Drains, sutures, and wound healing Flashcards
passive drain
thin walled, collapsible, latex rubber tubes, fluid escapes along the side of the drain
active drain
works with negative pressure, uses force of suction
Jackson Pratt drain
active drain
uses thick walled suction ball called a grenade
mechanical suction drain
electrical machine continuously suctions, aids in healing and granulation tissue
ex: vacuum assisted closure (VAC)
what is each suture tie called?
each suture tie is a throw
what is it called when there is 3-5 suture throws?
a suture knot
suture reactions
surgical gut is most reactive, may notice small bump over suture knot
skin glue
used for skin closure on lacerations, cat declaws, cuts, tail docking
contraindications: infected wounds, deep punctured wounds
monomeric formulation which upon contact with alkaline environment, polymerizes and forms thin flexible and waterproof bandage
must prep wound 1st
contains dye to help differentiate skin glue from body fluid
layered suture closure
most common
typically closed in 3-4 layers with small sutures on each layer
modified Smead-Jones suture closure
closed in 3 layers
small sutures on fascia and skin layers with a bigger one on the subcutaneous/subcuticular layers
mass suture closure
closed in 2 layers
a bigger suture around the fascia and subcutaneous layers and a smaller suture on the skin layer
retention suture closure
a small suture on the subcutaneous layer and a big suture around all 4 layers of the skin
purse string suture
commonly used for anal suture to prevent contamination during surgery
wound healing
requires inflammation and blood supply
heals from inside out and pushes debris to the surface
inflammation signs
erythema, heat, pain, edema, altered function
how do you prevent a nosocomial infection?
wear gloves, use aseptic technique, pack with sterile lube when clipping hair, flush with sterile saline and can use 0.05% chlorohexidine solution, dress wound
inflammatory phase
predominates 1st 6 hours ~ 5 days
initial vasoconstriction followed by vasodilation to control bleeding and then to clean and fill wound
exudates (high protein and cellular content) leak into wound which helps dilute contamination and spread WBCs into the wound
debridement phase
starts after 6-12 hours
neutrophils and monocytes phagocytize organisms and debris
lymphocytes join in later
repair phase
begins 3-5 days after injury
granulation tissue forms
fibroblasts make collagen and elastin
endothelial cells created= capillary infiltration
lympathic vessels develop
neutrophil numbers decrease while macrophages increase
epithelialization occurs over bed of granulation tissue
wound contraction begins (myofibroblasts)
maturation phase
starts after ~2-3 weeks
can last years in certain tissues
collagen remodeling slowly increases tissue strength
scar develops and is remodeled with time (flatten and contract)
scars are pale due to less capillaries in fibrous tissue
1st intention healing
bone fractures: internal fixation
promotes faster healing and less scarring
2nd intention healing
bone fractures: external fixation (casts, splints, etc)
proud flesh
exuberant granulation tissue produced in horses
can be prevented through primary wound closure and decreased movement
can be treated through Sx removal, caustic substance applied, steroid creams, and skin grafting
skin graft
removing skin from 1 location of the body and suturing it over the wound
its survival depends on having a well-vascularized recipient bed and rapid re-establishment of circulation
skin flaps
detaching an area of healthy skin adjacent to the wound, elevating it on all but 1 side, then rotating and suturing it onto the wound
more resistant to infection because blood supply is maintained which also helps improve circulation to recipient bed