Bandaging & Open Wound Management (15) Flashcards
Dr. Devine
When does granulation tissue appear? What about epithelialization?
granulation: day 5
epithelialization: days 4-6
What should you do when FIRST encountering a wound - equine?
stop the bleeding!
How long out can you close an equine wound - primary closure?
up to 12 hours
What else should you do upon triaging an equine wound patient?
check on tetanus status
When do you give a tetanus toxoid booster if a horse has a wound?
vaccinated more than 2 months ago
What is some patient restraint for equine patients when bandaging?
What should you visually asses for in equine wound patients?
wound location - check blood supply, synovial structure involvement, others?
contamination/infection: 10^5 organisms, foreign material, necrotic tissue
How do you clean an equine wound and surrounding tissues?
clip: apply sterile to wound, clip at least 2 in around the wound
antiseptics: povidone iodine, chlorhexidine, sterile saline
What are some equine wound anesthesia?
medications: lidocaine or mepivocaine
local: nerve blocks
What do use to explore with wound exploration/lavage?
digital palpation
sterile probe
radiographs - sterile probe or contrast material
What are the materials for wound lavage in equine?
18g needle on an 35 mL or 60 mL syringe
10-15 psi
What solution do you use to lavage an equine wound?
normal saline or LRS
What do you do for synoviocentesis?
sterile prep AWAY from the wound
- avoid going through edema/cellulitis and introducing bacteria
How do you know if a synovial structure is involved with a wound?
stick needle on the opposite side and see if it comes out the other
ex. Wound on the medial side? sterilely prep, stick needle with sterile saline on the lateral side
This is the medial side of a horse. Where should you stick sterile saline to see if it communicates with a synovial structure?
lateral side
What are the 3 main ways of equine wound debridement?
- sharp
- mechanical
- autolytic
How do you wound debride an equine wound - sharp?
use a scalpel blade - debride most superficial layer
How do you wound debride an equine wound - mechanical?
wet to dry bandage
not once epithelialization has started
How do you wound debride an equine wound - autolytic?
- moist wound healing
- white blood cells and enzymes degrade necrotic tissue, leave healthy tissue alone
What is a primary wound healing with equine?
- close immediately
- warn owner of possible dehiscence
What is a delayed primary wound healing with equine?
- close after a period of debridement
- within 3-5 days of the injury
- mild/moderate contamination
What is a delayed secondary wound healing with equine?
- close after granulation tissue is present
- excise exuberant granulation tissue first
What is a second intention healing with equine?
- no closure
- large wounds
- chronic, contaminated, skin loss
- after granulation tissue is present
What is the purpose of draining closed wounds?
important to prevent accumulation of exudate that will compromise closure
What materials for a closed drain?
Jackson-Pratt
doesn’t have to be ventral
What materials for an open drain?
Penrose
must be placed at most ventral location
What are the constraints of a Penrose drain?
must be placed at most ventral location
How do you suture equine wounds?
minimal tissue reactivity, sufficient strength
non-absorbable monofilament
What suture patterns for wound closure equine - non-tension?
simple interrupted
What suture patterns for wound closure equine - high tension?
vertical mattress and near-far-far-near
What are wound dressings for equine bandaging - gauze?
wet-to-dry bandages , debridement of heavily contaminated and exudative wounds
wet gauze with saline
What are wound dressings for equine bandaging - telfa pad?
surgical wounds or sutured wounds
- non-adherent, non-occlusive
How do you bandage equine limbs (direction, medial/lateral side)?
counterclockwise on the left limbs
clockwise on the right limbs
start on the medial side of the leg
Where do you put tension on the bandage?
as you pass over the dorsal cannon bone
What are the veterinary bandage supply steps?
telfa pad
white gauze
sheet cotton
brown gauze
vet wrap
elastikon
What are the reusable bandage materials?
standing wraps, pillow wraps, no bows, quilts
polo wraps, standing wraps
How do you bandage over joints?
- can do a stack wrap or center over the joint
- minimize pressure over boney prominences
- use gauze to pad the accessory carpal bone and point of hock
What does this diagram show?
carpal bandage
What does this diagram show?
tarsal bandage
What are these pictures showing?
splinting
What is splinting often made from?
often made of PVC pipe and duct tape or white tape
proper padding is VERY important
How do you apply a foot bandage?
- wrap tight on the hoof, loose on the skin
- may or may not have padding
- LOTS of duct tape on the bottom of the foot
What are complications of bandaging?
- exuberant granulation tissue formation
- pressure sores
- “bandage bows”
What are “bandage bows”?
extensor or flexor tendon inflammation (no actual disruption of the tendon)
Bandaging ruminants most commonly involve the ________
foot procedures
How do you perform a claw block?
block goes on the unaffected claw
What are some bandaging ruminant differences?
watch out for the dew claws
What is proud flesh?
exuberant granulation tissue
What can happen if you bandage after granulation tissue is present?
hypoxia
What happens with involvement of synovial structures?
small, seemingly innocuous wounds can VERY serious
requires immediate referral
What bone sequestrum?
dead, infected piece of bone
non-healing wound
What is cellulitis?
severe edema in the limb associated with a relatively small wound - infection of the subcutaneous tissues
requires aggressive therapy
