Exam 1 - Advanced Wound Management

Question 1

what is the number one reason horse owners seek veterinary care?

Answer 1

equine wounds

Question 2

T/F: only 25% of equine wounds successfully undergo healing by primary intention

Answer 2

true

Question 3

what is responsible for 16% of adult horse euthanasias?

Answer 3

wounds

Question 4

what are the 4 phases in wound healing?

Answer 4

1. inflammatory
2. debridement
3. fibroblastic/proliferative
4. remodeling

Question 5

what is contraction?

Answer 5

wound gets bigger/expands up to 1 week after before getting smaller

Question 6

what days does contraction typically occur in wound healing? why is this important?

Answer 6

days 5-7

want to impede expansion of the wound

Question 7

why are sutures removed around 14 days?

Answer 7

the wound has better tensile strength

Question 8

when does collagen synthesis begin in wound healing?

Answer 8

day 3 - getting closer to wound contraction

Question 9

at the end of wound healing, how much healing is expected? why can this be concerning?

Answer 9

80% original strength 1-2 years after injury

concerns about re-injury

Question 10

during the acute phase of wound healing, what are your big enemies? why?

Answer 10

motion, infection, foreign body, & ischemia

continues inflammation, pain, & poor blood supply

Question 11

what do the enemies of wound healing in the acute phase cause chronically?

Answer 11

proud flesh, sequestrae, fibrosis, & weak scar tissue

Question 12

other impediments to healing?

Answer 12

geriatrics - uncontrolled PPDH

poor nutrition, poor perfusion, seroma/hematoma, NSAIDS, & steroids

Question 13

why are steroids bad for healing?

Answer 13

they inhibit collagen crosslinking & impede epithelialization which extends the healing time

Question 14

therapy for wound healing should be aimed at mitigating what 3 factors?

Answer 14

1. motion
2. foreign bodies
3. infections

Question 15

how do you avoid motion therapeutically in wounds?

Answer 15

coaptation, stall rest

more motion - more gap to fill & more granulation tissue

Question 16

how do you avoid foreign bodies therapeutically in wounds?

Answer 16

radiographs, ultrasound, wound exploration

soil decreases the dose needed to cause infection in regards to bacteria

Question 17

how do you avoid infection therapeutically in wounds?

Answer 17

cllp/clean, surgical debridement, delayed closure, bandaging, & +/- antimicrobials

Question 18

during the chronic period of wound healing, what other factors must you consider?

Answer 18

cosmesis, functionality, & reinjury

Question 19

what should you be concerned about in the acute period of wounds?

Answer 19

synovial structure involvement!!!!

entrance into other body cavities, SQ emphysema, TBI, & hemorrhage

Question 20

why is it important to know the wound classification?

Answer 20

helps decide what treatment should happen & helps predict how the wound may behave over time

Question 21

what is a crush wound?

Answer 21

injury occurring when the body part is subjected to a high degree of force between 2 heavy objects

Question 22

what is a contusion?

Answer 22

a blow to the skin in which blood vessels are damaged or ruptured

Question 23

what is an abrasion?

Answer 23

damage to the skin epidermis & portions of the dermis by blunt trauma or shearing forces

Question 24

what is an avulsion?

Answer 24

loss of skin or tissue characterized by tearing of the tissue from its attachments

Question 25

what is an incision?

Answer 25

a wound created by a sharp object that has minimal adjacent tissue damage

Question 26

what is a laceration?

Answer 26

an irregular wound created by tearing of tissue - skin & underlying tissue damage can be variable

Question 27

what is a puncture?

Answer 27

a penetrating injury to the skin resulting in minimal skin damage & variable underlying tissue damage - contamination with dirt, bacteria, & hair is common

Question 28

what are the big 3 steps of the approach when looking at a wound on a horse?

Answer 28

1. overall impression of the patient - TPR, hemorrhage, etc 2. sedation & local anesthesia - don't overdue sedation if severely lame 3. rule out serious/catastrophic injuries - fractures, soft tissue structures, & synovial structure involvement

Question 29

why should you use a water soluble lube when clipping/cleaning a wound?

Answer 29

keeps hair out

Question 30

what should you clean a wound with?

Answer 30

chlorhexidine & betadine - DILUTED!!!! saline after

Question 31

T/F: antiseptics are toxic to wounds

Answer 31

true

Question 32

why is it so important to assess for synovial structure involvement?

Answer 32

it will start with infection & some mild inflammation that leads to distension which is what causes SEVERE LAMENESS

Question 33

how do you check a wound for synovial structure involvement?

Answer 33

sedate the horse, clip/clean the wound, block it place a needle away from the wound

Question 34

what is the exception to checking a wound for synovial structure involvement?

Answer 34

evidence of cellulitis - may accidentally seed the joint

Question 35

what is the procedure for tapping a joint?

Answer 35

use 4 syringes every time 1. get a sample using a 3mL syringe - need at least 0.5mL 2. get a wash if no sample using a 6ml syringe using saline 3. distend the joint - variable for each joint volume 4. put antibiotics into the joint before withdrawing the needle - usually amikacin

Question 36

what is the normal color of joint fluid?

Answer 36

light straw color & transparent

Question 37

what is the normal total nucleated cell count of joint fluid?

Answer 37

<1,500 cells/uL

Question 38

what is the normal total solids of joint fluid?

Answer 38

<1.5g/dL

Question 39

what is the normal lactate of joint fluid?

Answer 39

slightly higher than peripheral, up to ~3 mmol/L

Question 40

what is the normal SAA of joint fluid?

Answer 40

zero

Question 41

what is the normal glucose of joint fluid?

Answer 41

roughly equivalent to peripheral except after sedation

Question 42

what is an abnormal color of joint fluid?

Answer 42

turbid, serosanguineous, & not clear

Question 43

what is an abnormal total nucleated cell count of joint fluid?

Answer 43

30,000 cells/uL = suspicious 100,000 cells/uL or higher = slam dunk

Question 44

what is a normal WBC differential of joint fluid?

Answer 44

90% or greater lymphocytes

Question 45

what is an abnormal WBC differential in joint fluid?

Answer 45

90% or greater neutrophils

Question 46

what two measurements are best used serially to evaluate trends in regards to joint fluid?

Answer 46

lactate & SAA

Question 47

what is an abnormal total solids of joint fluid?

Answer 47

high, often 5-6 g/dL

Question 48

what is an abnormal lactate of joint fluid?

Answer 48

4-7mmol/L **why we don't use LRS as a wash**

Question 49

what is an abnormal SAA of joint fluid?

Answer 49

hundreds-thousands

Question 50

what is an abnormal glucose of joint fluid?

Answer 50

50mg/dL less than peripheral & <50mg/dL total

Question 51

what is primary closure?

Answer 51

immediate suture closure without tension

Question 52

what wound types are best suited for primary closure?

Answer 52

clean or clean-contaminated wound converted to a clean wound

Question 53

what is delayed primary closure?

Answer 53

performed 2-5 days after injury before granulation tissue appears - tissue debridement & wound lavage before closure

Question 54

what wounds are best suited for delayed primary closure?

Answer 54

clean-contaminated or contaminated wound with questionable tissue viability, edema, or skin tension

Question 55

what is secondary closure?

Answer 55

performed at least 5 days after injury - after granulation tissue appears & epithelialized skin edges are excised at the time of closure

Question 56

what wounds are best suited for secondary closure?

Answer 56

contaminated or infected wounds

Question 57

what is second intention healing?

Answer 57

healing by granulation tissue, wound contracture, & epithelialization

Question 58

what wounds are best suited for second intention healing?

Answer 58

wound tissue that is unsuitable for closure, large skin defects, & extensive tissue devitalization

Question 59

what halsted's principles are you thinking of with wound closure?

Answer 59

hemostasis with preservation of blood flow, asepsis/wound cleaning, accurate debridement, tension, compression, & dead space

Question 60

why is dead space important to consider in wound closure?

Answer 60

wounds do not heal in the absence of ventral/distal drainage

Question 61

what are your options for addressing dead space?

Answer 61

direct closure, compression, & drains

Question 62

what are the 4 big treatment options you can pursue when dealing with a chronic wound/granulation tissue?

Answer 62

1. sharp excision 2. immobilization 3. steroids 4. silicon bandages

Question 63

what is sharp excision with a chronic wound?

Answer 63

converting the chronic wound into a healthy, acute wound - start distally & work proximally

Question 64

for treating a chronic wound, why is immobilization a double-edge sword?

Answer 64

using splints/bandages/casts to prevent excessive motion that leads to granulation tissue but these can cause pressure sores

Question 65

when may you use steroids in a chronic wound?

Answer 65

angry, exudative wound

Question 66

what is the downfall of using steroids for a chronic wound?

Answer 66

impedes epithelialization

Question 67

why are silicon bandages a better alternative to steroids?

Answer 67

they provide peripheral microvascular occlusion but don't impede epithelialization

Question 68

what are your big three differentials for a non-healing wound?

Answer 68

1. habronemiasis 2. cancer - SCC & sarcoids 3. pythiosis