Wounds & Wound Healing

Question 1

The most commonly encountered classification of operative wounds

Answer 1

Clean wound

Question 2

A surgically created wound where:

No infection is encountered

Asepsis is maintained

No structure containing bacteria is opened (other than skin)

Answer 2

Clean wound

Question 3

A surgically created wound in which:

Hollow viscus or organ containing bacteria is opened BUT no contents are spilled

A minor break in asepsis has occurred (like a hole in the surgeon’s glove)

Answer 3

Clean-contaminated wound

Question 4

A surgically created wound in which:

A hollow viscus or organ is opened and GROSS SPILLAGE has occurred

A major break in asepsis has occurred

OR:

ANY TRAUMATIC WOUND

Answer 4

Contaminated wound

Question 5

A surgically created wound in which:

The opened structure contains PUS

or

Contents of a perforated hollow viscus

I.E. Peritonitis

Answer 5

DIRTY wound

Question 6

The risk of infection during surgery _______ every hour

Answer 6

DOUBLES

Question 7

A _________ wound implies infection

Answer 7

DIRTY

Question 8

What is the most common source of operative wound infection?

Answer 8

The patient’s endogenous flora (skin, GIT)

Question 9

When are prophylactic antibiotics indicated?

Answer 9

When the patient is very old or immunosuppressed

When the surgery is estimated to last over 1 hour

When risk of infection is high/would have catastrophic results

When the surgeon is inexperienced

Question 10

How long should prophylactic antibiotics be continued perioperatively?

Answer 10

Not longer than 24 hours (and longer will mask infection development)

Question 11

What type of antibiotics are preferred for prophylactic use?

Answer 11

SINGLE AGENT (not broad spectrum!)

Ex: Cefazolin or Cefoxitin

Question 12

Open traumatic wounds should initially be considered

______ at best

Answer 12

Contaminated

Question 13

How does healing of superficial wounds differ in dogs and cats?

Answer 13

In cats, SQ tissue plays an important role in healing and immune response.

(If SQ in cats is damaged, wound will take longer to heal)

Question 14

What is a common organism found in bite wounds in cats?

How is it treated?

Answer 14

Pasteurella

Tx with Penicillin Abx

Question 15

What type of suture material is most appropriate for

a clean-contaminated wound?

Answer 15

Short/intermediate lasting ABSORBABLE MONOfilament suture

(because suture can increase risk of infection)

Question 16

Burn wounds significantly ______ the metabolic state

Answer 16

INCREASE

Question 17

Fluid resuscitation is indicated in burns greater than ________% TBSA

(total body surface area)

Answer 17

15%

Question 18

What is the difference between a sinus and fistula draining tract?

Answer 18

Sinus tract = communication between MESOTHELIAL surfaces and skin

Fistula tract = communicatoin between 2 EPITHELIAL surfaces

Question 19

A non-healing sinus tract is most commonly caused by _________

Answer 19

PLANT material foreign bodies

Question 20

What is the “Golden Period” in relation to wound infection development?

How long is it generally?

Answer 20

The time from contamination to when bacteria invade and replicate

to > 10⁵ / gram of tissue

Generally 6 - 8 hours

Question 21

What is an IFP and where are they most likely found?

Answer 21

Infection Potentiating Factors

which are negatively charged particles with large surface ares that

inhibit phagocytosis and bacterial killing by the host

Most commonly found in soils and clays (grass awns)

Question 22

What is the best way to lavage a traumatic wound without causing

iatrogenic tissue damage?

Answer 22

Using Chlorhexidine (0.05%) under moderate pressure (7 - 8 psi)

and a syringe and needle (18 - 20G)

BEWARE using Chlorhexidine in CATS (hypersensitivity rxns)

Question 23

What are the disadvantages of using Providone-Iodine for wound lavage?

Answer 23

The residual activity is TOO SHORT (4 - 6 hours)

Forms inactive complexes with organic matter

Can be systemically absorbed –> TOXICITY and METABOLIC ACIDOSIS

Question 24

What is the most commonly used method of surgical debridement?

Answer 24

LAYERED debridement

(start at surface and work your way down until ok to have closure)

Question 25

What kind of wound dressing is used for Autolytic wound debridement?

Answer 25

Moisture retentive dressing

Question 26

Which method of wound debridment helps mobilize questionable tissue (either white or black eschar)?

Answer 26

_Enzymatic_ wound debridment (uses **Granulex**)

Question 27

What type of wound dressing is used for mechanical wound debridement?

Answer 27

ADHERENT primary dressing

Question 28

When is mechanical wound debridement primarily indicated?

Answer 28

Wounds in the LAG phase with heavy contamination or thick viscous exudate

Question 30

Negative wound pressure therapy (VAC) for open wound management works best when used on wounds in the __________ phase or \_\_\_\_\_\_\_\_\_\_ phase of wound healing

Answer 30

_LATE LAG (Debridement)_ Phase or _EARLY PROLIFERATIVE_ Phase of wound healing

Question 31

What is the major benefit of VAC (Negative wound pressure therapy)?

Answer 31

Accelerated granulation tissue formation (48 hours instead of 4 - 5 days)

Question 32

Which of the following does NOT promote granulation tissue formation? Calcium Alginate Honey Sugar Maltodextrin

Answer 32

Calcium Alginate (C-Salt)

Question 33

What are the indications for WET-to-DRY adherent dressings?

Answer 33

Necrotic tissue Foreign bodies High viscosity exudate

Question 34

What are the indications for DRY-to-DRY adherent dressings?

Answer 34

Wounds with high fluid production which need debridement (Degloving, bite wounds, lacerations, deep cavity wounds)

Question 35

These dressings are better than adherent dressing for wounds in LATE debridement/proliferative phase of wound healing

Answer 35

Non- adherent **moisture retentive** dressings (autolytic wound debridement)

Question 36

What is the most commonly used type of PASSIVE drain?

Answer 36

Penrose drains

Question 37

What is the most commonly used type of ACTIVE drain?

Answer 37

Jackson-Pratt drain

Question 38

What are the 4 classifications of wound closure?

Answer 38

Primary Delayed Primary Secondary Second Intention (Contraction and Epithelialization)

Question 39

What classification of wound closure is described by the following? Immediate closure of a wound after a procedure

Answer 39

Primary closure

Question 40

What classification of wound closure is described by the following? A wound closed BEFORE formation of granulation tissue that is left open for **2 - 5 days**

Answer 40

Delayed Primary Closure

Question 41

What classification of wound closure is described by the following? Wound closure AFTER granulation tissue is formed and covers the wound

Answer 41

Secondary CLOSURE

Question 42

What classification of wound closure is described by the following? Healing by union by adhesion of granulating surfaces, when the edges of the wound are far apart and cannot be brought together. AKA: Contraction and epithelialization

Answer 42

SECOND INTENTION healing