22. Wounds 1 Flashcards
How old is a wound if it has granulation tissue?
3-5 days minimum
What is a fatal flaw when examining a wound?
Ignoring a wound and not investigating its communication with a synovial structure
What kind of history questions should you ask when presented with a wound?
When did it happen?
Where? On what?
How long has it been there?
Are they UTD on tetanus?
Have you given any medications?
Does the horse look lame?
What would you do to evaluate the wound?
Stand and flex, look for swelling, abrasions, lacerations, bleeding, fluid leaking, dangerous locations, full thickness, acute, margin, visible fluid
How do you prepare a wound for examination?
Wear clean gloves and use chlorhex and iodine to clean
How do you prepare and explore a wound?
Gather supplies - glove, probe, sterile 4x4, arthrtocentis
Digit then probe
When cleaning a wound what percent betadine and chlorohexidine should be used?
0.1% Betadine (10ml in 1L)
0.05% Chlorhexidine (25ml/L)
What is the correct PSI and how do you get it to clean a wound but not drive bacteria into the tissues?
18G needle on 35cc syringe
10-15 PSI
What are some further diagnostics for wound management to consider?
Ultrasound - if you probe and have concern of a deeper tract
X-ray - if lameness not explained by wound look for fracture
Bloodwork - only referral or systemic
What are some issues with primary closure in equine wounds?
Dehiscence, anaerobic tissue, dirty
What are some purposes for bandaging a horse wound?
Control hemorrhage, protect tissue, control swelling, reduce motion, maintain topical meds, absorb exudate and wound debridement
Disadvantage:
Increase granulation tissue formation
What is a wet to dry bandage?
Wet with saline apply, then adhere as it dries, when remove take off top layer of cells (help debride)
If you are suspicious of synovial involvement and need to tap a joint, what should you never tap through?
Swollen, edema, cellulitis, wound
How do you know if a synovial structure is involved?
Arthrocentesis and Synoviocentesis
Fluid sample - Red culture, purple cytology
-Look at cells - neutrophils
(Use contrast if not enough fluid or leaked out/ take a rad to see needle right spot/use sterile saline to see if leaks out)
If a horse has a penetrating wound into a synovial structure but it is still open, are they more or less likely to be lame?
Less, closed ones more lame due to distension
Are you more concerned about a wound involving the flexor or extensor tendons?
Flexors - guarded
Extensor - ok
If you have a horse thats toe is coming off the ground when planted…what structure is most likely disrupted?
Deep Digital Flexor Tendon
How do you treat a horse with a DDFT injury?
Refer it and dorsal splint so it can walk on its toe
What is the prognosis for a horse with an injury to the DDFT and Sheath?
Guarded for survival
Poor athletics
What are the goals of equine wound management?
Full epithelization without a scar
quick
no recurrence, dehiscence or breakdown
cost effective
When you are thinking of a wound and all possible structures involved, how do you classify that wound?
Open/closed
Clean vs contaminated
Abrasion, avulsion, incision, laceration
