Complications of wound healing

Question 1

Esmarch’s principals of wound management

Answer 1

non-introduction of anything harmful
tissue rest
wound drainage
avoidance of venous stasis
cleanliness

Question 2

swelling at the incision site - causes

Answer 2

acute haemorrhage + haematoma
incisional swelling + oedema
acute infection
seroma
abscess
scarring + contracture
draining tracts
exposed bone
non-healing wounds

Question 3

swelling at the incision site - evaluation

Answer 3

body wall integrity - palpation, ultrasound etc.

Question 4

swelling at the incision site - treatment

Answer 4

massage
support dressing
remove constricting sutures

Question 5

acute haemorrhage + haematoma treatment

Answer 5

apply pressure dressing

Question 6

mature haematoma treatment

Answer 6

resolve over time

warm compress

Question 7

acute haemorrhage + haematoma

Answer 7

separation of wound edges
prevention of adherence of grafts + flaps
barrier to leucocyte migration
growth medium for bacterial growth

Question 8

infection - treatment

Answer 8

asses wound
culture any discharge
antibiotic therapy

Question 9

seroma -causes

Answer 9

skin seperation
skin flaps + grafts
interferences with blood supply + WBC migration

Question 10

seroma - contributing factors

Answer 10

inflammation
lymphatic injury
poor haemostasis
traumatic surgery/implants
movement
dead space

Question 11

seroma - therapy

Answer 11

control dead space
drain
remove sutures - 2nd intention healing
surgery if dehiscence or infection

Question 12

dehiscence

Answer 12

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

Question 13

dehiscence - causes

Answer 13

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

Question 14

dehiscence - treatment

Answer 14

dependant on tissue layer affected
if exposes vital structures then should be closed
in skin + is infected the wound should be treated as open

Question 15

wound infection

Answer 15

dependant on many factors - contamination at time of surgery, degree of damage/disection, surgeon exp, use + timing of antibiotics, presence of systemic disease

Question 16

wound infection - treatment

Answer 16

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

Question 17

delayed wound infection

Answer 17

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

Question 18

tissue necrosis/sequestration

Answer 18

debridement of the wound needed

increased risk of infection, abscesses, continuing infl, additional metabolic load, delayed wound healing

Question 19

excessive scarring

Answer 19

excessive collagen deposition
may limit mobility in joints
cause closure or functional incompetence near natural body orifices

Question 20

scarring reduction

Answer 20

atraumatic technique
control of infection
early wound closure

Question 21

wound contracture

Answer 21

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

Question 22

treating contracture after it has occured

Answer 22

z-plasties
scar excision with reconstruction
partial myotomies 
temp splintage
physiotherapy + return to normal funtion

Question 23

adhesions

Answer 23

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

Question 24

reducing adhesions

Answer 24

atraumatic tissue handling
keeping tissues moist
strict asepsis

Question 25

sinus - define

Answer 25

blind ending tract than extends from an epithelial surface

Question 26

fistula - define

Answer 26

communcating tract that extends from one epithelial surface to another

Question 27

draining tracts

Answer 27

associated with - pockets of necrotic tissue, resistant bacteria/fungi, underlying osteomyelitis/sequestrum, foreign bodies + neoplasia

Question 28

draining tracts - diagnosis

Answer 28

radiography for foreign bodies

ultrasonography to identify tract + foreign bodies

Question 29

draining tracts - treatments

Answer 29

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

Question 30

granulation tissue formation imparement

Answer 30

necrosis
devitalised tissue
wound infection
poor blood supply
movement

Question 31

failure of wound contraction

Answer 31

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

Question 32

failure of epithelialisation - causes

Answer 32

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

Question 33

failure of epithelialisation - treatment

Answer 33

debridement + lavage, antibiotics, excision of chronic wound bed + re-establishment of new granulation tissue, immobilisation of affected area, physical protection of wound

Question 34

indolent pocket wound

Answer 34

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

Question 35

indolent pocket wound - treatment

Answer 35

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