complex wounds workshop Flashcards
Describe this wound
Necrotic skin due to poor blood supply
Clear demarcation of healthy & unhealthy skin
Debridement required
What can be seen now and what can be done to improve it
Findings:
- Chronic granulation tissue
- Exposed mandible with no periosteum → bone can’t support granulation
- Irregular wound edges → poor-quality granulation
- Risk of infection; second intention healing won’t work
Management:
- Fenestration (foraging): Drill holes into mandibular cortex to access medullary cavity → stimulates vascularisation & healthy granulation
- Epithelial coverage:
* Pinch punch graft (effective but time-consuming)
* Flap (more robust coverage)
* Free skin graft (challenging in this area)
What has been done here
Loop sutures placed and antimicrobial dressing that encourages moisture can than be tied in
What was done here
Subdermal (random) single pedicle advancement flap
Used skin from neck that was elevated and pulled forward
Animals have subdermal plexus so good blood supply allowing for displacement of skin
What is going on here? (few months after skin flap surgery)
Small portion of flap failed but healed by second intention
What is going on here? What structures are involved? What are the challenges? What should be done next?
Lateral aspect of hock joint
Ring of healthy epithelial tissue but cant make any progress because no healthy granulation bed
Infection in granulation bed & not smooth
Underlying structures:
hock joint (synovial involvement? – unlikely in this case as horse is not lame)
Splint bones
Metatarsal bones?
X-ray it
Challenges:
Foreign body (e.g. bone fragment)
Lots of movement (over joint)
Bandaging can cause pressure
What views are these and what can be seen?
RHS: standard view (cranio-caudal)
LHS: slightly oblique
Can see a bone fragment/foreign body that must be removed via debridement
Can also see lots of soft tissue on side of fragment
Whats the issue here?
Infection & foreign material gone but have a lot of tension on wound
Wound needs to be dressed (difficult over hocks – back of hock is major pressure point)
