CAL 4: wound reconstruction, dressings and bandages

Question 1

Define exudate

Answer 1

Fluid that discharges from a wound

Question 2

Define wound contraction

Answer 2

reduction in size of a wound following centripetal movement of skin edges

Question 3

Define fungating

Answer 3

a wound characterised by ulceration, necrosis and proliferative components which is often smelly

Question 4

How would you deal with a wound with slough/discharge?

Example?

Answer 4

Remove debris and discharge

Dressing example: hydrogel or alginate

Question 5

How would you deal with a wound that is granulating?

Example?

Answer 5

protect fragile tissues and vessels

Example = hydrogel, foam, paraffin gauze

Question 6

How would you deal with a wound that is epithelialising?

Example?

Answer 6

promote new epithelium and wound contraction

perforated film, foam, parffin gauze

Question 7

What is a vapour-permeable dressing?

When should you use one?

Answer 7

a dressing that is impermeable to water and bacteria

aids moisture and protection
not for infected wounds

Question 8

What is a hydracolloid wound dressing?

When should you use one?

Answer 8

a dressing that is good for dissolving necrotic tissue and slough

more gentle debridement of wounds than wet-to-dry dressing. not for infected wounds.

Question 9

What is an alginate wound dressing?

When should you use one?

Answer 9

good for bleeding wounds, packing wounds and heavy exudate

they are absorbent, augment haemostasis and increase rate of GT formation

Question 10

What sort of dressing maintains a moist environment and is suitable for exudating wounds?

Answer 10

passive absorbent foam dressing (polyurethane most absorbent)

Question 11

What sort of dressing do you use of a smelly, fumagating wound?

Answer 11

carbon dressing (absorb exudates and bacteria and help reduce odour, can be used on infected wounds, impregnating dressing with silver particles –> anti-bacterial action)

Question 12

What sort of dressing may you use for debriding devitalised tissue?

Answer 12

wet to dry or dry to dry

Question 13

What sort of dressing may be used for a free skin graft?

Answer 13

passive non-adherent dressing (crucial otherwise graft may be removed when dressing is changed)

Question 14

What is an example of a barrier dressing? When are they changed?

Answer 14

spray-on barrier film (replenished as needed e.g. every 2-3 days and will dry and flake off a few days later)

Question 15

What sort of dressing may be applied to a surgical site before incision?

Answer 15

vapour-permeable film (conflicting evidence as to whether these dressings reduce contamination of the surgical site and infection. But they also reduce drape strike-through and may reduce the incidence of peri-operative hypothermia)

Question 16

What do hydrogels provide?

Answer 16

gentle debridement that may be used in an infected wound

Question 17

What method of wound management, type of closure and reconstruction may you use in a distal limb degloving wound?

Answer 17

MANAGEMENT: open wound until a healthy bed of GT forms. Only second intention healing if small wound.

CLOSURE: free skin graft or distant direct flap

Question 18

What method of wound management, type of closure and reconstruction may you use in an elective laparotomy wound?

Answer 18

MANAGEMENT: primary closure, passive non-adherent dressing (e.g. perforated polyurethane with a foam backing and adhesive edges such as Primapore)

Question 19

What method of wound management, type of closure and reconstruction may you use for the surgical excision of a mammary tumour affecting gland 5?

Answer 19

primary closure
simple apposition of edges (most)
If defect is too large –> undermine the skin, walking sutures too to permit tension-free closure
If glands are removed from left and right chains, skin closure is difficult so bilateral surgeries are best performed as a staged procedure

Question 20

What method of wound management, type of closure and reconstruction may you use for a perianal wound?

Answer 20

second intention (if sufficient surrounding tissue)
functional sphincter incompetence is possible
primary closure or a relaxing incision (bipedicle advancement flap) allows first intention healing near anus to occur, with management of the donor site by primary closure or second intention healing

Question 21

What method of wound management, type of closure and reconstruction may you use after removing a mass from the dorsal surface of the metacarpus?

Answer 21

primary closure if possible

avoid tension or tourniquet effect

Question 22

What method of wound management, type of closure and reconstruction may you use excision of a large soft tissue sarcoma from skin over sternum?

Answer 22

primary closure with simple appositon unlikely to be possible
skin adheres to underlying mm here –> skin undermining is harder and risks damage to BVs
***local flaps (advancement, rotation, transposition) or flaps from axillary fold are best method **

Question 23

What method of wound management, type of closure and reconstruction may you use for a shallow puncture wound over dorsal flank?

Answer 23

difficult to explore puncture wounds fully to ensure they ar esuitable for primary closure so should be managed by delayed primary closure or should undergo an en bloc excision and be closed primarily

Question 24

How can circular wounds be closed? 3

Answer 24

by converting into an ellipse with long axis directed parallel to tension lines (simple) OR close centripetally from 3 or 4 points (harder) OR close wound in linear fashion, parallel to tension lines and manage the resulting dog-ears at each end

Question 25

How would you deal with a bite wound affecting thoracic cavity?

Answer 25

explore to assess extent and depth
SMALL: en bloc debridement and primary closure
LARGER/DEEPER: surgical debridement and management as an open wound prior to closure. If the wound involves vital structures (e.g. thoracic cavity) then more rigorous debridement and closure is more important

Question 26

How would you deal with a shearing wound affecting the medial aspect of the hock?

Answer 26

Manage as an open wound until a healthy bed of GT develops and then close. Small defects may heal by second intention (resulting fibrosis may help stabilise limb). Free skin graft is often needed for larger defects

Question 27

How do you manage dog-ears resulting from wound closure with edges of unequal lengths?

Answer 27

simplest method = incise the dog-ear down the middle and remove one small triangle of skin from each side (other methods too but little benefit)

Question 28

How would you manage a recent sharp laceration to the proximal thoracic limb? 2

Answer 28

if minimal debris and devitalised tissue then = ‘surgically clean’ with debridement and lavage, then primary closure. A drain is normally used if primary closure is used.
OR
manage as an ope wound for a few days and then delayed primary closure.