Wounds, Injuries

Question 1

Classification of injuries by cause

Answer 1

1. Mechanical caused
2. Chemical caused
3. Thermal caused
4. Radioactive caused

Question 2

Thermal caused injuries. Burns. Degrees

Answer 2

Burn - combustio
—
1 degree: combustio erythematosa
Dry fur, swollen skin, warm, loss of epithelium
—
2 degree: combustio bullosa
Vasodilation, leak of serum, vesicles, pain
—
3 degree: combustio escharctica
Cell injuries, protein aggregation, thrombosis, necrosi
—
4 degree: carbonisatio

Question 3

Thermal caused injuries. Frostbites. Degrees

Answer 3

Frostbite — congelatio
—
1 degree: ischaemia, hyperaemic, leak of serum, not sensitive
—
2 degree: stasis, thrombus, vesicles, infection
—
3 degree: cell degeneration, stop of circulation, necrosis, loss of larger body parts

Question 4

Chemical caused necrosis

Answer 4

• acid caused -> coagulation necrosis
• alkali caused -> colliquation necrosis

Question 5

Radioactive injuries

Answer 5

• very rare in vet medicine
• locally: redness, vesicles, loss of hair, necrosis, depigmentation, hyperkeratosis, ulceration
• generally: vomitus, diarrhoea, apathy

Question 6

Electricity caused injuries

Answer 6

• above 50mA critic general status
• above 100mA always death
• local symptoms: cell degeneration, cell coagulation

Question 7

Electricity caused injuries

Answer 7

• above 50 mA critic general status
• above 100 mA always death
• local symptoms: cell degeneration, cell coagulation

Question 8

Determination of injury

Answer 8

Loss of continuity in the skin, mucous membrane or in the organ with or without underlying tissue damage

Question 9

How do we classify wounds?

Answer 9

1. Localisation
2. Shape and size
3. Types
4. Origin
5. Age
6. Healing stadium
7. In what way (?)

Question 10

Classification of wounds. Localisation

Answer 10

• anatomical region (e.g. head, neck, thoracical region etc)
• skin, mucous membrane, muscle, tendon, joint, etc

Question 11

Classification of wounds. Shape and size

Answer 11

• point-like
• line-like
• lobed
• cavernous (пещеристый)
• loss of materia
• loss of body part
  —
• regular
• irregular

Question 12

Classification of wounds. Types

Answer 12

• superficial: e.g. graze (царапина), erosion, abrasion (натертость ?) (denuding of the epidermis, minimal bleeding, some serum exsudation)
• deep

Question 13

Classification of wounds. Origin

Answer 13

1. Surgical
2. Traumatical

Question 14

Classification of wounds. Age

Answer 14

• fresh
• old

Question 15

Classification of wounds. Healing stadium

Answer 15

• regularity healing
• irregularily healing
• infected or with complication

Question 16

Classification of wounds. In what way (specific wounds)

Answer 16

• incised -> vulnus scissum et caesum
• lacerated -> vulnus lacerum s. ruptum
• confused -> vulnus contusum
• puncture -> vulnus punctum
• gunshot -> vulnus scolopetarum
• bite -> vulnus morsum

Question 17

Wound caused by incision?

Answer 17

Vulnus scissum et caesum

Question 18

Wound caused by bite?

Answer 18

Vulnus morsum

Question 19

Vulnus scissum et caesum (incised wounds)

Answer 19

• produced by sharp objects
• tissue damage is minimal
• edges of wound are linear and smooth
• pain is minimal
• underlying tissues are damaged only in the line

Question 20

Lacerated wounds

Answer 20

• produced by irregular objects
• tissue damage is extensive
• edges of wound are smooth
• painful
• extensive damage of underlying tissue

Question 21

Vulnus contusum - confused wounds

Answer 21

• produced by dull objects
• extensive tissue damage
• irregular edges of wound
• very painful
• extensive damage of underlying tissues
• prognosis is unfavourable

Question 22

Vulnus punctum - puncture wounds

Answer 22

• produced by sharp ended objects
• superficial -> point-like; deep -> channel
• anaerobic infection very probable

Question 23

Vulnus morsum - bite wounds

Answer 23

• carnivores -> puncture wounds
• herbivores -> contused wounds
• anaerobe infection very probable

Question 24

Vulnus sclopetarium - gunshot wounds

Answer 24

• inlet: primer necrotical zone
• channel: necrobiotical zone
• outlet: molecular commotional zone

Question 25

What are 2 processes involved in healing?

Answer 25

Repair and regeneration — **Regeneration**: replacement of damaged tissues with normal cells of type lost. Tissue type should be capable to mitosis (epithelium, bone and liver) — **Repair**: stopgap reaction designed to reestablish the continuity of interrupted tissues, results in scar tissue

Question 26

Wound healing of partial thickness wounds (abrasion, erosion)

Answer 26

Primarily by **migration and proliferation of epidermal cells** from the underlying epithelium + adnexal structures (hair follicles, swear and sebaceous glands) with **little participation of inflammatory or mesenchymal cells**

Question 27

Wound healing of full thickness wounds

Answer 27

Involves 3 coordinated phases: 1. **acute inflammation** 2. **cellular proliferation** 3. **remodelling** with scar formation

Question 28

What is special in wound healing in horses?

Answer 28

- many traumatic wounds **can not** be sutured in horses because of massive tissue loss, extreme contamination, continuous movement and skin tension - study: primary closure was successful in only 24% of horse wounds and 39% of pony wounds (>50% of wounds located on the limb)

Question 29

Acute inflammation.

Answer 29

1. **Bleeding, pain** - immediately 2. **Vasoconstriction** - 5-10 minutes Mediated by: sympathomimetic amines, thromboxane (eicosanoid, produced by platelets. Main role is to promote platelet aggregation and vasoconstriction) 3. **Vasodilation** 4. **Increased capillary permeability** Mediated by: histamine, bradykinin, prostaglandins (E1, E2) (**pain!**), leukotriene B4 => cellular and non-cellular blood components can enter into the wound by diapedesis. Blood components will form fibrinogen-fibrin-fibronektin accumulation 5. **Fibrocellular clot** Barrier to protect subcutaneous tissues. PMNs (polymorphonuclear neutrophils) die - release enzymes - **pus** 6. Fibrocellular clot dehydrates -> **scab** 7. **Accumulation of an inflammatory exsudate** — Duration: 6-12 hours

Question 30

Cellualar components in the wound during inflammatory stage of acute inflammation

Answer 30

- **Neutrophils** - break down tissue debris, kill microorganisms. (Although the neutrophils help create a favourable wound environment and serve as a source of pro inflammatory cytokines, the are not essential to repair in uninflected wounds - **Mononcytes, lymphocytes, complements, Ig** - remove damaged tissues, combat infection, provide the building blocks needed for subsequent wound repair

Question 31

Debridement stage of acute inflammatory phase

Answer 31

- 6 hours after injury - removal of damaged and necrotic tissues - elimination of any infection - duration depends on quantity of necrotic tissue, contamination of the wound - **polymorphonuclear leukocytes** - aid breakdown of injured tissues - **Igs and complement system** - opsonins - removal of bacteria - **monocytes and macrophages** - phagocytosis, also regulate fibroblast functions and attract fibroblasts to the wound — **fibroblasts influx means end of this stage**