Exam 1 Flashcards
What are the four stages of wound healing?
Inflammatory stage, debridement stage, proliferative/repair stage, maturation stage.
What is the role of macrophages in wound healing?
Produce cytokines and growth factors that modulate the wound healing process, phagocytize necrotic tissue and debris, attract mesenchymal cells into the wound and influence their differentiation into fibroblasts.
What is the function of neutrophils in wound healing?
phagocytizing bacteria
What are the 3 processes that occur in the repair stage?
Fibroplasia, capillary infiltration, epithelial proliferation and migration.
What are the features of a clean wound?
Surgically created
No infection encountered
Aseptic technique maintained
No structure normally containing bacteria opened.
What are the feature of a clean - contaminated wound?
Surgically created
Hollow viscus organ normally containing bacteria is opened, but no contents are spilled.
Minor break in technique occurs (e.g. hole in glove detected).
What are the features of a contaminated wound?
Surgical wound with gross spillage of hollow viscus organ or major break in technique.
Traumatic wounds
What are the features of a dirty wound?
Contains pus
Contains contens of perforated hollow viscus organ
What impact does hypothermia have on surgical patients with regard to wound care?
hypothermia is positively correlated with risk of infection
What is the most common source of operative wound infections?
Patients endogenous flora (skin and gi)
Under what circumstances would prophylactic antibiotics be warranted for surgical patient?
When the risk of infection is high or when infection would have catastrophic results.
When are prophylactic antibiotics started and stopped?
Administer 30-60 minutes prior to skin incision. Only maintained for 24 hours post-op (max)
When would cefazolin be a good choice as a prophylactic antibiotic choice?
To prevent infection from skin flora. (no contact with GIT)
When would Cefaxitin be a good choice as a prophylactic antibiotic choice?
If the GIT is encountered - it’s a broad spectrum, second generation cephalosporin.
Four quadrant antibiotic therapy.
Choose ab antibiotic that covers gram negative, gram positive, anaerobic and aerobic organisms.
What is meant by physiologic degloving injury?
Skin is devitalized but still in place
What is meant by anatomic degloving injury?
Skin is avulsed from the underlying tissue
At what point should necrosed skin from a physiologic degloving injury be removed?
Once it no longer formed a barrier (when there’s a break and it separates)
What method(s) can be used to determine the total body surface area that is affected in burn patients? Describe each.
Rule of 9s - estimates. head 9%, forelimb 9%, hemiflank 18%, hind limb 18%, tail 1%
Burn card - A card that measures 45cm^2 and can be held up to the patient to see how many “cards” his burn is. Then calculate total body surface area and you can calculate a fairly accurate affected body percentage
How are veterinary patients evaluated for “depth of burn”?
Partial thickness vs. full thickness. (Full thickness goes through both epidermis and dermis)
At what point should fluid resuscitation be considered for burn patients?
Burns > 15% TBSA
If a burn wound does not epilate easily, what does that imply?
The follicle is still in tact which means the dermis is still in tact
What types of foreign bodies have adverse effects to wound healing?
Porous and organic materials are poorly tolerated and must be removed. (e.g. plant-based)
How crucial is it that B.B. pellets be removed from a patient?
Not. Hard materials such as glass, gravel, pellets (steal and lead) are relatively inert unless contaminated.
What’s a sinus tract and what causes them?
Wound lined by granulation tissue often occur in response to a foreign body (plant material most often).
Wounds often pseudo heal with antibiotics and then return after antibiotics are discontinued
What is the easiest way to identify a foreign body (as the cause of a wound)?
Ultrasound
When following a sinus tract surgically, how can you differentiate between the granulation tissue that surrounds it and other soft tissue?
Inject methylene blue in the sinus tract. You can follow the stained tissue to search for the foreign body
What may occur if non-absorbable suture material is used on the ovarian pedicle?
Sinus tract may develop on the patients dorsal flank(s)
What role might soil play in wound management protocol?
Clays and organic soil compounds are much more likely to bring about infection (they bind to antibiotics, interfere with neutrophils’ abilities to phagocytize/kill pathogens), if you’re practicing in an are with this type of soil, you need to be more diligent about flushing the wound.
At what point should antiseptic solutions be discontinued in wound lavage?
Once granulation tissue is present. All antiseptics are cytotoxic and can interfere with wound healing.
What is the significance of diluting Povidone-iodine? At what percentage should it be diluted?
Dilute to 1:10 or less
Povidone-iodine solutions are bound to molecules and only released when diluted. If it’s not diluted, it has no antimicrobial properties. Bottle can become contaminated
What is the residual activity of Povidone-iodine?
4-6 hours
Short residual activity is because iodine can bind to various bits of organic material and become inactivated.
How long is diluted chlorhexidine effective when diluted with polyionic solutions? Why?
14 days max
It forms a precipitate which removes some chlorhexidine from solution and renders it inert.
What’s the difference between layered surgical debridement and “en bloc”?
Layered: cut around the edges of the wound to “freshen” the edges.
“En bloc” - dissect around the wound cavity well enough that you never enter the wound itself.
In what circumstances would chemical debridement be preferred?
poor anesthetic candidates
This can also be used in cases where surgical debridement may cause damage to important structures.
What is granulex?
Chemical debriding agent.
Contains:
Trypsin - debriding agent
Castor Oil - minimizes tissue dessication
Balsam of Peru - Simulates capillary formation.
Under what circumstances would it be inappropriate to close a wound (i.e. preferred to manage as an open wound)?
- Unable to remove all devitalized tissue and/or foreign bodies
- Viability of the tissue is questionable
- Concerns about infection before of level of contamination
- Amount of wound exudate
- Tissue swelling/edema
- Patient condition poor
- Wound condition not appropriate for the reconstructive procedure indicated for closure
What are the benefits of vacuum-assisted closure?
Increased tissue blood flow
Decreased interstitial edema
Decreases bacterial burden in wound
May help remove inflammatory cytokines from wound
Accelerated granulation tissue formation
Less frequent bandage changes
What is Calcium Alginate?
nonwoven felt-like material derived from seaweed
- Extremely hydrophilic
- Promotes autolytic wound debridement and wound healing
- Aids in hemostasis.
What are the indications for using calcium alginate wound dressing?
- Moderate to heavily exudative wounds in early stages of healing
- Wound adequately debrided but not amenable for closure
What is maltodextrin? What does it do?
Hydrophilic soluble powder composed of D-glucose polysaccharide
Chemotactic for PMNs, lymphocytes, macrophages.
Provides energy for cells
Stimulates more rapid granulation tissue formation and epithelialization
Antibacterial properties.
Very similar to medical grade honey, but has some added benefits
What are the indications for using a wet-to-dry bandage?
- Necrotic tissue and/or foreign bodies
* High viscosity exudate
At what point should adherent dressings be discontinued?
when wound bed is healthy
What are the indications for dry-to-dry dressings?
Wounds with large amounts of serosanguinous exudate. E.g. degloving injuries, bite wounds, lacerations, deep “cavity” wounds
What are the indications for non-adherent dressings?
Wounds in reparative stage (healthy granulation tissue, serosanguineous exudate, epithelial migration from margins)
