Wounds

Question 1

Classification of Surgical Wounds
‘Clean’

Answer 1

Aseptic conditions, closed by sutures

Question 2

Classification of Surgical Wounds
‘Clean- contaminated’

Answer 2

Aseptic conditions- mild contamination e.g entering into alimentary, urogenital, respiratory tract.

Question 3

Classification of Surgical Wounds
‘Contaminated’

Answer 3

Fresh traumatic wound or surgical wound with break in aseptic technique

Question 4

Classification of Surgical Wounds
‘Dirty’

Answer 4

A traumatic wound over 6 hours old.

Question 5

Incised wound

Answer 5

Usually caused by sharp cutting object

Question 6

Laceration

Answer 6

Tear (dog fight RTA)

Question 7

Avulsed

Answer 7

skin torn away from body- flap

Question 8

Abrasion

Answer 8

graze

Question 9

3 phases of wound healing

Answer 9

Inflammation
Proliferation/granulation
Remodelling/maturation

Question 10

Roles of inflammatory exudate

Answer 10

rich in protein and RBCs
Dilutes irritants/toxins
Delivers fibrinogen/antibodies/nutrients/O2.

Question 11

What do we need to consider when assessing a
wound?

Answer 11

Severity of injury?
open or closed wound?
Tissue involved?
Age of wound?

Question 12

Healing by primary (first) intention

Answer 12

Suturing.

Question 13

Healing by Secondary Intention

Answer 13

Significant tissue loss, healing by granulation.

Question 14

Delayed primary healing

Answer 14

High infection risk- delayed closure.

Question 15

What does granulation tissue contain

Answer 15

Macrophages, fibroblasts, connective tissue and blood vessels.

Question 16

Wound Factors Affecting Healing

Answer 16

• Blood supply
• Dehydration of wound
• Excessive exudate
• Foreign body
• Necrosis
• Recurring trauma
• Low temperature
• Seroma formation

Question 17

Systemic diseases which effect wound healing

Answer 17

• Malnutrition
• Haematological disease
• Cardiac disease
• Respiratory disease
• Renal/hepatic disease
• Chronic infection
• Certain drugs

Question 18

Conditions that impair

Answer 18

Tissue perfusion:
Immune response: FIV
Mobility

Question 19

Drugs affecting wound healing

Answer 19

• Cytotoxic
• Antineoplastic
• Immunosuppressive agents
• Corticosteroids
• NSAIDs
• Anticoagulants

Question 20

Sinus

Answer 20

A blind infected tract lined with granulation tissue
leading to a focus of infection

Question 21

Fistula

Answer 21

tract connecting two epithelial
surfaces.
Congenital or acquired

Question 22

Incisional hernia

Answer 22

A hernia that occurs through a previously
made incision in the abdominal wall, i.e. the scar left from
a previous surgical operation

Question 23

GRANULATION TISSUE characteristics

Answer 23

Immature connective tissue
Granular surface
Highly resistant to infection (macrophages)
stronger repair (high no. fibroblasts)

Question 24

Fibrous tissue characterists

Answer 24

Mature connective tissue
white collagenous fibres
Scar tissue caused (fibrosis)

Question 25

Reasons for the Use of Drains

Answer 25

Remove dead space in wounds Drain contamination remove fluid or air from the body cavities

Question 26

Drains work by

Answer 26

* Pressure differentials * Overflow * Gravity * Capillary action

Question 27

Methods That Can Be Used To Eliminate Dead Space

Answer 27

1. Surgery (sutures) 2. Pressure bandages 3. Surgical drains

Question 28

How long can you leave a surgical drain in for

Answer 28

up to 3-5 days

Question 29

Open Drains

Answer 29

prophylactic drainage therapeutic drainage of contaminated wounds All are passive * Rely on capillary action for drainage

Question 30

Penrose Drains

Answer 30

Open Drain latex rubber passive drainage Capillary action and gravity no fenestrations mainly flows over the outside of the tube can cause tissue reactions

Question 31

Corrugated Drains

Answer 31

ribbed strips of rubber or PVC no internal lumen more rigid than Penrose drains likely to cause tissue damage and reactions

Question 32

Yeats Corrugated Drain

Answer 32

lots of tubes placed side by side allowing fluid to pass over the surface as well as through the lumen

Question 33

Tube Drains

Answer 33

cylindrical rigid materials can be used for active suction fluid travels through the lumen

Question 34

Sump Drain

Answer 34

have two or more lumens one large and one small. large lumen: exit for fluid smaller lumen: allows air into the wound reduced risk of drain blocking

Question 35

Sump Penrose Drain

Answer 35

sump drains placed in the middle Penrose drain

Question 36

Facts for placing drains

Answer 36

Radiopaque never exit a wound through the primary incision Dressing should cover drains to prevent infection Hair must be clipped around the drain exit sites

Question 37

Complications Associated With Drain Placement

Answer 37

Wound infection Wound dehiscence (breakdown) Premature loss or retention Failure of drainage Pain or irritation Drain tract cellulitis

Question 38

Active Drains

Answer 38

use suction to remove exudate or air Closed system mechanical or manual suction

Question 39

Most common active drain

Answer 39

Thoracic

Question 40

Jackson-Pratt (JP)

Answer 40

Active drain bulb shaped

Question 41

Chest Drain Placement

Answer 41

between ribs 9 and 12 open end: between the 7th and 8th intercostal space

Question 42

Chest drain suction unit

Answer 42

Underwater seal or air tap

Question 43

Chest drain Heimlich valve

Answer 43

One-way valve that allows air to move out of the thorax as the animal breathes. Animals that way >8-10KG Needs constant monitoring

Question 44

Care and Management of Drains

Answer 44

* Note type and amount of fluid * Ensure patency * aseptic technique * Avoid reflux back onto body cavity * Change dressings regularily

Question 45

Chest Drain Removal

Answer 45

Removed 24 – 48 hours post-operatively Suction applied to prevent air being sucked back into the chest