22. Classification of wounds and management options

Question 1

22. Classification of wounds and management options

Answer 1

Wounds
-wound–injury to the body that results in disruption of the continuity of the body structure
-can be classified in several ways(clean, contaminated etc.)
-the main principles of wound healing are the same for all types

Classification of wounds
-open wounds
>surgical incision
>laceration
>abrasion
>avulsion
*degloving
*shearing
>puncture
*bite/sting:cat/dog;snake;insect;tick
*firearm
-burn:thermal;chemical;electrical;radiation
>pressure sores
>cast- and bandage-related
-closed wounds
>contusion
>hematoma
>crush injury
>hygroma

Incisional injuries and lacerations
-surgical or traumatic
edges generally clean and free from tissue damage
-tend not to get infected
>minimal contamination
>sufficient bleeding to decrease tissue colonization
>rarely significant damage to surrounding tissues
-deep wound–physical exploration/imaging!
-surgical management

Abrasions
-superficial damage not extending beyond the dermis
-frictional forces when moving parallel to a rough surface,usually at speed
-combination of graze,abrasion and avulsion
-generally heavily contaminated
-severe abrasions with ongoing tissue necrosis might become avulsions
-surgical vs open wound management

Avulsions(degloving injuries)
-avulsion-the separation of tissue from their deeper
attachments(usually including muscle)(kudosten eriytyminen)
-degloving-skin and deeper tissues torn from an
extremity,just as a glove is removed from the hand(mechanical vs physiological)
-defects often extensive and complex
-may be initially free of bacterial contamination,but without appropriate wound management rapid
colonization and infection of necrotic tissue will occur
-degloved skin should be preserved where possible
-surgical/open wound management/in combination

Avulsions(shearing injuries)
-usually involve loss of deeper tissues(including skin,tendons,muscle, possibly bone)
-the joints of the distal limb frequently exposed
-heavily contaminated with bacteria and debris
-extremely prone to infection
-need for orthopedic surgery?
-open wound management

Puncture wounds
-caused by any sharp object that pierces the skin to create a relatively small deficit or hole
-bite wounds(also insects/snakes);impalement (full penetration);oropharyngeal; firearm wounds(lead!?)
-contamination/infection variable
-damage assessment!
-risk of abscessation
-damage assessment!!(possible perforation
of a cavity without a
skin wound)
-entry holes smaller than exit holes

Burns
-caused by extreme temperature(hot or cold)or by contact with a chemical substance,electricity or radiation
* 1st,2nd,3rd degree→thickness(damage)
-‘’rule of nines“?(not accurate in veterinary medicine)
-may require prolonged treatment,monitoring(inpatient)
-treatment depends on the case

Pressure sores
-caused by pressure typically on the elbows and hocks of large dogs
-open or closed wounds
-open sores prone to infection(bones and joints)
-hygromas(best treated medically)
-medical/surgical treatment

Cast-and bandage-related wounds
-iatrogenic wounds are common
>ischemic injury due to overtight application of bandaging
>inadequate padding of vulnerable areas
>excessive exercise,allowing bandage slippage
>wet or dirty bandages(higher risk of bacterial strikethrough and infection)
-serious wounds may result in the loss of digits or limbs