101
Q

What is the most selective type of debridement?

A

Autolytic debridement- spares healthy cells by only targeting necrotic/damaged tissue

102
Q

What is the least desired form of debridement?

A

Mechanical debridement (nonselective)- physical removal of tissue adhered to a dried on dressing

103
Q

What are the three layers of bandages?

A

Primary (contact) layer (sterile)
Intermediate (secondary) layer (non-sterile)
Outer (tertiary) layer (non-sterile)

104
Q

What is the adherent layer used for?

A

Mechanical debridement of necrotic tissue and debris and absorption of wound exudate

105
Q

When is non-adherent bandage used?

A

When granulation tissue has formed but current wound care standards recommended use of hydrophilic nonadherent contact layers for all wounds

106
Q

What is the most commonly used bandage in veterinary medicine?

A

Semi-occlusive

107
Q

Wet-to dry and dry-to-dry bandages are examples of what type of bandage?

A

adherent bandage

108
Q

Telfa, adaptic, hydrogels and hydrocolloids are examples of what type of bandages?

A

Non-adherent bandage

109
Q

T/F: once granulation tissue has formed you can still use wet-to-dry bandages?

A

FALSE- only used in early wound management

110
Q

What kind of debridement does wet-to-dry bandage use?

A

Mechanical debridement- moving away from these bandages

111
Q

___ MVTR strongly correlates w/ positive wound healing outcome and predictive of healing

A

Low MVTR (moisture vapor transmission rate)

112
Q

What should bandages be covered with?

A

3-layer modified Robert Jones

113
Q

How often should bandages be changed during the inflammatory phase?

A

Q2-3 days

114
Q

How often should bandages be changed once granulation tissue has formed?

A

Q5-7 days

115
Q

What are three different substances used in open wounds?

A

Manuka honey, sugar and low-level laser therapy

116
Q

What pressure increases blood flow to a wound, accelerates rate of granulation tissue formation, decreases bacterial counts &improves flap survival?

A

125 mmHg NPWT

117
Q

When are negative pressure wound therapy used?

A

Large open & effusive wounds devoid of granulation tissue; chronic non-healing wounds, postop mgt of tissue flaps, open abdominal mgt for septic abdomen

118
Q

T/F: Not all bites are considered contaminated

A

FALSE- all bites are contaminated wounds

119
Q

Why are all bite wounds considered contaminated?

A

contain polymicrobial flora reflecting the flora of the oral cavity of biter, skin of victim and environmental pathogens

120
Q

What is the most common pathogen cultured from bite wounds?

A

Pasteurella multocida

121
Q

What kind of injury is caused by a K9 dog bite?

A

Crushing, tearing and avulsion injury

122
Q

What is the iceburg effect?

A

appearance of wound doesn’t look bad but the damage underneath is extensive

123
Q

Where do bites occur in large breed dogs vs. small dogs?

A

Large breed dogs: neck & face

Small breed dogs: dorsum

124
Q

Cat bites have more of puncture wounds, what concern rises from that?

A

Higher risk of infection

125
Q

Cervical injuries have risk for damaging what leading to what two major side effects?

A

trauma to trachea potentially leading to pneumomediastinum w/ potential for respiratory embarrassment

126
Q

What should always be done when a patient is presented with thoracic and abdominal wounds?

A

Radiographs to ensure penetration into a cavity hasn’t occurred

127
Q

Why are drains not needed in the head and extremities?

A

Natural drainage due to gravity

128
Q

What confirms abdominal penetration?

A

Free peritoneal air, visible hernia- always explore and probe wound

129
Q

What is required in a patient IMMEDIATELY when presented with abdominal bite wounds?

A

Immediate exploratory laparotomy

130
Q

What is the term for when heat energy is applied at a faster rate than tissue can absorb &dissipate?

A

Thermal injury= coagulative necrosis & irreversible skin damage

131
Q

What is the recommended source of heat in veterinary practice for patients?

A

HotDogTM- circulates warm water in a mat

132
Q

What type of burn involves the outermost epidermis and typically heals spontaneously within 3 weeks via epithelialization?

A

1st degree burn

133
Q

What type of burn involves full thickness epidermis & dermis, non-painful and dark brown in color?

A

3rd degree burn

134
Q

what type of burn involves the epidermis and a portion of the dermis, painful and can spontaneously re-heal but takes months?

A

2nd degree burn

135
Q

Burns involving <15% TBSA require what?

A

Minimal supportive therapy

136
Q

Burns involving >20% leads to what?

A

Greater risk of systemic effects

137
Q

Burns involving >50% may warrant what?

A

Euthanasia

138
Q

When managing wounds, how should the hair be clipped?

A

WIDE- to ensure that there are no underlying bruises, small wounds or cuts under hair

139
Q

What is the best protection agains wound colonization & infection?

A

Silver sulfadiazine

140
Q

When are degloving injuries commonly seen?

A

limb caught beneath a car tire and dragged- typically involving the tarsocrural joint

141
Q

What results from injury of collateral ligament or fracture of medial or lateral malleolus?

A

Subluxation

142
Q

What results form injury of both medial & lateral collateral ligament complexes, fracture of both malleoli or fracture of one w/ injury to contralateral collateral ligament complex

A

Luxation

143
Q

What type of wound closure is always the ideal choice?

A

Primary wound closure

144
Q

What are the six goals of wound closure?

A 
Minimal tension
full return to function
pain-free final outcome
cost effective
acceptable cosmesis
satisfied owner
145
Q

What are the Halsted Principles?

A 
Gentle tissue handling
Meticulous control of hemorrhage
Observe strict aseptic technique
Preserve blood supply to tissues
Eliminate dead space
Appose tissues accurately w/ minimal tension
146
Q

What are the seven wound factors for decision making/planning?

A

Size, geometric shape, anatomic location, chronicity, bacterial load, structural damage, peri-wound status

147
Q

What species has lower cutaneous perfusion and early wound breaking strength?

A

Cats

148
Q

What type of closure patterns are used for fascial/intramuscular closure?

A

Simple interrupted or continuous

149
Q

What is the most common suture material?

A

Polydioxanone (PDS)

150
Q

What is the minimum amount of throws to start continuous PDS?

A

5

151
Q

What is the minimum amount of throws to finish continious PDS?

A

7

152
Q

What size suture is used for SQ wound closure?

A

3-0 & 4-0

153
Q

What suture pattern is used for SQ wound closure?

A

Simple continious

154
Q

What does adding 2 extra throws do?

A

Increases knot volume & tissue reactivity by factor of 1.5

155
Q

What are the typical subcuticular –> intradermal closure patterns?

A

Continuous horizontal, continuous vertical or SQ-to-intradermal

156
Q

What are the typical suture material for cutaneous wounds?

A

Ethilon or polypropylene

157
Q

What type of wound closure should be avoided in wounds with tension?

A

Tissue adhesives (cyanoacrylate)

158
Q

What happens if a wound was closed by direct approximation of edges?

A

Tension will lead to ischemia from suture pressure

159
Q

What is commonly seen on wound closures of the extremities?

A

Biological tourniquet effect

160
Q

CT orients in what direction in relation to tension?

A

parallel

161
Q

What is the best way to close wounds in relation to tension lines?

A

Should be closed parallel with the tension lines

162
Q

How are incision lines made in relation to tension lines?

A

Parallel to tension lines

163
Q

How should you close wounds on extremities in relation to tension lines?

A

Perpendicular with tension lines

164
Q

What is undermining and the purpose of it?

A

Draws upon full elastic potential of skin in closure used to allow for tension relief

165
Q

What are the two methods to undermine tissue?

A

Blunt technique- closed to open blades. Performed in loose areolar hypodermal tissues associated w/ truncal skin
Sharp technique- open to closed blades. Appropriate in extremities

166
Q

What are the three tension relieving suture patterns?

A

Mattress sutures (vertical/horizontal)
Far far near near
Far near far near

167
Q

WHy is the horizontal mattress not ideal?

A

Concerned of potential compromised blood supply

168
Q

What is the purpose of the far-far and near-near aspects of the tension relieving suture pattern?

A

Far-far eliminates tension-placed 1 cm from edge

Near-near apposes and placed 5 mm from wound edges

169
Q

What is the purpose of the releasing incision?

A

Made near defect to allow skin apposition

170
Q

What is the purpose of walking sutures?

A

used to advance skin towards center of wound

171
Q

When is a V-Y plasty indicated?

A

Chronic defects surrounded by inelastic skin & closing wounds near structures that would be distorted by closure under tension
Ex: eye

172
Q

Which direction should the point of the chevron be made in terms of the defect?

A

Point of the chevron should be made away from defect

173
Q

What direction of the central arm of the z-plasty made in terms of the wound direction?

A

Perpendicular to long axis of the wound

174
Q

When is m-plasty used?

A

When one end of incision would be compromised by orifice, foot pad or for reconstruction of cranial aspect of mastectomy

175
Q

What is the mechanical creep?

A

Skin can extend its natural boundaries through phenomenon

176
Q

What is stress relaxation?

A

Less fore required to maintain collagen fibers because collagen loses natural recoil

177
Q

Where should the first suture be placed when closing fusiform shaped defects?

A

Across widest part of wound-continue dividing in half with subsequent sutures

178
Q

When closing crescent shaped defects, which side should have sutures placed farther apart?

A

Longer side of the wound- closes in a T

179
Q

What stitch should be used to close the center of triangle shaped defects?

A

half-buried horizontal mattress stitch

180
Q

What kind of suture pulls dog ear down and away from wound?

A

Apex cutaneous suture

181
Q

What are the three distinct plexuses that make up subdermal plexus?

A

SQ- deep plexus
Cutaneous- middle
Subpapillary- superficial

182
Q

Ensure adequate ___ & ___ of surroudning skin with subdermal pelxus flap

A

Redundancy & vascularity

183
Q

What is the ideal flap length of a subdermal pleuxs flap?

A

1.5X length of wound

184
Q

What is an advancement flap?

A

Shifting skin w/out rotation

185
Q

What is a roatational pivotal flap?

A

Pivotal flaps that have curvillinear configuration- designed immediately adjacent to defect & best used to close triangular defects

186
Q

What is a transpostition pivotal flap?

A

pivotal flap w/ linear axis

3:1 rule= flap length:width

187
Q

How is a interpolation pivotal flap different from the transposition flap?

A

Base is located at some distance from defect

188
Q

What areas on the body are flaps commonly predisposed to. seromas and why?

A

Flaps from lateral flank & thorax

Large amount of deadspace

189
Q

What do axial pattern flaps rely on at the base of the flap?

A

cutaneous artery and vein

190
Q

When are axial flaps most commonly used?

A

facilitate wound closure after tumor resection or trauma

191
Q

What flap is most commonly used to repair caudal abdominal flank, inguinal, preputial, perineal, thigh and stifle defects?

A

Caudal superficial epigastric APF

192
Q

What flap is good for sternal defects?

A

Cranial superficial epigastric APF

193
Q

What flap is good for medial/lateral tibial defects?

A

Genicular APF

194
Q

What is. the most common composite flap?

A

Myocutaneous

195
Q

What composite flaps are commony used for forelimb defects?

A

Latissimus dorsi myocutaneous flap

196
Q

What flap is used to repair prepubic tendon ruptures or femoral hernias?

A

Cranial & Caudal Sartorius MF

197
Q

What are the four phases of graft incorporation?

A
  1. Adherence
  2. plasma imbibition
  3. Inosculation
  4. Vascular ingrowth
198
Q

When does Phase I adherence occur in graft incorporation and what occurs in this phase??

A

0-72 hrs

Contraction of fibrin strands pulling graft closer to bed

199
Q

When does Phase II adherence occur in graft incorporation and what occurs in this phase?

A

72 hrs-10 days

fibrin to fibroblasts, leukocytes, phagocytes –> fibrous adhesion (glue)

200
Q

Describe the plasmatic imbibition stage of graft incoporation

A

0-72+ hrs
graft vessels dilate & pull fibrinogen free, serum like fluid & cells into graft via capillary action
nourishes wound prior to blood vessel development

201
Q

When does inosculation stage occur in graft incorporation and what occurs in this phase?

A

48/72 h-6 days

anastomosis of cut ends of graft vessels w/ recipient bed

202
Q

When does vascular ingrowth stage occur in graft incorporation and what occurs in this phase?

A

48 h-6/8 days

ingrowth of new vessels from bed into graft

203
Q

What is vascular ingrowth controlled by?

A

Cytokines

204
Q

How long until reinnervation occurs after graft implantation?

A

3 weeks

205
Q

What is a common graft used that has multiple slits cut parallel in rows to allow the graft to expand in two directions and increase in size?

A

Full-thickness meshed skin graft

206
Q

What does the meshing of the skin graft provide?

A

Drainage, flexibility, conformity & expansion

207
Q

When would you use a full-thickness meshed skin graft?

A

Drainage from a wound w/ minor exudate
Cover large defects
Reconstruction of irregular shaped surfaces

208
Q

What type of mesh graft is recommended for most grafting needs?

A

Non-expanded- full thickness mesh graft

SA Sx (22 decks)

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