CAL 4: wound reconstruction, dressings and bandages Flashcards
Define exudate
Fluid that discharges from a wound
Define wound contraction
reduction in size of a wound following centripetal movement of skin edges
Define fungating
a wound characterised by ulceration, necrosis and proliferative components which is often smelly
How would you deal with a wound with slough/discharge?
Example?
Remove debris and discharge
Dressing example: hydrogel or alginate
How would you deal with a wound that is granulating?
Example?
protect fragile tissues and vessels
Example = hydrogel, foam, paraffin gauze
How would you deal with a wound that is epithelialising?
Example?
promote new epithelium and wound contraction
perforated film, foam, parffin gauze
What is a vapour-permeable dressing?
When should you use one?
a dressing that is impermeable to water and bacteria
aids moisture and protection
not for infected wounds
What is a hydracolloid wound dressing?
When should you use one?
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.
What is an alginate wound dressing?
When should you use one?
good for bleeding wounds, packing wounds and heavy exudate
they are absorbent, augment haemostasis and increase rate of GT formation
What sort of dressing maintains a moist environment and is suitable for exudating wounds?
passive absorbent foam dressing (polyurethane most absorbent)
What sort of dressing do you use of a smelly, fumagating wound?
carbon dressing (absorb exudates and bacteria and help reduce odour, can be used on infected wounds, impregnating dressing with silver particles –> anti-bacterial action)
What sort of dressing may you use for debriding devitalised tissue?
wet to dry or dry to dry
What sort of dressing may be used for a free skin graft?
passive non-adherent dressing (crucial otherwise graft may be removed when dressing is changed)
What is an example of a barrier dressing? When are they changed?
spray-on barrier film (replenished as needed e.g. every 2-3 days and will dry and flake off a few days later)
What sort of dressing may be applied to a surgical site before incision?
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)
What do hydrogels provide?
gentle debridement that may be used in an infected wound
What method of wound management, type of closure and reconstruction may you use in a distal limb degloving wound?
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
What method of wound management, type of closure and reconstruction may you use in an elective laparotomy wound?
MANAGEMENT: primary closure, passive non-adherent dressing (e.g. perforated polyurethane with a foam backing and adhesive edges such as Primapore)
What method of wound management, type of closure and reconstruction may you use for the surgical excision of a mammary tumour affecting gland 5?
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
What method of wound management, type of closure and reconstruction may you use for a perianal wound?
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
What method of wound management, type of closure and reconstruction may you use after removing a mass from the dorsal surface of the metacarpus?
primary closure if possible
avoid tension or tourniquet effect
What method of wound management, type of closure and reconstruction may you use excision of a large soft tissue sarcoma from skin over sternum?
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 **
What method of wound management, type of closure and reconstruction may you use for a shallow puncture wound over dorsal flank?
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
How can circular wounds be closed? 3
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
How would you deal with a bite wound affecting thoracic cavity?
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
How would you deal with a shearing wound affecting the medial aspect of the hock?
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
How do you manage dog-ears resulting from wound closure with edges of unequal lengths?
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)
How would you manage a recent sharp laceration to the proximal thoracic limb? 2
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.
