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A U E R S & T > Chapter 27 - Management of Superficial Wounds, deeps and chronic wounds, sinus tracts, fistulas > Flashcards

Chapter 27 - Management of Superficial Wounds, deeps and chronic wounds, sinus tracts, fistulas Flashcards

1
Q

What is the largest organ in the body

A

skin

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2
Q

What are the main functions of the skin

A
  1. Protect against wear + baterial invasion
  2. Aid thermal regulation
  3. Prevent water loss
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3
Q

What is the average of the skin thickness?

A

3.8 mm thcik
near body opening 3.3 mm
mane and tail 6.2 mm

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4
Q

The skin of horses is _______ than swine, goats, and sheep and thinner than that of ________

A

The skin of horses is __thicker_____ than swine, goats, and sheep and thinner than that of _____beef catle___

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5
Q

From superificial to deep the skin is composed by epidermis and dermis. Mention the 4 layers of keratinocytes of epidermis from superficial to deep

A
  1. Stratum corneum: diminish water loss
  2. Stratum germinativum
  3. Stratum spinosum
  4. Stratum basale
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6
Q

What is the main vascular supply of the dermis?

A

it comes from the subcutaneous area

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7
Q

The dermis underlis and supports the epidermis. Mention the 2 layers

A
  1. Superficial papillary layer
  2. Deep reticular layer
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8
Q

What other ç beside keratinocytes are visible in the epidermis?

A
  1. melanocytes
  2. Merkel cells for mechanoreception of light touch
  3. Langerhans ç - engulfing foreign material
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9
Q

Where does the dermis has a third layer of collagenous fibers?

A

In the:
1. lumbar
2. sacral
3. gluteal regions

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10
Q

To each hair follicle the are _____(nº) sebaceous glands, sweat glands and nerves

A
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11
Q

Ckevage lines or _________ (1w) lines of tension whose orientation is parallel to the predominant orientation fo the collagen fibers

A

Langer lines. When possible incisions should be made parallel to the clevage lines

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12
Q

What is the most important step in wound therapy?

A

Wound assessment

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13
Q

What should be assessed before using sedation?

A

Systemic status

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14
Q

What could sedation cause in a horse that has lost a lot of blood?

A

Collapse

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15
Q

What alternatives exist to systemic sedation?

A

Manual restraint, local anesthesia

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16
Q

What is applied over the wound before clipping hair?

A

Sterile lubricating gel

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17
Q

What can make an initially insignificant wound dangerous later?

A

Invaded synovial structures

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18
Q

What does débridement reduce in a wound?

A

Bacterial load, necrotic tissue

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19
Q

What factor reduces the number of bacteria required for infection in the presence of foreign material?

A

10-fold (from 10^5 to 10^4)

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20
Q

What are the most common types of débridement?

A

Sharp, mechanical, chemical, biological, autolytic

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21
Q

What types of débridement are preferred in equine wound care?

A

Sharp, autolytic

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22
Q

What is the major drawback of sharp débridement?

A

Irreversible tissue removal

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23
Q

What are tools used for sharp débridement?

A

Scalpel, scissors, lasers

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24
Q

What can mechanical débridement be performed with?

A

Woven gauze,
lavage,
dressings

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25
Q

What is the recommended pressure for wound lavage?

A

10-15 psi

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26
Q

19 G needle or catheter to a 35mL sering the psi is how much?

A

15 psi =perfect

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27
Q

Which fluids are often used in wound lavage?

A

Dilute antiseptics, saline

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28
Q

Why tap water should be avoided?

A

because is cytotoxic to fibroblasst

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29
Q

type of debridement

A
  1. Mechanical débridement with sterile saline.
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30
Q

Type of gauze a) and B

A

Nonwoven (a) and woven (b) gauze.

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31
Q

how many psi?

A

16 Gneedle to punch 4-8 hores in cap of a 1L bottle –> only 3.9 psi

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32
Q

Mention the different solution for chemical debridement

A

Dakin solution
diluted sodium hypochlorite (bleach)
hydrogen peroxide
acetic acid
hypertonic saline

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33
Q

What are two other common chemical agents used for wound care besides Dakin solution?

A

Hydrogen peroxide, acetic acid

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34
Q

What type of dressings provide effective chemical débridement in early healing stages?

A

Hypertonic saline dressings

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35
Q

What is the most commonly used enzyme in enzymatic débridement of diabetic foot ulcers?

A

Collagenase

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36
Q

Which stage must occur before enzymatic débridement for a rigid eschar to be effective?

A

Sharp débridement

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37
Q

What organism is used in biological débridement?

A

Lucilia sericata (greenbottle fly larvae)

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38
Q

What is a key advantage of autolytic débridement over other methods?

A

Least traumatic

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39
Q

Larval secretion has some proprieties name them

A

debridement
antibacterial effects
promotion of angiogenesis

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40
Q

What must be present for autolytic débridement to be effective?

A

Moist wound

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41
Q

In wound healing, which stage involves the migration of neutrophils and macrophages?

A

Débridement stage

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42
Q

What type of fibroblasts are responsible for wound contraction?

A

Myofibroblasts

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43
Q

The options for wound closure can be categorized in 3. Name them

A

primary closure
delayed primary closure
second-intention healing

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44
Q

What are the four stages of wound healing

A
  1. inflammatory/cellular reaction stage
  2. debridement stage (sometimes considered part of inflammatory stage)
  3. tissue formation/proliferation stage
  4. maturation/remodeling stage
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45
Q

The duration and intensity of the inflammatory stage is determined by

A

extent of injury
Example: surgical wound has much shorter inflammatory stage than a severe degloving wound

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46
Q

The inflammatory stage can be prolonged by the presence of 3 things, name them

A
  1. debris
  2. foreign material
  3. infection
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47
Q

The debridement stage begins in the early in the inflammatory stage and is marked by the migration of

A

neutrophils and macrophages into the wound site

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48
Q

WBC phagocytize bacteria but also enzymatically remove __________ (2w)

A

necrotic tissue

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49
Q

The debridement stage has lenght that is dependent on the

A

size of the wound
amount of necrotic debris present

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50
Q

Proliferation or tissue formation stage involves fibroblast migration and proliferation as well as

A

epitheliazation of the wound

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51
Q

Wound contaction is most effective in areas with

A

excess of skin

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52
Q

Wound contraction stops when cells of the same type are brought together or when

A

skin tension equals the ability

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53
Q

Maturation stage of wound healing occurs when an equilibrium between ___________(1w) and production and _______(1w) destruction occurs

A

collagen

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54
Q

During maturation the number of ______________ (1w) decrease

A

fibroblasts

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55
Q

The wound contamination is classified based on the degree of contamination. Name them

A

Clean wound
Celan-contaminated wound
Contaminated wounds

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56
Q

Which wound classification involves gross contamination and necrotic debris?

A

Contaminated wounds

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57
Q

In the RYB color code, what does black indicate?

A

Necrotic tissue

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58
Q

Please enunciated the meaing of RYB

A

The “R” refers to red, and indicates granulation tissue. The “Y” refers to yellow, and indicates purulent debris. The “B” refers to black, and indicates necrotic tissue.
Some wound-care specialists add a “P,” which refers to pink and indicates epithelialization, and others will add a “G,” which refers to green and indicates gangrenous tissue.

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59
Q

What bacterial count generally indicates active infection?

A

Greater than 10^5 per gram of tissue

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60
Q

Enunciate the difference btw baterial contamination and bacterial colonization

A

Bacterial contamination describes the presence of bacteria in a wound without active multiplication or trauma to the host. Bacterial colonization indicates that the bacteria have attached to the tissue and are multiplying but not necessarily causing trauma to the host.

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61
Q

Enunciate the meaning of bacterial infection

A

Bacterial infection occurs when bacteria invade healthy tissue and actively multiply, overwhelming the host’s immune response.
Frequent bandage changes have been implicated with an increase in bacterial numbers, as the wound is left exposed to the environment during the dressing change

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62
Q

What are the 2 types of bacteriologic assesment?

A
  1. Qualitative assessment
  2. Quantitative bacteriology
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63
Q

What are the signs of infection?

A

Signs such as discolored granulation tissue, edema in and around the wound, purulent exudate, odor, and lameness can indicate an infection.
However, a wound can be infected without these overt signs. If infection is suspected, the wound should be culture

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64
Q

Is quantative common to be performed in veterinary medicine?

A

No it is qualitative with sensitivity testing. In vet medicine, is not performed but it should be considered when a wound is not progressing as anticipated or when a skin graft fails. Bacterial counts greater than 105 per gram of tissue generally indicate an active infection.

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65
Q

Which three strategies prevent bacterial infection of wounds?

A

Effective wound cleansing and debridement
Apropriate dressing
Topic antimicrobials

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66
Q

Antiseptic agents, are effective against gram +, gram - or both?

A

Both, however they do not penetrate necrotic debris and are unlikely to reduce baterial populations in wound bed

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67
Q

Which topical antibiotic is one of the most effective in wound healing?

A

Triple-antibiotic ointment

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68
Q

Which antiseptic agent should be reconsidered for open wounds due to potential ill effects?

A

Chlorhexidine

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69
Q

Why should nitrofurazone not be recommended for wound care?

A

Toxic to wounds

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70
Q

MRSA means

A

methicillin-resistant Staphylococcus aureus

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71
Q

What is a major difference between antiseptics and topical antimicrobial agents?

A

topical antimicrobial agents provide efficacy against bacteria within the wound bed and, depending on the vehicle, they have minimal negative side effects on wound healing
Antiseptics cannot target specific bacteria, but topical antibiotics can.

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72
Q

When are the topical antimicrobials ideal?

A

In chornic infections the blood supply to the surface is diminished and topical antimicrobials are required

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73
Q

What is one of the most effective topical antibiotic in wound healing

A

Triple-antibiotic ointment

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74
Q

The type of closure technique to use depends on

A

what caused the wound,
the time from injury,
the degree of contamination,
the extent of the injury,
the potential dead space,
the location of the wound on the patient, and the veterinarian’s surgical skills

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75
Q

Golden period for primary closure

A

6 hours post trauma

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76
Q

Candidates to primary closure are wounds with certain caratheristics (3)

A
  1. only in wounds with minimal tissue loss,
  2. minimal bacterial contamination,
  3. minimal tension on the wound edges after closure.
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77
Q

What are the wound closure techniques after sucessful debriment and cleaning?

A
  1. Suture closure
  2. Healing by second intention
  3. skin grafting
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78
Q

Primary closure is ideal in wounds with certain caracteristics

A
  1. minimal tissue loss
  2. minimal bacterial contamination
  3. minimal tension on the wound edges after closure
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79
Q

Which surgical tx is the most satisfactory for 1ary closure with apposition of skin edges and at same time tension relief?

A

Near-far-far-near suture

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80
Q

What are the mattress patterns?

A

vertical mattress and horizontal mattress

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81
Q

Mattress sutures have ____ (1w) to reduce pull-through at the skin suture interface

A

stents

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82
Q

4 tx for diminish the dead space in a wound

A
  1. suture
  2. meshing the skin
  3. passive or active drains
  4. pressure bandages
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83
Q

Excess suture (too many sutures, too large diamete, too many knots) can potentiate infection - TRUE or FALSE

A

TRUE

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84
Q

What choice of suture should you give preference to avoid infection

A

smallest diameter, monofilament, absorbable

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85
Q

Drains can allow evacuation of dead space but also the disadvantage of

A

codnuit for bacteria to enter the wound

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86
Q

Delayed primary closure is reserved for wounds that have

A

mild to moderate bacterial contamination
minimal tissue loss
minimal tension on the wound edges

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87
Q
A

Figure 27-9. A chronic wound that has been débrided and partially closed with near-far-far-near sutures. Delay primary closure

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88
Q

Second intention healing occurs when ?

A

when wounds have gross contamination and moderate-to-severe tissue loss that would make closure impossible.

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89
Q

What is the concept behind moist wound healing

A

wound exudate provides necessary cells and a substrate rich in enzymes, growth factors cemotactic factors and provides environment for healing

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90
Q

Enzymes come from what?

A

Come from breakdown of white blood cells and metalloproteinases

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91
Q

Occlusive dressings keep the wound fluid in contact with the wound _______ (1w) to encourage autolytic debridement

A

Occlusive dressings keep the wound fluid in contact with the wound bed to encourage autolytic débridement.

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92
Q

Local growth factors and cytokines provide a stimulus for the

A

fibroblasts, epithelial cells, and angiogenesis

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93
Q

moist environment allows better migration of neutrophils and macrophages than a ________ (1w)wound environment.

A

moist environment allows better migration of neutrophils and macrophages than a dry wound environment.

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94
Q

Hypertonic saline dressings have been designed for use on

A

necrotic or heavily exuding wounds

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95
Q

hypertonic saline dressing work by ___________(1w) action to remove necrotic tissue and bacteria

A

They work by osmotic action to remove necrotic tissue and bacteria

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96
Q

Hypertonic dressings need to be changed every to h

A

24 to 48 h

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97
Q

Ideal percentage of hypertonic saline and preparation

A

20% = 200 g of salt in 1 L of hot water

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98
Q

Honey has been used for centuries due to its _______________________bactericidial/bacteriostatic effec

A

Honey has been used in wound healing for centuries because of its ascribed bactericidal effects

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99
Q

what does it mean PHMB?

A

active agent is polyhexamethylene biguanide (PHMB)

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100
Q

PHMB belongs to a class of

A

PHMB belongs to a class of cationic surface-active agents that have been used as preservatives in aqueous solutions and as disinfectants and antiseptics

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101
Q

PHMB when impregnated into fabric has been shown to

A

have shown the capability to suppress microbial growth and penetration. Microbial death occurs by destabilization and disruption of the cytoplasmic membrane, resulting in leakage of macromolecular components

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102
Q

Silver should be used in clean wounds, infected wounds

A

infected wound and change bandage every 3 days (open) to 7 days (closed wound)

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103
Q

Wound gel dressings ar ecomposed of water, glycerin, polymers and are ideal for

A

dry wounds
change 4-7 d

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104
Q

Calcium-alginate dressings are used 1arily for the ________(1w) phase of wound repair

A

granulating phase

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105
Q

How does it work the calcium from calcium alginate dressings to work?

A

The calcium in the dressing interacts with sodium in the wound, providing a wound exudate that stimulates myofibroblasts and epithelial cells, and speeds wound homeostasis. The calcium also modulates epithelial cell proliferation and migration.

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106
Q

Calcium alginate dressings have been shown to improve superficial bone healing and avoid bone sequestrum?

A

yes, Calcium alginate dressings have been shown to improve superficial bone healing and are very effective in reestablishing the periosteum over bones in horses, reducing the possibility of sequestrum formation

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107
Q

Topical dressings such as collagens and maltodextrins are designed for the used in the
A) granulation stage
B) epithialization stage
C) inflamation stage
D) debridement stage

A

A) granulation stage

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108
Q

What is the purpose of biological dressings?

A

Cell migration framework

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109
Q

Name two porcine-derived biological dressings.

A

Small intestinal submucosa (SIS), bladder basement membrane

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110
Q

Which biological dressing reduces granulation tissue and enhances epithelialization?

A

Porcine SIS

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111
Q

What dressing reduces wound retraction and granulation tissue formation?

A

Equine amnion

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112
Q

What is the main benefit of stem cells in wound healing?

A

Granulation tissue formation

113
Q

What signals are hypothesized to be released by stem cells?

A

Paracrine signals

114
Q

Name three effects of stem cells on wound healing.

A

Granulation, vascularization, immune response

115
Q

What does PDGF (Platelet-Derived Growth Factor) stimulate?

A

Fibroblasts, smooth muscle cells, inflammatory cells

116
Q

Which growth factor is associated with granulation tissue formation?

A

Transforming growth factor-β (TGF-β)

117
Q

What are the two growth factors?

A

Platelet-derived growth factor (PDGF) and transofrming growth factor-β (TGF-β) and Platelet rich plasma (PRP)

118
Q

What is the role of wound fluid in healing?

A

Stimulates fibroblast/endothelial growth

119
Q

Which treatment enhances dermal collagen organization in horses?

A

Platelet-rich plasma (PRP)

120
Q

In what wound stages are growth factors most useful?

A

Granulating, epithelialization

121
Q

Which type of wounds are semiocclusive foam dressings best for?

A

Mildly exudative wounds

122
Q

What should be removed before applying foam dressings?

A

Necrotic debris, bacteria

123
Q

How long should semiocclusive foam dressings be left on wounds?

A

4 to 7 days

124
Q

Are semiocclusive foam dressing useful in skin grafting?

A

yes

125
Q

What is the consititution of semiocclusive foam dressan and what does it mean when impregnated with AMD?

A

Constituin of polyurethane layers prevent strikethrough while still allowing moisture vapor transmission, reducing skin maceration. It is also now possible to use semiocclusive foam dressings impregnated with an antimicrobial (AM D Foam).

126
Q

What are silicone dressings used for in wound care?

A

Improve epithelialization, reduce scar formation

127
Q

What benefit does negative-pressure wound therapy provide in wound healing?

A

Increases blood flow, angiogenesis

128
Q

What foam type in negative-pressure therapy reduced bacterial numbers?

A

Polyvinyl alcohol foam

129
Q

What is one key effect of extracorporeal shock wave therapy (ESWT)?

A

Enhances wound healing

130
Q

What preparation is needed before applying negative-pressure wound therapy in horses?

A

Clipping, shaving, degreasing with alcohol

131
Q

What therapy shortens wound-healing time despite an unknown mechanism?

A

ESWT

132
Q

Which gene expression is reduced by ESWT?

A

TGF-β1

133
Q

What is the main negative effect of corticosteroids in wound healing?

A

Inhibit wound repair

134
Q

What does hydrocortisone upregulate?

A

Plasminogen activator inhibitor-1

135
Q

Which collagen types are affected by dexamethasone?

A

Type I and III
Type III collagen plays a major role in the induction of wound healing and is affected more dramatically by dexamethasone

136
Q

What effect does triamcinolone have on vascular growth?

A

Decreases growth

137
Q

Which hormone delays wound healing in mice?

A

Testosterone

138
Q

What process is more important than steroids for reducing excess granulation?

A

Wound débridement

139
Q

What should be minimized in wound healing for the best cosmetic results?

A

Inflammation

140
Q

What should unvaccinated horses receive to prevent tetanus?

A

Tetanus toxoid, antitoxin

141
Q

What body areas heal better than extremities?

A

Head, neck, body

142
Q

What factors prolong wound healing in extremities?

A

Reduced vascularity, infection

143
Q

Which structure’s injury in a head wound might not show immediate neurological signs?

A

Cranium

144
Q

What diagnostic tool provides excellent renderings of head injuries?

A

CT, MRI

145
Q

What should be done when cranial fractures are suspected?

A

Neurologic examination

146
Q

What should be avoided around the eye during wound cleaning?

A

Chlorhexidine

147
Q

What type of suture material is recommended for eyelid lacerations?

A

Small-diameter, absorbable

148
Q
A

Figure 27-16. Intraoperative photograph of a horse with an orbital fracture repaired with a reconstruction plate.

149
Q

What is used to treat orbital fractures in horses?

A

Bone-reconstruction plates

150
Q

What material supports ear lacerations to minimize movement?

A

Rolled gauze, plastic film

151
Q

What are possible complications of sinus lacerations?

A

Bone sequestration, fistula formation

152
Q

What type of flap may help close defects from sinus lacerations?

A

Rotational skin flap,
periosteal flap

153
Q

What can encourage bone formation in sinus lacerations?

A

ACell

154
Q

What structure is difficult to evaluate in mandibular lacerations?

A

Salivary ducts

155
Q

What may happen if the parotid salivary duct can’t be anastomosed?

A

Ligate duct

156
Q

What happens to the salivary gland after duct ligation?

A

Gland atrophies

157
Q

What might be required to stop salivary secretion if anastomosis isn’t possible?

A

Chemical ablation

158
Q

What is the key to successful nares reconstruction?

A

Thorough débridement, multiple layers of sutures

159
Q

At what age of a wound is second-intention healing recommended before reconstruction?

A

7 to 20 days

160
Q

What diagnostic aids help evaluate head wounds?

A

Radiographs, ultrasonography, CT, MRI

161
Q

What is essential before head and neck wound exploration?

A

Complete physical examination

162
Q

What is a significant risk in lacerations involving the cranium?

A

Septic encephalitis

163
Q

What type of sutures is used in areas with high motion (like eyelids)?

A

Mattress sutures

164
Q

Why might an ear laceration be difficult to repair?

A

Ear mobility, cartilage support

165
Q

What percentage of ear mobility can complicate laceration repairs?

A

270 degrees

166
Q

When should eyelid lacerations be closed?

A

Primarily if possible

167
Q

What should be used to stabilize ear lacerations during healing?

A

Semi-rigid plastic film, mattress sutures

168
Q

What type of anesthesia is suggested for ear laceration repairs?

A

General anesthesia

169
Q

What is a key advantage of primary closure in nares lacerations?

A

Reduces dehiscence risk

170
Q

What technique is used to evaluate mandibular salivary duct integrity?

A

Observe salivary fluid loss

171
Q

What aids sinus laceration bone defect closure?

A

Periosteal flap

172
Q
A

Figure 27-15. Computed tomography scan of a horse with trauma to the left maxillary sinus and subsequent filling of the sinus with blood. The arrow shows the entry wound. L, Left; R, right.

173
Q

Laceration around the eye should be closed primarily to reduce functional problems of the lids

A

Lids should be closed in multiple layers using small diameter suture material to provide more stability in areas of incresead motion

174
Q
A

Figure 27-25. A groove director (above a scalpel).

175
Q
A

Figure 27-23. Radiograph of the carpal region of a horse that had a draining sinus tract just proximal to the carpus. Note the sequestrum on the distal radius.

176
Q
A

Figure 27-21. (A) A chronic wound near the fetlock. (B) Radiographic evidence of osteomyelitis and new bone production.

177
Q

What tissue stretches the skin in chronic wounds?

A

Scar tissue

178
Q

What healing method is used when a portion of the wound is left open?

A

Second intention

179
Q

How far from the wound edge is skin typically unhealthy for sutures?

A

1 cm

180
Q

What distinguishes keloids from hypertrophic scars?

A

Extend beyond wound and rarely regress

181
Q

What cell type is linked to keloid formation?

A

Langerhans cells
The pathogenesis of keloid formation is unknown

182
Q

What condition might vasoconstrictive agents help prevent?

A

Hypertrophic scars

183
Q

Treatment options for keloid

A

Injection with steroid
surgical excision
radiation therapy
compression
tension reduction

184
Q

What dietary compound has shown promise in treating keloid cells?

A

Quercetin (flavonol)

185
Q

What supports the ear’s range of motion?

A

Cartilage

186
Q

What degree of motion do ears have?

A

270 degrees

187
Q

What is used to support ear movement during healing?

A

Rolled gauze

188
Q

What is used as an alternative support for ear lacerations?

A

Plastic film

189
Q

What should be used to repair ear lacerations for the best cosmetic result?

A

General anesthesia

190
Q

What might be necessary if a wound involves large bone defects?

A

Periosteal flap

191
Q

What should be done for stable bone fragments in sinus lacerations?

A

Elevated back

192
Q

What should be done for loose bone fragments devoid of periosteum?

A

Removed

193
Q

What occurs if a nares laceration is older than 7 days?

A

Second intention

194
Q

What is necessary for nares laceration closure?

A

Multiple layers

195
Q

What complication is a concern with thoracic lacerations?

A

Pneumothorax

196
Q
A

Figure 27-17. Lateral radiographic view of a horse with a thoracic injury and subsequent development of pneumothorax. Note the dorsal edge of lung outlined by arrowheads.

197
Q
A

Valve helmich

198
Q

What should be performed to help rule out pneumothorax?

A

Thoracic auscultation

199
Q

What should be placed if pleural penetration occurs?

A

Chest tube

200
Q

What should be attached to remove air from the chest cavity?

A

Ideally chest tube. If not Teat cannula instead of chest tube (if not available) to a 60 mL syringe with 3 way stopcock to remove air from chest cavity

201
Q

Where should be placed the chest tube or teat cannula?

A

In the upper third of the chest to enable the removal of the largest volume of air

202
Q

What technique is used for all thoracic wound exams?

A

Aseptic

203
Q

What might be used for diagnosing pleuritis?

A

Thoracoscopy

204
Q

What diagnostic procedure helps monitor abdominal wall wounds?

A

Abdominocentesis

205
Q

What should be done if abdominal penetration is confirmed?

A

Abdominal lavage with polyonic fluid + large spectrum B + Abdo support

206
Q

What happens when air accumulates in axillary lacerations?

A

subcutaneous emphysema

207
Q

What might axillary lacerations lead to in severe cases?

A

Pneumothorax

208
Q

What should be done if synovial structures are involved in lacerations?

A

Lavage

209
Q

What diagnostic step should be done in suspected synovial involvement?

A

Synovial distention

210
Q

What is used to reduce movement in heel bulb lacerations?

A

slipper cast

211
Q

What should be ruled out before treating heel bulb lacerations?

A

synovial involvement

212
Q

What is often critical in the treatment of chronic wounds?

A

Surgical débridement

213
Q

What diagnostic tools are used for identifying foreign materials in wounds?

A

Radiography, ultrasonography

214
Q

Ogden 2021 VRU Which diagnostic tool ID better foreign materials in wounds?

A

CT better than MRI and radio

215
Q

What often indicates infection in chronic wounds?

A

Inflammation, odor

216
Q

What bacterial count signifies an infected wound?

A

10^5 or 106 bacteria

217
Q

What type of testing identifies effective antibiotics for wounds?

A

Sensitivity testing

218
Q

What imaging technique is particularly useful for metallic foreign bodies?

A

Radiography

219
Q

What type of foreign body can migrate through tissues due to sharp edges?

A

Wood or metal

220
Q

What does soft tissue swelling on radiographs indicate?

A

Foreign material presence

221
Q

What is the key difference between a fistula and a sinus tract?

A

Fistula between organs - intestine and skin enterocutaneous fistula, tendon sheath and joint - synovial fistula
Sinus tract is a cavity or channel

222
Q

Sarcoids are the most common cutaneous tumor in horse and appear in location of previous wounds - TRUE or FALSE

A

TRUE

223
Q

Chronic sinus tracts in horses commonly occur secondary to

A

trauma and foreign bodies.

224
Q

Chronic sinus tracts in horses involving lowerlimbs are associated with

A

bone sequestra
nonabsorbale suture material
foreign body (wood, metal, sand)

225
Q

What foreign body type is often not degraded by lysosomal enzymes?

A

Inert

226
Q

What type of contrast material is used in positive-contrast sinography?

A

Water-soluble

227
Q

What is the primary treatment for chronic sinus tracts?

A

Foreign body extirpation

228
Q

What surgical tool is used to guide sharp dissection of sinus tracts?

A

Groove director

229
Q

What dye can stain a sinus tract for easier recognition during surgery?

A

Evan’s blue

230
Q

What tool is used to debride the sinus tract?

A

Sharp bone curette

231
Q

rasonography is also useful in the diagnosis of foreign bodies such as

A

wood, especially those embedded in muscle

232
Q

What feature of a sinus tract membrane aids in identification?

A

Dark purple color

233
Q

What is imperative to perform in order to stop the sinus tract from draining?

A

remove all lining of the sinus and debrid most of the bacterial contamination and the tract flushed with sterile saline
Pack the tract with 20% saline soaked gauze

234
Q

What should be suspected when a sinus tract develops on the head?

A

Sinus infection or dental problem

235
Q

sinus tract opening found near the base of the ear is usually the result of a

A

dentigerous cyst

236
Q

The dentigerous cyst can be diagnosed by

A

RADIOGRAPHY

237
Q

sinus tract over the pole or the withers region may indicate the development of an

A

infected bursa

238
Q

A sinus tract over the pole is called

A

pole evil

239
Q

A sinus tract of the withers is called

A

fistulous withers
Brucella titer might be the cause

240
Q
A

Sinus tracts located at the base of the ear usually indicate the presence of a conchal cyst. This can usually be palpated just cranial to the ear as an enlargement (A), radiographs confirm that it is a tooth (B),

241
Q
A

Figure 27-29. Any time a sinus tract develops along the withers, the condition of fistulous withers is suspected, and this can be confirmed radiographically. However, because this condition may be caused by a Brucella infection (zoonosis risk), cultures and a titer should be obtained prior to further diagnostic workup and treatment. (See Chapter 83 for more details on this condition.)

242
Q

What should be avoided to prevent complications during sinus tract surgery?

A

Large vessels

243
Q

What is a possible complication of sinus tract exploration?

A

Laceration of organs

244
Q

What material often causes multiple sinus tracts?

A

Wood or nonabsorbable sutures

245
Q

What might cause drainage from a sinus tract if no foreign body is found?

A

Sinus lining

246
Q

What might recur after sinus tract surgery despite intervention?

A

New cloaca

247
Q

What tissue reaction is noted in radiographs near foreign bodies?

A

Periosteal reaction

248
Q

The pole evil is situated where exactly?

A

atlantal (cranial nuchal) bursa

249
Q

The fistulous withers is situtated where exactly?

A

supraspinous bursa in fistulous withers

250
Q

Ferreira et al VS 2019 in the thermografic evaluation of 1ary closure and 2nd intention healing in dairy calves What was the primary objective of the study?
a) To assess the effectiveness of second intention healing in calves
b) To evaluate the use of infrared thermography in wound healing assessment
c) To compare different wound healing methods in adult cows
d) To investigate temperature changes in wound healing using biopsy punches

A

b) To evaluate the use of infrared thermography in wound healing assessment

251
Q

What effect did time after wound creation have on skin temperature?
a) Skin temperature increased over time
b) Skin temperature remained constant
c) Skin temperature was warmer shortly after wound creation
d) No significant effect on skin temperature was observed

A

c) Skin temperature was warmer shortly after wound creation

252
Q

What was concluded about the use of infrared thermography in this wound healing model?
a) It effectively detected differences between primary and second intention healing
b) It showed that second intention healing was significantly slower
c) It was unable to detect differences between primary closure and second intention healing
d) It revealed significant variations in wound healing

A

c) It was unable to detect differences between primary closure and second intention healing

253
Q

Sloan et al 2022 Equine heel bulb lacerations - What was the primary objective of the study regarding heel bulb lacerations in horses?
a) To determine the cost-effectiveness of treatments
b) To characterize clinical findings and outcomes
c) To assess the genetic predisposition of horses to lacerations
d) To evaluate the success of different surgical techniques

A

b) To characterize clinical findings and outcomes

254
Q

Which factor was significantly associated with a higher clinical outcome score in horses with heel bulb lacerations?
a) Duration of the wound
b) Degree of lameness
c) Treatment prior to presentation
d) Involvement of synovial structures

A

a) Duration of the wound

255
Q

What percentage of horses for which follow-up information was available returned to their previous level of work?
a) 50%
b) 60%
c) 70%
d) 78%

A

d) 78% and 95.2% survived to discharge

256
Q

Freeman 2020 EVJ Wounds guidelines - the most effective pressure for seolving wound infection in horses

A

13 psi (12 mL syringe with 22G needle)

257
Q

Freeman 2020 EVJ what is the evidence of maggot therapy?

A

Maggot therapy has weak evidence of wound debridement

258
Q

Freeman et al 2020 EVJ does manuka honey improves the speed of healing?

A

Yes only the speed up to 21 days, after that the evidence is insufficient for long term conclusions

259
Q

Freeman et al 2020 EVJ does the user of laser therapy reduce the duration of wound healing?

A

Inssuficient evidence to determine

260
Q

Mandel et al 2020 EVJ intralesional application of medical grade honey improves healing of surgically tx lacerations - What was the primary objective of the study regarding medical grade honey (MGH) application in horses?
a) To investigate the economic feasibility of MGH in wound healing
b) To assess the impact of topical MGH on wound healing after closure
c) To evaluate whether intralesional MGH reduces infection and dehiscence
d) To compare MGH with other antimicrobial treatments

A

c) To evaluate whether intralesional MGH reduces infection and dehiscence

261
Q

What was the outcome for horses treated with MGH compared to control cases regarding complete healing?
a) No significant difference was found
b) Control cases were more likely to heal completely
c) MGH-treated horses were more likely to heal completely
d) Both groups had equal healing outcomes

A

c) MGH-treated horses were more likely to heal completely

262
Q

What was one of the main limitations of the study noted by the authors?
a) Lack of sufficient sample size
b) Variability between wounds and subjective evaluation methods
c) Incomplete data collection at the time of suture removal
d) Limited access to MGH for treatment

A

b) Variability between wounds and subjective evaluation methods

263
Q
A

Fig 4: Appearance of the open digital flexor tendon sheath after
tenectomy of the SDFT and debridement of the DDFT. in Lenoir EVE 2022

264
Q
A

Fig 5: a) Measurements of the width of the limb are performed at four levels of the metatarsal region to tailor the padding of the
articulated support boot to the size of the limb. b) The tailored articulated boot is fitted to the injured left hindlimb - orthotic
support boot (FastTrack System). in Lenoir 2022 Tenectomy of the SDFT as a tx of
suspected septic tendinitis and tenosynovitis of the digital flexor
tendon sheath followed by rehabilitation with an orthotic device

265
Q
A

Fig 2: Transverse ultrasonographic images obtained at the level of the fetlock canal (Zone 3C) (lateral is to the left) on Days 3 (a) and
18 (b and c). There are no obvious tendinous abnormalities on Day 3 (a) but on Day 18, hypoechoic and anechoic lesions extend
through the dorsal and plantar borders of the SDFT, and the plantar border of the DDFT. The shape and size of both tendons has
changed, and they have irregular margins (b). There is Doppler signal concurrent with lesions in the SDFT (c). Image (a) was obtained
with the limb nonweightbearing and was the nearest saved image available to Zone 3C from the initial examinations that were
performed on Day 0 and Day 3. in Lenoir 2022 EVE

266
Q

In Lenoir 2022 EVE the affected leg started with a
dorsal fetlock angle of 170°, which was decreased to 160°
and 150° at what days?

A

days 5 and 45 postoperative

267
Q

What are the structures to take into consideration in JAVMA 2020 Lores Repair of an oronasal fistula with 2 layer closure method (6 structures)

A
  1. Dorsal buccal branches
  2. . Intraorbital nerves
  3. . Parotid salivary glands
  4. . Bucal salivary glands
  5. . Mandibular labial artery
  6. . Greater pallatine artery
268
Q

The article of Lores 2020 JAVMA of oronasal fistula repair which technique failed?

A

The repair with slidding mucoperiosteal hard palate flap

269
Q

what is the technique?

A

Intraoperative photograph showing the creation
of an alveolar bone flap in the pony in Figure 1. The buccinator
muscle was dissected from the right maxilla. Three osteotomies
of the maxilla (arrowheads) were performed dorsally,
rostrally, and caudally, leaving the ventral aspect of the alveolar
bone flap intact where it was fractured so that the
flap could be deflected axially, across the medial wall of the
alveolus. in JAVMA 2020 Lores

270
Q

what is this tx?

A

Figure 4—Intraoperative photograph showing the creation
of a sliding mucoperiosteal hard palate flap in the pony in Figure
1. Through the buccotomy incision (arrowheads), the mucoperiosteal
hard palate flap (arrows) is visible, having been
advanced laterally and sutured to the gingiva.

271
Q
A

Figure 6—Photographs of the oral cavity of the pony in Figure 1. A—Schematic representations of the sites of the oronasal
fistula (black oval), buccotomy (red line), fascia lata graft placement (green circle), and oral mucosa flap harvest (used to cover
the fascial graft; blue dotted line). B—Same photograph without these representations, showing that the oronasal fistula was
completely healed at 12 months after surgical repair of the oronasal fistula with a fascia lata graft

272
Q

Hevesi et al 2019 mentions that ormaxillary fistula are common due to

A

cheek tooth repulsion or supranumerary cehck teeth

273
Q

Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. How many layers does masseter have?

A

2 layers they used the superficial layer leaving the deep in place.
14 holes in the bone 3.2 drill bit to secure the wound matrix dressing
Reflected muscle flap laid over wound matrix and sutures were passed through wound matrix and muscle to fix it
cancellou bone graft were placed between the wound matrix and muscle flap

274
Q

Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. How much of cancellous bone and from where?

A

Tuber coxae 8 ml with 5.5 mm drill bit collected with bone curette

275
Q

Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. What is the type of incision and size?

A

I shape 20 cm vertical by 12 cm and the flap is undermined subcutaneous between zone of harvest and fistula and placed above the cancellous bone graft and wound matrix
skin was retracted 1 cm from edges

276
Q

Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. The blood comes from where in the masseter?

A

The superficial part of the masseter receives blood supply from
1. facial artery,
2. external carotid artery,
3. masseteric branches of the transverse facial artery

277
Q

Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. What skin flap was made in the end?

A

Rotational skin flap

278
Q
A

Image showing the muscle flap **levator labi superioris muscle sutured to the adjacent
subcutaneous tissues and the outline of skin incision used to
create the full-thickness rotational skin flap

A U E R S & T (121 decks)

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