1 – Wound Management

Question 1

What are the 4 clinical considerations for wound management?

Answer 1

• Anatomic location
• Mechanism of trauma
• Degree of contamination
• Duration of injury

Question 2

Anatomic location and what to consider

Answer 2

• Head, body, limbs
  o Limbs=harder time healing (especially distally)
• Severity of wound
  o Degree of tissue disruption
  o Supporting structure injury
  o Joint involvement

Question 3

What are the various mechanisms of trauma?

Answer 3

• Laceration
• Avulsion or degloving
• Chemical burns
• Gunshot
• Puncture
• Hit by car
• Blunt trauma
• Thermal burns
• Septic injury

Question 4

Laceration

Answer 4

• Direct anatomic disruption
• Little collateral injury
• *should heal well, but takes time

Question 5

Avulsion or degloving

Answer 5

• Direct tissue loss
• Collateral damage
• *try and use skin as a biological ‘shield’

Question 6

Puncture

Answer 6

• Extent of injury undetermined
  o Use radiographs
• Predisposed to infection: bite wounds
• Predisposed to foreign body: non-healing draining tract

Question 7

Blunt trauma

Answer 7

• Massive soft tissue
• Severe skeletal damage

Question 8

Thermal burns

Answer 8

• Typically fire
  o Smoke inhalation
  o Protein loss
  o Sepsis: lost our biggest barrier (skin)
• Oncology patients: radiation injury

Question 9

Chemical burns

Answer 9

• Direct and collateral tissue injury
• Ex. Iatrogenic (ex. grounding plate, or chlorohexidine scrub)
• Ex. Copper tox
• Ex. serum scald (from wound ‘drainage’)
• Ex. chronic diarrhea

Question 10

Gun shot injuries

Answer 10

• Low velocity: tumbling phenomenon
• High velocity: shockwave collateral injury, exit wound
• *significant contamination

Question 11

Hit by vehicle

Answer 11

• High energy injury
• Frequent collateral injury
• Evaluate major body systems

Question 12

Vascular injury: what is an example?

Answer 12

• Cast complication
  o If left on too long
  o Usually over palmar/plantar aspect of fetlock

Question 13

Septic injury

Answer 13

• Secondary to Clostridial Myositis
  o Why don’t inject Flunixin Megimide IM, even though label says you can (cause need to cut open tissues to get O2 in)

Question 14

**What are the 4 classifications of wounds? (and know examples=following points)

Answer 14

1. Clean
2. Clean-contaminated
3. Contaminated
4. Dirty
   *infection rates increase as you go along

Question 15

Clean wound

Answer 15

• Exploratory laparotomy
• Ovariohysterectomy
• Castration
• *elective procedures: we have control
  o Aseptic technique
  o No viscus violated
  o No drain (so nothing can go back ‘up’)

Question 16

Clean surgery: prophylactic antibiotics?

Answer 16

• Inexperienced surgeons
  o If going to take longer or have poor technique
• Target likely pathogen (ex. Na-penicillin + gentamicin=broad spectrum antibiotics)

Question 17

Clean-contaminated surgery

Answer 17

• Small intestinal resection (you have “control”)
• Enterotomy
• Respiratory
• Hollow (viscous) organ: minimal contamination
• Perforation of surgical glove
• *if have drain=contaminated

Question 18

Clean-contaminated surgery: prophylactic antibiotics

Answer 18

• Target likely pathogens

Question 19

Contaminated wound/surgery

Answer 19

• Laceration
  o Open fresh wounds <4hrs old
• Cystostomy: infected urine spillage
• GI surgery
• *contamination

Question 20

Contaminates surgery: antibiotics therapeutic

Answer 20

• Best guess
• Wound culture

Question 21

Dirty wound/surgery

Answer 21

• Abscess
• Perforated intestinal tract
• Peritonitis
• Chronic wound (>4 hrs)
• *GIT rupture
• **antibiotics essential

Question 22

What are some patient-related factors to consider?

Answer 22

• Hypotension
• Endocrinopathies
• Gender
• Obesity
• Hypothermia
• Immunosuppressive medications
• Blood loss

Question 23

What are some procedure-related factors to consider?

Answer 23

• Surgical site clipping
• Anesthesia
• Operating room conditions
• Implanted medical devices
• Surgeon experience
• Surgical time
• Tissue handling
• Suture material electrocautery