Chapter 27 - Management of Superficial Wounds, deeps and chronic wounds, sinus tracts, fistulas Flashcards
What is the largest organ in the body
skin
What are the main functions of the skin
- Protect against wear + baterial invasion
- Aid thermal regulation
- Prevent water loss
What is the average of the skin thickness?
3.8 mm thcik
near body opening 3.3 mm
mane and tail 6.2 mm
The skin of horses is _______ than swine, goats, and sheep and thinner than that of ________
The skin of horses is __thicker_____ than swine, goats, and sheep and thinner than that of _____beef catle___
From superificial to deep the skin is composed by epidermis and dermis. Mention the 4 layers of keratinocytes of epidermis from superficial to deep
- Stratum corneum: diminish water loss
- Stratum germinativum
- Stratum spinosum
- Stratum basale
What is the main vascular supply of the dermis?
it comes from the subcutaneous area
The dermis underlis and supports the epidermis. Mention the 2 layers
- Superficial papillary layer
- Deep reticular layer
What other ç beside keratinocytes are visible in the epidermis?
- melanocytes
- Merkel cells for mechanoreception of light touch
- Langerhans ç - engulfing foreign material
Where does the dermis has a third layer of collagenous fibers?
In the:
1. lumbar
2. sacral
3. gluteal regions
To each hair follicle the are _____(nº) sebaceous glands, sweat glands and nerves
2
Ckevage lines or _________ (1w) lines of tension whose orientation is parallel to the predominant orientation fo the collagen fibers
Langer lines. When possible incisions should be made parallel to the clevage lines
What is the most important step in wound therapy?
Wound assessment
What should be assessed before using sedation?
Systemic status
What could sedation cause in a horse that has lost a lot of blood?
Collapse
What alternatives exist to systemic sedation?
Manual restraint, local anesthesia
What is applied over the wound before clipping hair?
Sterile lubricating gel
What can make an initially insignificant wound dangerous later?
Invaded synovial structures
What does débridement reduce in a wound?
Bacterial load, necrotic tissue
What factor reduces the number of bacteria required for infection in the presence of foreign material?
10-fold (from 10^5 to 10^4)
What are the most common types of débridement?
Sharp, mechanical, chemical, biological, autolytic
What types of débridement are preferred in equine wound care?
Sharp, autolytic
What is the major drawback of sharp débridement?
Irreversible tissue removal
What are tools used for sharp débridement?
Scalpel, scissors, lasers
What can mechanical débridement be performed with?
Woven gauze,
lavage,
dressings
What is the recommended pressure for wound lavage?
10-15 psi
19 G needle or catheter in 35 ml syringe (15 psi)
19 G needle or catheter to a 35mL sering the psi is how much?
15 psi =perfect
Which fluids are often used in wound lavage?
Dilute antiseptics, saline
Why tap water should be avoided?
because is cytotoxic to fibroblasst
type of debridement
- Mechanical débridement with sterile saline.
Type of gauze a) and B
Nonwoven (a) and woven (b) gauze.
how many psi?
16 Gneedle to punch 4-8 hores in cap of a 1L bottle –> only 3.9 psi
Mention the different solution for chemical debridement
Dakin solution
diluted sodium hypochlorite (bleach)
hydrogen peroxide
acetic acid
hypertonic saline
What are two other common chemical agents used for wound care besides Dakin solution?
Hydrogen peroxide, acetic acid
What type of dressings provide effective chemical débridement in early healing stages?
Hypertonic saline dressings
What is the most commonly used enzyme in enzymatic débridement of diabetic foot ulcers?
Collagenase
Which stage must occur before enzymatic débridement for a rigid eschar to be effective?
Sharp débridement
What organism is used in biological débridement?
Lucilia sericata (greenbottle fly larvae)
What is a key advantage of autolytic débridement over other methods?
Least traumatic
Larval secretion has some proprieties name them
debridement
antibacterial effects
promotion of angiogenesis
What must be present for autolytic débridement to be effective?
Moist wound
In wound healing, which stage involves the migration of neutrophils and macrophages?
Débridement stage
What type of fibroblasts are responsible for wound contraction?
Myofibroblasts
The options for wound closure can be categorized in 3. Name them
primary closure
delayed primary closure
second-intention healing
What are the four stages of wound healing
- inflammatory/cellular reaction stage
- debridement stage (sometimes considered part of inflammatory stage)
- tissue formation/proliferation stage
- maturation/remodeling stage
The duration and intensity of the inflammatory stage is determined by
extent of injury
Example: surgical wound has much shorter inflammatory stage than a severe degloving wound
The inflammatory stage can be prolonged by the presence of 3 things, name them
- debris
- foreign material
- infection
The debridement stage begins in the early in the inflammatory stage and is marked by the migration of
neutrophils and macrophages into the wound site
WBC phagocytize bacteria but also enzymatically remove __________ (2w)
necrotic tissue
The debridement stage has lenght that is dependent on the
size of the wound
amount of necrotic debris present
Proliferation or tissue formation stage involves fibroblast migration and proliferation as well as
epitheliazation of the wound
Wound contaction is most effective in areas with
excess of skin
Wound contraction stops when cells of the same type are brought together or when
skin tension equals the ability
Maturation stage of wound healing occurs when an equilibrium between ___________(1w) and production and _______(1w) destruction occurs
collagen
During maturation the number of ______________ (1w) decrease
fibroblasts
The wound contamination is classified based on the degree of contamination. Name them
Clean wound
Celan-contaminated wound
Contaminated wounds
Which wound classification involves gross contamination and necrotic debris?
Contaminated wounds
In the RYB color code, what does black indicate?
Necrotic tissue
Please enunciated the meaing of RYB
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.
What bacterial count generally indicates active infection?
Greater than 10^5 per gram of tissue
Enunciate the difference btw baterial contamination and bacterial colonization
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.
Enunciate the meaning of bacterial infection
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
What are the 2 types of bacteriologic assesment?
- Qualitative assessment
- Quantitative bacteriology
What are the signs of infection?
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
Is quantative common to be performed in veterinary medicine?
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.
Which three strategies prevent bacterial infection of wounds?
Effective wound cleansing and debridement
Apropriate dressing
Topic antimicrobials
Antiseptic agents, are effective against gram +, gram - or both?
Both, however they do not penetrate necrotic debris and are unlikely to reduce baterial populations in wound bed
Which topical antibiotic is one of the most effective in wound healing?
Triple-antibiotic ointment
Which antiseptic agent should be reconsidered for open wounds due to potential ill effects?
Chlorhexidine
Why should nitrofurazone not be recommended for wound care?
Toxic to wounds
MRSA means
methicillin-resistant Staphylococcus aureus
What is a major difference between antiseptics and topical antimicrobial agents?
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.
When are the topical antimicrobials ideal?
In chornic infections the blood supply to the surface is diminished and topical antimicrobials are required
What is one of the most effective topical antibiotic in wound healing
Triple-antibiotic ointment
The type of closure technique to use depends on
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
Golden period for primary closure
6 hours post trauma
Candidates to primary closure are wounds with certain caratheristics (3)
- only in wounds with minimal tissue loss,
- minimal bacterial contamination,
- minimal tension on the wound edges after closure.
What are the wound closure techniques after sucessful debriment and cleaning?
- Suture closure
- Healing by second intention
- skin grafting
Primary closure is ideal in wounds with certain caracteristics
- minimal tissue loss
- minimal bacterial contamination
- minimal tension on the wound edges after closure
Which surgical tx is the most satisfactory for 1ary closure with apposition of skin edges and at same time tension relief?
Near-far-far-near suture
What are the mattress patterns?
vertical mattress and horizontal mattress
Mattress sutures have ____ (1w) to reduce pull-through at the skin suture interface
stents
4 tx for diminish the dead space in a wound
- suture
- meshing the skin
- passive or active drains
- pressure bandages
Excess suture (too many sutures, too large diamete, too many knots) can potentiate infection - TRUE or FALSE
TRUE
What choice of suture should you give preference to avoid infection
smallest diameter, monofilament, absorbable
Drains can allow evacuation of dead space but also the disadvantage of
codnuit for bacteria to enter the wound
Delayed primary closure is reserved for wounds that have
mild to moderate bacterial contamination
minimal tissue loss
minimal tension on the wound edges
Figure 27-9. A chronic wound that has been débrided and partially closed with near-far-far-near sutures. Delay primary closure
Second intention healing occurs when ?
gross contamination and moderate-to-severe tissue loss that would make closure impossible.
What is the concept behind moist wound healing
wound exudate provides necessary cells and a substrate rich in enzymes, growth factors cemotactic factors and provides environment for healing
Enzymes come from what?
Come from breakdown of white blood cells and metalloproteinases
Occlusive dressings keep the wound fluid in contact with the wound _______ (1w) to encourage autolytic debridement
Occlusive dressings keep the wound fluid in contact with the wound bed to encourage autolytic débridement.
Local growth factors and cytokines provide a stimulus for the
fibroblasts, epithelial cells, and angiogenesis
moist environment allows better migration of neutrophils and macrophages than a ________ (1w)wound environment.
moist environment allows better migration of neutrophils and macrophages than a dry wound environment
Hypertonic saline dressings have been designed for use on
necrotic or heavily exuding wounds
hypertonic saline dressing work by ___________(1w) action to remove necrotic tissue and bacteria
They work by osmotic action to remove necrotic tissue and bacteria
Hypertonic dressings need to be changed every to h
24 to 48 h
Ideal percentage of hypertonic saline and preparation
20% = 200 g of salt in 1 L of hot water
Honey has been used for centuries due to its _______________________bactericidial/bacteriostatic effec
Honey has been used in wound healing for centuries because of its ascribed bactericidal effects
what does it mean PHMB?
active agent is polyhexamethylene biguanide (PHMB)
PHMB belongs to a class of
PHMB belongs to a class of **cationic surface-active agents*£ that have been used as preservatives in aqueous solutions and as disinfectants and antiseptics
PHMB when impregnated into fabric has been shown to
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
Silver should be used in clean wounds or infected wounds
infected wound and change bandage every 3 days (open) to 7 days (closed wound)
Wound gel dressings ar ecomposed of water, glycerin, polymers and are ideal for
dry wounds
change 4-7 d
Calcium-alginate dressings are used 1arily for the ________(1w) phase of wound repair
granulating phase
How does it work the calcium from calcium alginate dressings to work?
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.
Calcium alginate dressings have been shown to improve superficial bone healing and avoid bone sequestrum?
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
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) granulation stage
What is the purpose of biological dressings?
Cell migration framework
Name two porcine-derived biological dressings.
Small intestinal submucosa (SIS), bladder basement membrane
Which biological dressing reduces granulation tissue and enhances epithelialization?
Porcine SIS
What biological dressing reduces wound retraction and granulation tissue formation?
Equine amnion
What is the main benefit of stem cells in wound healing?
Granulation tissue formation
What signals are hypothesized to be released by stem cells?
Paracrine signals
Name three effects of stem cells on wound healing.
Granulation, vascularization, immune response
What does PDGF (Platelet-Derived Growth Factor) stimulate? 3 cells
Fibroblasts,
smooth muscle cells,
inflammatory cells
Which growth factor is associated with granulation tissue formation?
Transforming growth factor-β (TGF-β)
What are the two growth factors?
Platelet-derived growth factor (PDGF) and transofrming growth factor-β (TGF-β) and Platelet rich plasma (PRP)
What is the role of wound fluid in healing?
Stimulates fibroblast/endothelial growth
Which treatment enhances dermal collagen organization in horses?
Platelet-rich plasma (PRP)
In what wound stages are growth factors most useful?
Granulating, epithelialization
Which type of wounds are semiocclusive foam dressings best for?
Mildly exudative wounds
What should be removed before applying foam dressings?
Necrotic debris, bacteria
How long should semiocclusive foam dressings be left on wounds?
4 to 7 days
Are semiocclusive foam dressing useful in skin grafting?
yes
What is the consititution of semiocclusive foam dressan and what does it mean when impregnated with AMD?
Constitution of polyurethane layers prevent striée through while still allowing moisture vapor transmission, reducing skin maceration. AMD = antimicrobial dressing features
What are silicone dressings used for in wound care?
Improve epithelialization, reduce scar formation
What benefit does negative-pressure wound therapy provide in wound healing?
Increases blood flow, angiogenesis
What foam type in negative-pressure therapy reduced bacterial numbers?
Polyvinyl alcohol foam
What is one key effect of extracorporeal shock wave therapy (ESWT)?
Enhances wound healing
What preparation is needed before applying negative-pressure wound therapy in horses? 3 steps
Clipping, shaving, degreasing with alcohol
What therapy shortens wound-healing time despite an unknown mechanism?
ESWT
Which gene expression is reduced by ESWT?
TGF-β1
What is the main negative effect of corticosteroids in wound healing?
Inhibit wound repair
What does hydrocortisone upregulate?
Plasminogen activator inhibitor-1
Which collagen types are affected by dexamethasone?
Type I and III
Type III collagen plays a major role in the induction of wound healing and is affected more dramatically by dexamethasone
What effect does triamcinolone have on vascular growth?
Decreases growth
Which hormone delays wound healing in mice?
Testosterone
What process is more important than steroids for reducing excess granulation?
Wound débridement
What should be minimized in wound healing for the best cosmetic results?
Inflammation
What should unvaccinated horses receive to prevent tetanus?
Tetanus toxoid, antitoxin
What body areas heal better than extremities?
Head, neck, body
What factors prolong wound healing in extremities?
Reduced vascularity, infection
Which structure’s injury in a head wound might not show immediate neurological signs?
Cranium
What diagnostic tool provides excellent renderings of head injuries?
CT, MRI
What should be done when cranial fractures are suspected?
Neurologic examination
What should be avoided around the eye during wound cleaning?
Chlorhexidine
What type of suture material is recommended for eyelid lacerations?
Small-diameter, absorbable
Figure 27-16. Intraoperative photograph of a horse with an orbital fracture repaired with a reconstruction plate.
What is used to treat orbital fractures in horses?
Bone-reconstruction plates
What material supports ear lacerations to minimize movement?
Rolled gauze, plastic film
What are possible complications of sinus lacerations?
Bone sequestration, fistula formation
What type of flap may help close defects from sinus lacerations?
Rotational skin flap,
periosteal flap
What can encourage bone formation in sinus lacerations?
ACell
What structure is difficult to evaluate in mandibular lacerations?
Salivary ducts
What may happen if the parotid salivary duct can’t be anastomosed?
Ligate duct
What happens to the salivary gland after duct ligation?
Gland atrophies
What might be required to stop salivary secretion if anastomosis isn’t possible?
Chemical ablation
What is the key to successful nares reconstruction?
Thorough débridement, multiple layers of sutures
At what age of a wound is second-intention healing recommended before reconstruction?
7 to 20 days
What diagnostic aids help evaluate head wounds?
Radiographs, ultrasonography, CT, MRI
What is essential before head and neck wound exploration?
Complete physical examination
What is a significant risk in lacerations involving the cranium?
Septic encephalitis
What type of sutures is used in areas with high motion (like eyelids)?
Mattress sutures
Why might an ear laceration be difficult to repair?
Ear mobility, cartilage support
What is the range in degrees of ear mobility can complicate laceration repairs?
270 degrees
When should eyelid lacerations be closed?
Primarily if possible
What should be used to stabilize ear lacerations during healing?
Semi-rigid plastic film, mattress sutures
What type of anesthesia is suggested for ear laceration repairs?
General anesthesia
What is a key advantage of primary closure in nares lacerations?
Reduces dehiscence risk
What technique is used to evaluate mandibular salivary duct integrity?
Observe salivary fluid loss
What aids sinus laceration bone defect closure?
Periosteal flap
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.
Laceration around the eye should be closed primarily to reduce functional problems of the lids. What type of suture?
Lids should be closed in multiple layers using small diameter suture material to provide more stability in areas of incresead motion
Figure 27-25. A groove director (above a scalpel).
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.
Figure 27-21. (A) A chronic wound near the fetlock. (B) Radiographic evidence of osteomyelitis and new bone production.
What tissue stretches the skin in chronic wounds?
Scar tissue
What healing method is used when a portion of the wound is left open?
Second intention
How far from the wound edge is skin typically unhealthy for sutures?
1 cm
What distinguishes keloids from hypertrophic scars?
Extend beyond wound and rarely regress
What cell type is linked to keloid formation?
Langerhans cells
The pathogenesis of keloid formation is unknown
What condition might vasoconstrictive agents help prevent?
Hypertrophic scars
Treatment options for keloid
Injection with steroid
surgical excision
radiation therapy
compression
tension reduction
What dietary compound has shown promise in treating keloid cells?
Quercetin (flavonol)
What supports the ear’s range of motion?
Cartilage
What degree of motion do ears have?
270 degrees
What is used to support ear movement during healing?
Rolled gauze
What is used as an alternative support for ear lacerations?
Plastic film
What should be used to repair ear lacerations for the best cosmetic result?
General anesthesia
What might be necessary if a wound involves large bone defects?
Periosteal flap
What should be done for stable bone fragments in sinus lacerations?
Elevated back
What should be done for loose bone fragments devoid of periosteum?
Removed
What occurs if a nares laceration is older than 7 days?
Second intention
What is necessary for nares laceration closure?
Multiple layers
What complication is a concern with thoracic lacerations?
Pneumothorax
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.
Valve helmich
What should be performed to help rule out pneumothorax?
Thoracic auscultation
What should be placed if pleural penetration occurs?
Chest tube
What should be attached to remove air from the chest cavity?
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
Where should be placed the chest tube or teat cannula?
In the upper third of the chest to enable the removal of the largest volume of air - 12-15th
What technique is used for all thoracic wound exams?
Aseptic
What might be used for diagnosing pleuritis?
Thoracoscopy
What diagnostic procedure helps monitor abdominal wall wounds?
Abdominocentesis
What should be done if abdominal penetration is confirmed?
Abdominal lavage with polyonic fluid + large spectrum B + Abdo support
What happens when air accumulates in axillary lacerations?
subcutaneous emphysema
What might axillary lacerations lead to in severe cases?
Pneumothorax
What should be done if synovial structures are involved in lacerations?
Lavage
What diagnostic step should be done in suspected synovial involvement?
Synovial distention
What is used to reduce movement in heel bulb lacerations?
slipper cast
What should be ruled out before treating heel bulb lacerations?
synovial involvement
What is often critical in the treatment of chronic wounds?
Surgical débridement
What diagnostic tools are used for identifying foreign materials in wounds?
Radiography, ultrasonography
Ogden 2021 VRU Which diagnostic tool ID better foreign materials in wounds?
CT better than MRI and radio
What often indicates infection in chronic wounds?
Inflammation, odor
What bacterial count signifies an infected wound?
10^5 or 106 bacteria
What type of testing identifies effective antibiotics for wounds?
Sensitivity testing
What imaging technique is particularly useful for metallic foreign bodies?
Radiography
What type of foreign body can migrate through tissues due to sharp edges?
Wood or metal
What does soft tissue swelling on radiographs indicate?
Foreign material presence
What is the key difference between a fistula and a sinus tract?
Fistula between organs - intestine and skin enterocutaneous fistula, tendon sheath and joint - synovial fistula
Sinus tract is a cavity or channel
Sarcoids are the most common cutaneous tumor in horse and appear in location of previous wounds - TRUE or FALSE
TRUE
Chronic sinus tracts in horses commonly occur secondary to
trauma and foreign bodies.
Chronic sinus tracts in horses involving lowerlimbs are associated with
bone sequestra
nonabsorbale suture material
foreign body (wood, metal, sand)
What foreign body type is often not degraded by lysosomal enzymes?
Inert
What type of contrast material is used in positive-contrast sinography?
Water-soluble
What is the primary treatment for chronic sinus tracts?
Foreign body extirpation
What surgical tool is used to guide sharp dissection of sinus tracts?
Groove director
What dye can stain a sinus tract for easier recognition during surgery?
Evan’s blue
What tool is used to debride the sinus tract?
Sharp bone curette
rasonography is also useful in the diagnosis of foreign bodies such as
wood, especially those embedded in muscle
What feature of a sinus tract membrane aids in identification?
Dark purple color
What is imperative to perform in order to stop the sinus tract from draining?
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
What should be suspected when a sinus tract develops on the head?
Sinus infection or dental problem
sinus tract opening found near the base of the ear is usually the result of a
dentigerous cyst
The dentigerous cyst can be diagnosed by
RADIOGRAPHY
sinus tract over the pole or the withers region may indicate the development of an
infected bursa
A sinus tract over the pole is called
pole evil
A sinus tract of the withers is called
fistulous withers
Brucella titer might be the cause
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),
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.)
What should be avoided to prevent complications during sinus tract surgery?
Large vessels
What is a possible complication of sinus tract exploration?
Laceration of organs
What material often causes multiple sinus tracts?
Wood or nonabsorbable sutures
What might cause drainage from a sinus tract if no foreign body is found?
Sinus lining
What might recur after sinus tract surgery despite intervention?
New cloaca
What tissue reaction is noted in radiographs near foreign bodies?
Periosteal reaction
The pole evil is situated where exactly?
atlantal (cranial nuchal) bursa
The fistulous withers is situtated where exactly?
supraspinous bursa in fistulous withers
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
b) To evaluate the use of infrared thermography in wound healing assessment
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
c) Skin temperature was warmer shortly after wound creation
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
c) It was unable to detect differences between primary closure and second intention healing
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
b) To characterize clinical findings and outcomes
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) Duration of the wound
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%
d) 78% and 95.2% survived to discharge
Freeman 2020 EVJ Wounds guidelines - the most effective pressure for seolving wound infection in horses
13 psi (12 mL syringe with 22G needle)
Freeman 2020 EVJ what is the evidence of maggot therapy?
Maggot therapy has weak evidence of wound debridement
Freeman et al 2020 EVJ does manuka honey improves the speed of healing?
Yes only the speed up to 21 days, after that the evidence is insufficient for long term conclusions
Freeman et al 2020 EVJ does the user of laser therapy reduce the duration of wound healing?
Inssuficient evidence to determine
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
c) To evaluate whether intralesional MGH reduces infection and dehiscence
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
c) MGH-treated horses were more likely to heal completely
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
b) Variability between wounds and subjective evaluation methods
Fig 4: Appearance of the open digital flexor tendon sheath after
tenectomy of the SDFT and debridement of the DDFT. in Lenoir EVE 2022
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
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
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?
days 5 and 45 postoperative
What are the structures to take into consideration in JAVMA 2020 Lores Repair of an oronasal fistula with 2 layer closure method (6 structures)
- Dorsal buccal branches
- . Intraorbital nerves
- . Parotid salivary glands
- . Bucal salivary glands
- . Mandibular labial artery
- . Greater pallatine artery
The article of Lores 2020 JAVMA of oronasal fistula repair which technique failed?
The repair with slidding mucoperiosteal hard palate flap
what is the technique?
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
what is this tx?
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.
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
Hevesi et al 2019 mentions that ormaxillary fistula are common due to
cheek tooth repulsion or supranumerary cehck teeth
Yoshimura 2020 Sinocutaneous fistula repair with masseter muscle transposition flap combined with wound matrix and cancellous bone graft. How many layers does masseter have?
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
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?
Tuber coxae 8 ml with 5.5 mm drill bit collected with bone curette
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?
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
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?
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
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?
Rotational skin flap
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
