23. Wounds 2 Flashcards
What may be some concerns with a wound on the trunk?
Penetration Abdomen or Thorax
How do you determine if a wound penetrated the Ab or Thorax?
Abdomen - take sample abdominal fluid to look neutrophils
Thorax - palpation, RR and effort, ultrasound
How do wounds on the thorax heal?
best through secondary intention and contraction
What is faster? Epithelization or contraction of a wound?
Contraction
If the thought of putting a drain in crosses your mind then you should…
Put in a drain
What should you consider with a deep wound?
Infection, good blood supply, need drainage
Close it if clean (not clean and old then dont)
Good prognosis
What is the prognosis for a wound on the front side of the cannon bone all the way down to the bone? How does it happen? Is it common?
Very common - high tensile wire
Great prognosis
Cannon bone exposed and dry so at risk of sequestrum therefore want to suture bandaid back on
What is mechanical and biological creep?
Mechanical- pull and strech skin to realign collagen and make it easier to close (1-2 hours to realign)
Biological - make more skin - expanders
What should you always remember to do ASAP with an extensor wound?
Spint it to support the limb and prevent them from knuckling over and destroying your work
What should you always warn the owner about extensor lesions?
That they will look worse before they get better
30-50% dehiscence
How and why perform a regional limb perfusion?
Intra-articular or IV
Higher antibiotic concentation (ones you cant afford systemically)
Sedate
tourniquet
Butterfly cath
aminoglyocise (amikacin)
30 min
freqency
What are some forms of wound debridement?
Mechanical - sterile saline, gauze, dressing, sharp
Chemical
Autolytic - own proteases
What does unhealthy granulation tissue or proud flesh look like?
Puffy, raised tissue that protrudes over the epithelial layer (bleeds a lot since very vascular)
How do you treat proud flesh?
Trim it back
(no need to sedate cause no nerves)
What is the most common cause of inguinal lacerations?
Foreign Body
What diagnostic should you perform to ensure you got all of the FB from an inguinal wound?
Ultrasound
What is key to treating an inguinal puncture wound?
Packing it, hosing it or exercising to keep it open to drain
What’s the prognosis for an inguinal laceration?
Great
What structures are you concerned with in a heel bulb laceration?
Pastern, coffin joint, tendon shealth, collateral cartilage
What is the longest amount of time a wound can be left in a cast before looking at it?
2 weeks
What is the key to healing a heel bulb laceration?
Immobilization
What are some types of skin grafting?
Free or Pedicle
Sheet or Island
Full thickness (punch)
Split thickness (pinch)
Autografting - from self
How does a graft heal in place?
24-48 hours after graft, nutrition from host anastomosis vessel, capillary bug invade graft
Fibrin hold in place and nutrition diffusion
10 days very firm
Why might a skin graft fail?
Reciepent bed not ready
poor harvesting
infection
movement
hematoma/seroma
wound exudate
poor blood supply
tumor/sarcoid
What are some advantages and disadvantages of skin grafting?
Easy, cheap, standing horse, functional, rewarding
Cosmetic and large wound too big
What do you need to perform a skin graft?
Needle, scaple, cotton applicator, punch biopsy
How do you know your recipents bed is ready?
Smooth
No infection
No necrotic tissue
bleed readily
If not ready prep and return 24-48 hours later cause blood make it not work as well
Where are the donor sites?
neck, pectorals, back, belly
How do you prep a donor site?
Clip, surgical prep, local anesthesia, rinse with sterile saline
Do you normally store a skin graft?
No, not enough
When placing the grafts how do you get them to stick?
Make a punch with a smaller punch biopsy guy
Make a pocket for the pinch
When wrapping the side what should you tell the owner?
Dont remove for 3-4 days, then be very careful
Use gauze that dont adherer as much
