Equine wound evaluation and treatment Flashcards
What are the 4 important areas to assess when evaluating a wound?
- bone
- soft tissue
- synovial structures
- others (foreign body)
What are the steps to wound evaluation?
- Observation & History
- Restraint & Sedation
- Local Anaesthesia
- Clip
- Clean
- Digital palpation
- Probe wound
- Imaging/ Synoviocentesis?
- Closure?
- Bandaging?
What should you include in your observation?
Assess Lameness
Clinical Examination: Palpation
* Weight bearing & Non-Weight bearing
* Range of motion
* Pain on flexion
Site / Extent / Severity
* Heat
* Pain
* Swelling
* Crepitus
* Effusion
What questions should we make sure to ask when getting history?
- When / Where / How?
- Tetanus vaccination status?
- Any NSAIDs administered?
What does limb positioning tell us?
Which associated structures are affected
How would you desensitise wound? What is the aim?
- Local Anaesthetic
- Allows safe examination
- Allows closure
- Regional Nerve Block > Local Infiltration
What information will you get from digital palpation and probing?
- Extent / Direction / Depth
- Associated structures
- Often innocuous wounds have deep pockets
What imaging could you use to evaluate a wound?
Radiography
- prior to ultrasound and synoviocentesis
- 4 orthogonal views for limbs
- probes useful
Ultrasound
- foreign body
- surface of bone
Synoviocentesis
- to confirm synovial involvement
Name the structures highlighted by A, B, C, E and H
A - metacarpo (tarso) phalangeal joint
B - proximal interphalangeal joint
C - distal interphalangeal joint
E - digital flexor tendon sheath
H - navicular bursa
Name the structures highlighted by A, B, C and D
A - radiocarpal joint
B - intercarpal joint
C - carpometacarpal joint
D - carpal sheath
Name structures highlighted by letters A, B, C, E, F and G
A - Tarsocrural and proximal intertarsal joints
B - Distal intertarsal joint
C - Tarsometatarsal joint
E - Gastrocnemius calcaneal bursa
F - Subcutaneous calcaneal bursa
G - Intertendinous calcaneus bursa
How is synoviocentesis undertaken when assessing a wound?
- Sterile Prep
- Insert Needle into Joint/Sheath/Bursa (*site distant to wound NOT through wound)
- Aspirate fluid for macroscopic analysis
- Inject sterile saline until fully distended
- Either fluid egress from wound (=communication) or pressure built up and distends synovial structure (=no communication)
What factors influence our decision making for referral in wounds where synovial contamination is identified or suspected?
- Financial constraints
- Insurance
- Horse’s purpose
- Horse’s age
- Age of wound
What are the different ways to debride a wound? What is the aim?
Sharp
Scalpel blade and forceps most used. Least traumatic / least expensive
Mechanical
Saline lavage, scrub pads
Chemical
Hypertonic saline
Autolytic
Occlusive dressings, Maggots
Remove devitalised tissues, foreign material and bacteria
What are the recommendations for lavage of contaminated wounds in horses?
