Complications of wound healing Flashcards
Esmarch’s principals of wound management
non-introduction of anything harmful tissue rest wound drainage avoidance of venous stasis cleanliness
swelling at the incision site - causes
acute haemorrhage + haematoma incisional swelling + oedema acute infection seroma abscess scarring + contracture draining tracts exposed bone non-healing wounds
swelling at the incision site - evaluation
body wall integrity - palpation, ultrasound etc.
swelling at the incision site - treatment
massage
support dressing
remove constricting sutures
acute haemorrhage + haematoma treatment
apply pressure dressing
mature haematoma treatment
resolve over time
warm compress
acute haemorrhage + haematoma
separation of wound edges
prevention of adherence of grafts + flaps
barrier to leucocyte migration
growth medium for bacterial growth
infection - treatment
asses wound
culture any discharge
antibiotic therapy
seroma -causes
skin seperation
skin flaps + grafts
interferences with blood supply + WBC migration
seroma - contributing factors
inflammation lymphatic injury poor haemostasis traumatic surgery/implants movement dead space
seroma - therapy
control dead space
drain
remove sutures - 2nd intention healing
surgery if dehiscence or infection
dehiscence
breakdown of surgical wounds
rarely caused by inability of tissue to heal
usually seen 3-5 days post-op
serosanguinous discharge, swelling, necrosis, bruising, discharge
dehiscence - causes
excessive force on incision - activity level, skin tension, trauma
poor wound holding strength - suture selection, knot security, wound edges compromised, wound infection, neoplastic tissue in wound
dehiscence - treatment
dependant on tissue layer affected
if exposes vital structures then should be closed
in skin + is infected the wound should be treated as open
wound infection
dependant on many factors - contamination at time of surgery, degree of damage/disection, surgeon exp, use + timing of antibiotics, presence of systemic disease
wound infection - treatment
for superficial wound infection - open wound management, removal of sutures if needed, debridement of devitalised tissue, lavage + drainage.
deep wound infection may need exploration + drain implantation
samples taken + cultured
bacterial infection can cause systemic infection + septicaemia
delayed wound infection
commonly caused with implants + non-absorbable suture material
failure of adequate debridement initially
may present with local signs of wound infection + eventual draining tract development
tissue necrosis/sequestration
debridement of the wound needed
increased risk of infection, abscesses, continuing infl, additional metabolic load, delayed wound healing
excessive scarring
excessive collagen deposition
may limit mobility in joints
cause closure or functional incompetence near natural body orifices
scarring reduction
atraumatic technique
control of infection
early wound closure
wound contracture
loss of a body part due to excess scarring
placing limb in more comfortable position like flexion to avoid weight bearing can cause this
early recognition of wounds at risk needed
larger wounds healing by 2nd intention at greater risk
wounds more than half circumference of limb unlikely to heal by 2nd intention
treating contracture after it has occured
z-plasties scar excision with reconstruction partial myotomies temp splintage physiotherapy + return to normal funtion
adhesions
adhesions in the abdomen + involving entrapment of parts of the GIT uncommon in small animals
occur when equilibrium between normal fibrin deposition + fibrinolysis is disrupted
causative factors - ischaemia, haemorrhage, foreign bodies + infection
reducing adhesions
atraumatic tissue handling
keeping tissues moist
strict asepsis
sinus - define
blind ending tract than extends from an epithelial surface
fistula - define
communcating tract that extends from one epithelial surface to another
draining tracts
associated with - pockets of necrotic tissue, resistant bacteria/fungi, underlying osteomyelitis/sequestrum, foreign bodies + neoplasia
draining tracts - diagnosis
radiography for foreign bodies
ultrasonography to identify tract + foreign bodies
draining tracts - treatments
surgical exploration, debridement + tissue biopsy for culture
if possible each tract should be excised
if not possible to excise, explore + lavarge then by open wound management or closure
granulation tissue formation imparement
necrosis devitalised tissue wound infection poor blood supply movement
failure of wound contraction
peripheral countertension due to lack of loose skin around the wound
restrictive fibrosis - mechanically impairs skin advancement from wound edges
if wound contraction limited - wound healing more dependant on epilthelialisation
failure of epithelialisation - causes
necrotic tissue, infection, fibrotic scar tissue, poor quality chronic granulation tissue, repeated surface trauma to the wound, loose bandages causing abrasion, tissue desiccation + movement at wound site
failure of epithelialisation - treatment
debridement + lavage, antibiotics, excision of chronic wound bed + re-establishment of new granulation tissue, immobilisation of affected area, physical protection of wound
indolent pocket wound
granulation tissue forms with pliable skin around wound
surrounding skin becomes elevated from wound bed + doesnt stick to margins of defect
cavity forms in hypodermal space
epithelial cells from skin edge migrate to line dermal surface + edges curl under
granulation tissue becomes chronic with increase in amount of fibrous tissue + reduction in vascular tissue + may get infected
most common in inguinal, axillary + flank regions, esp in cats
indolent pocket wound - treatment
control infection, excise scar border + restrictive dermal scar, closure of wound, anchor skin edges to underlying granulation tissue bed, manage dead space with drains, use skin flaps for closure, use omentalisation if vascular supply compromised
