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Module 7 > Equine Wounds > Flashcards

Equine Wounds Flashcards

1
Q

how long does the inflammatory phase last

A

several days

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2
Q

what occurs to maintain hemostasis in the inflammatory phase

A
  1. reflex vasoconstriction
  2. platelet aggregation
  3. fibrin deposition

platelet and fibrin are activated by thrombin, leading to clot formation

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3
Q

what protects against infection during the inflammatory phase

A

leukocyte migration

granulocytes first (neutrophils) –> peak at day 2

macrophages later –> starting from 24 hours, lasts days to weeks

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4
Q

what does the inflammatory phase do

A

provides substrate and cellular signals for later stages of healing

synthesis and release of growth factors by macrophages initiates proliferation phase

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5
Q

when does the proliferation phase occur

A

active by 3rd day and continues for several weeks

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6
Q

how is angiogenesis initiated by

A

low O2 tension, high lactate concentration and low pH

capillary endothelial cells grow at 0.4-1mm per day

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7
Q

what are the major cell type by the 4th day

A

fibroblasts –> peak numbers by 7-14 days

recruited from adjacent tissue, undergo local proliferation and transform from local stem cells

initially –> proliferate and migrate –> later on: synthesis and re-organize

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8
Q

how is collagen deposited

A

fibroblasts produce collagen in a haphazard arrangement

begins slowly on 3rd day, peaks within 1-3 weeks

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9
Q

what is epitheliazation

A

slow process, first apparent 4-5 days after wounding

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10
Q

what occurs during the epithelialization during proliferation phase

A

migration and proliferation of basal keratinocytes

interaction of fibroblasts and keratinocytes –> further keratinocyte proliferation

migration of keratinocytes only occurs over a healthy granulation tissue

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11
Q

what is contact inhibition

A

occurs when keratinocytes meet in the middle of the wound

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12
Q

when does contraction occur

A

starts in 2nd week, lasts several weeks

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13
Q

what is the purpose of contraction

A

reduces surface area of wound by 40-80%

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14
Q

what occurs during contraction

A

differentation of fibroblasts into myofibroblasts

process slows and ceases when wound edges meet and/or when skin tension surrounding the wound becomes too high

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15
Q

when does the remodelling phase occur

A

begins during 2nd week and ends scar tissue 1-2 years later

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16
Q

what are the features of scar tissue

A

10-15% weaker than original tissue

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17
Q

how does wound activity slow

A

fibroblast proliferation and migration stops

growth factors signal decline

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18
Q

what is collagen re-arrangement

A

randomly orientated collagen fibres are re-arranged into bundles, cross-linked and aligned along lines of tension by fibroblasts –> gradual increase in would strength

19
Q

when does wound strength improve

A

20% by 3 weeks

50% by 3 months

70-80% at conclusion of maturation

20
Q

what are the differences between ponies and horses

A

ponies heal faster –> quicker and more intense inflammatory response, less dehiscence, less bone sequestra

21
Q

why do body wounds heal faster

A

differences in rate of epithelialization and contraction

22
Q

what causes exuberant granulation tissue

A

prolonged inflammatory response + excessive proliferation phase (proud flesh)

exuberant granulation tissue characterized by abundance of capillaries surrounded by collagen

23
Q

what factors affect wound healing (11)

A
  1. systemic health and medications
  2. necrotic tissue
  3. tissue deficit
  4. Iatrogenic factors
  5. poor tissue oxygenation
  6. infection
  7. neoplastic formation
  8. foreign body
  9. loss of blood supply
  10. local factors
  11. continued trauma
24
Q

how does concurrent disease/immunosuppression affect wound healing

A

pituitary pars intermedia dysfunction (PPID or Cushings) –> high endogenous cortisol –> decrease inflammation –> delayed healing +/- increase in change of wound infection

lymphosarcoma

viral disease

25
Q

how does concurrent drug therapy affect wound healing

A

oral predisolone for asthma

26
Q

how does malnutrition affect wound healing

A

protein is required for wound healing

hypoproteinaemia –> alterations in fibroplasia, angiogenesis, remodelling

alteration in wound healing will be effective well in advance of clinical evidence of hypoproteinaemia, weight loss, etc

27
Q

what causes acute disruption to vasculature

A

arterial

venous

capillary

occlusion of vasculature by swelling

28
Q

how does anemia affect wound healing

A

due to major hemorrhage –> decrease oxygen carrying capability –> local tissue hypoxia

local tissue hypoxia can also occur with inappropriate bandaging

29
Q

how is angiogenesis affected by O2 tension

A

vessels forming in low O2 environments are immature and bleed easily

vessels forming in high O2 environments mature and form faster

30
Q

what other wound healing processes affected by O2 tension

A

fibroblastic replication and migration and development of collagen

wounds with low O2 tension are more susceptible to infection as leukocyte activity is slowed

31
Q

what areas of the wound are most commonly affected by necrotic tissue

A

skin margins and subcutaneous tissues

32
Q

what occurs when bone is exposed

A

susceptible to necrosis

when the wound has exposed bone and/or disrupted periosteal blood supply

leads to sequestrum formation which acts like a foreign body

sequestra are more likely to occur if wound is infected

33
Q

what is tissue deficit

A

skin most commonly affected

can also affect subcutaneous tissues –> dead space

blood vessels –> impaired blood supply

soft tissues –> dead space +/- alteration of function

34
Q

what occurs during infection of a wound

A

very common inhibitor of healing

mainly bacteria but can also be fungi and parasites (biofilms)

usually characterized by purulent exudate

35
Q

what can be done to minimize infection

A
  1. cleaning with antiseptics
  2. lavaging with isotonic fluids
  3. debridement
  4. choice of wound dressing
  5. debridement
  6. use of antibiotics
36
Q

how does movement affect wound healing

A

between skin and deeper tissues

as a result of normal anatomical structures

during walking

within the wound bed

37
Q

what can be done to minimize movement

A
  1. bandaging
  2. splints
  3. casts
  4. restricted movement
38
Q

what local factors affect wound healing

A
  1. dead space
  2. cold/heat
  3. desiccation/maceration
  4. pH variations
  5. tension
39
Q

how does continued trauma affect wound healing

A
  1. distal limb wounds –> almost always require bandaging
  2. harness/tack –> need time off from working
  3. recumbency –> especially in weak/emaciated horses
  4. self inflicted trauma –> not as common as dogs/cats
40
Q

how do neoplastic transformations affect wound healing

A
  1. equine sarcoid –> most common
  2. squamous cell carcinoma –> both can appear similar to granulation tissue
41
Q

what iatrogenic factors affect wound healing

A
  1. neglect by owner
  2. mismanagement

(errors of managment, over treatment, aggressive tissue insults)

42
Q

what are wound characteristics

A
  1. location
  2. age
  3. type
  4. contamination
  5. stage of healing
43
Q

what are the types of contamination in wounds

A
  1. clean: surgical wound created under aseptic conditions
  2. clean-contaminated: surgical would where the respiratory, alimentary or urogenital tract has been entered under controlled conditions
  3. contaminated: surgical wound with major break in aseptic technique or any open, acute, accidental wounds
  4. dirty or infected: old with devitalized tissue or gross contamination with foreign material

Module 7 (50 decks)

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