6 – Second Intention Healing Flashcards
What are the key components to second intention healing?
- Granulation
- Contraction
- Epithelization
**What are the rates of contraction on the body and the limbs?
- Body: 1mm/day
- Limbs: 0.2mm/day
- *body better than limbs
What can cause delays in contraction?
- Inelasticity of skin
- Vascular insufficiency
- Fewer myofibroblasts
- Cytokines
What stops contraction?
- Myofibroblasts disappear (longer or older wounds)
- Contact inhibition
- Opposing tension
**What are the rates of epithelization?
- Body: 0.2mm/day
- Limbs: 0.09mm/day
- *body better than limbs
What impacts epithelization?
- Dry wound bed (scab)
- Infection
- Poor blood supply
- Necrotic tissue
- Presence of foreign bodies (ex. suture)
- Systemic factors
How long do you keep a foot cast on?
- 6 weeks
What is the philosophy behind a bandage?
- Pressure early
- After inflammation phase: “catch 22”
Pressure early (bandage)
- Minimize limb swelling
- Effectively reduces wound size
- Some degree of external coaptation (drawing tissues together)
After inflammatory phase: “catch 22” (bandage)
- May need mechanical protection
- Reduces oxygen: increase in granulation tissue production
- Slow healing
Why might a horse wound not be healing?
- Might result in sarcoid formation=may never heal
How do you need to address exuberant granulation tissue?
- Good wound management (debridement, sterile dressings, pressure bandages)
- Prevention is key
o Discontinue pressure bandage when level with skin edges
o Transition to semi-occlusive dressing
What are some examples of semi-occlusive bandages?
- Gauzes
- Films
- Foams
- Hydrogels
- Hydrocolloids
- *need people to follow the instructions you provide them with
What are some options for managing exuberant granulation tissue?
- Surgical debridement
- Topical medications
Surgical debridement
- Predictable result
- Repeat as necessary
- Hemostasis: bandage
Topical medications
- Owner friendly
- Control granulation tissue
- Impede healing
o Contraction
o Slow epithelization
What are examples of topical medications commonly used?
- Corticosteroids
- White wound lotion
- Copper sulfate
- Furacin
- Prepation H
- Amnion
- Honey
- Collagen preparations
- Split-thickness skin graft
Corticosteroids (topical medication)
- INHIBIT granulation tissue
- Slow epithelization
- Common preparations:
o Panolgo, green wound cream, 0.1% dexamethasone ointment - GOOD AND BAD
White wound lotion (topical medication)
- Lead acetate and zinc sulfate
- Metabolic toxins
- Kill fibroblasts
- Slow epithelization
- Lead poisoning
- *BAD
Copper sulfate (topical medication)
- Astringent/caustic
- Kills fibroblasts
- 10% concentration: mix with corn-starch
- *BAD
Furacin (topical medication)
- Stimulates granulation tissue production
- “sweat wounds”
- Inhibits epithelization
- Harbors pseudomonas
- BAD
Preparation H (topical medication)
- Yeast extract
- Stimulates production of granulation tissue
- Slows contraction and epithelization
- BAD
Amnion (topical medication)
- Wound dressing
- Inhibits granulation tissue
- Promotes epithelization
- Speeds healing
- *GOOD
Honey (topical medication)
- Unpasteurized (pasturized is okay)
- Osmotic: ‘sweat an animal’
- *GOOD
