2. Wound management Flashcards
First aid and stabilization
assess systemic status
Active arterial hemorrhage
Structural support
Diagnostics
PE - clostridium tetani
Rads
US
Probe wound
Wound management
Assessment - move to a better location when stable
Restraint/analgesia
Treatment
Prognosis
Classification of wounds
Open - partial vs full thickness Closed Clean Clean-contaminated Contaminated Infected/dirty
Golden period in Horses
NO
Choice of closure
Decision:
time appearance, type of injury, location,complications
Must understand wound healing
Closure options (4)
Primary (intention) closure (healing)
Delayed primary closure
Secondary closure
Second intention healing
Primary closure
immediate closure
Clean and clean-contaminated
Delayed primary closure
2-5d after injury - before granulation
Contaminated/questionable to properly treat
Edema and tension
Secondary closure healing
> 5d after injury - after granulation tissue
Contaminated/infected wounds
Second intention healing
Granulation tissue, wound contraction, epithelization
Phases of would healing
Inflammation/log
Proliferation
Remodeling
Inflammation/log phase
hemostasis and acute inflammation
Hemostasis: platelets, vasoconstriction -> vasodilation, fibrin deposition
Inflammation: activated platelets, PMNs, macrophages, fibroblast
Proliferation phase
Tissue formation
Macrophages - growth factors, initiation proliferation
Angiogenesis - via O2 tension, high lactate, low pH
Fibroplasia/collage/granulation tissue deposition
Collagen 2-3d after wounding (40% type 3)
Epitheliazation and wound contraction
Remodeling phase
Regaining of strength - begins in 2nd week - for years
Final scar: 15-50% weaker than original
First aid protocols
CV support Prevent further injury Hemostasis Minimize contamination Stabilize limb Tetanus toxoid
Optimal wound care
Adequate restraint: A2 agonists, NSAIDs, Opioids
Analgesia - multimodal
DEBRIDEMENT - single most important factor
Lavage - non toxics
Closure + bandage
Preventing bacterial infection of wounds
Effective wound cleansing and debridement
Dressings and bandages
Appropriate topicals
scarlet oil - granulation
Silver sulfadiazine
Polysporin ointment
Wound dressings
Hypertonic saline Antimicrobial dressing Honey Negative pressure therapy DO NOT USE CORTICOSTEROID
Hypertonic saline dressing
good for exudative or necrotic wounds
Antimicrobial dressing
Kerlix AMD - best: Polyhexamethylene biguanide
Microbes are unable to become resistant
Chronic wounds
Due to delay of owners - potions!!
Requires surgical excision, few topical agents, bandaging
