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
Chronic granulation tissue
Exposed bone (mandible)
Periosteum is gone meaning exposed bone wont support granulation tissue on top of it
Edges not completely flat which can indicate that granulation bed isn’t healthy
If left like this likely to get infected
Second intention healing wont work
Faraging to create holes into cortex of mandibular bone to enter medullary cavity with bone marrow which is rich in blood vessels
- this promotes vascularisation and granulation to achieve healthy granulation bed for healing
Then bring epithelium in:
Free skin graft (difficult in this area)
Flap
Pinch punch graft (good but time consuming)
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)
