Exam 1 - Advanced Wound Management Flashcards
what is the number one reason horse owners seek veterinary care?
equine wounds
T/F: only 25% of equine wounds successfully undergo healing by primary intention
true
what is responsible for 16% of adult horse euthanasias?
wounds
what are the 4 phases in wound healing?
- inflammatory
- debridement
- fibroblastic/proliferative
- remodeling
what is contraction?
wound gets bigger/expands up to 1 week after before getting smaller
what days does contraction typically occur in wound healing? why is this important?
days 5-7
want to impede expansion of the wound
why are sutures removed around 14 days?
the wound has better tensile strength
when does collagen synthesis begin in wound healing?
day 3 - getting closer to wound contraction
at the end of wound healing, how much healing is expected? why can this be concerning?
80% original strength 1-2 years after injury
concerns about re-injury
during the acute phase of wound healing, what are your big enemies? why?
motion, infection, foreign body, & ischemia
continues inflammation, pain, & poor blood supply
what do the enemies of wound healing in the acute phase cause chronically?
proud flesh, sequestrae, fibrosis, & weak scar tissue
other impediments to healing?
geriatrics - uncontrolled PPDH
poor nutrition, poor perfusion, seroma/hematoma, NSAIDS, & steroids
why are steroids bad for healing?
they inhibit collagen crosslinking & impede epithelialization which extends the healing time
therapy for wound healing should be aimed at mitigating what 3 factors?
- motion
- foreign bodies
- infections
how do you avoid motion therapeutically in wounds?
coaptation, stall rest
more motion - more gap to fill & more granulation tissue
how do you avoid foreign bodies therapeutically in wounds?
radiographs, ultrasound, wound exploration
soil decreases the dose needed to cause infection in regards to bacteria
how do you avoid infection therapeutically in wounds?
cllp/clean, surgical debridement, delayed closure, bandaging, & +/- antimicrobials
during the chronic period of wound healing, what other factors must you consider?
cosmesis, functionality, & reinjury
what should you be concerned about in the acute period of wounds?
synovial structure involvement!!!!
entrance into other body cavities, SQ emphysema, TBI, & hemorrhage
why is it important to know the wound classification?
helps decide what treatment should happen & helps predict how the wound may behave over time
what is a crush wound?
injury occurring when the body part is subjected to a high degree of force between 2 heavy objects
what is a contusion?
a blow to the skin in which blood vessels are damaged or ruptured
what is an abrasion?
damage to the skin epidermis & portions of the dermis by blunt trauma or shearing forces
what is an avulsion?
loss of skin or tissue characterized by tearing of the tissue from its attachments
what is an incision?
a wound created by a sharp object that has minimal adjacent tissue damage
what is a laceration?
an irregular wound created by tearing of tissue - skin & underlying tissue damage can be variable
what is a puncture?
a penetrating injury to the skin resulting in minimal skin damage & variable underlying tissue damage - contamination with dirt, bacteria, & hair is common
what are the big 3 steps of the approach when looking at a wound on a horse?
- overall impression of the patient - TPR, hemorrhage, etc
- sedation & local anesthesia - don’t overdue sedation if severely lame
- rule out serious/catastrophic injuries - fractures, soft tissue structures, & synovial structure involvement
why should you use a water soluble lube when clipping/cleaning a wound?
keeps hair out
what should you clean a wound with?
chlorhexidine & betadine - DILUTED!!!!
saline after
T/F: antiseptics are toxic to wounds
true
why is it so important to assess for synovial structure involvement?
it will start with infection & some mild inflammation that leads to distension which is what causes SEVERE LAMENESS
how do you check a wound for synovial structure involvement?
sedate the horse, clip/clean the wound, block it
place a needle away from the wound
what is the exception to checking a wound for synovial structure involvement?
evidence of cellulitis - may accidentally seed the joint
what is the procedure for tapping a joint?
use 4 syringes every time
- get a sample using a 3mL syringe - need at least 0.5mL
- get a wash if no sample using a 6ml syringe using saline
- distend the joint - variable for each joint volume
- put antibiotics into the joint before withdrawing the needle - usually amikacin
what is the normal color of joint fluid?
light straw color & transparent
what is the normal total nucleated cell count of joint fluid?
<1,500 cells/uL
what is the normal total solids of joint fluid?
<1.5g/dL
what is the normal lactate of joint fluid?
slightly higher than peripheral, up to ~3 mmol/L
what is the normal SAA of joint fluid?
zero
what is the normal glucose of joint fluid?
roughly equivalent to peripheral except after sedation
what is an abnormal color of joint fluid?
turbid, serosanguineous, & not clear
what is an abnormal total nucleated cell count of joint fluid?
30,000 cells/uL = suspicious
100,000 cells/uL or higher = slam dunk
what is a normal WBC differential of joint fluid?
90% or greater lymphocytes
what is an abnormal WBC differential in joint fluid?
90% or greater neutrophils
what two measurements are best used serially to evaluate trends in regards to joint fluid?
lactate & SAA
what is an abnormal total solids of joint fluid?
high, often 5-6 g/dL
what is an abnormal lactate of joint fluid?
4-7mmol/L
why we don’t use LRS as a wash
what is an abnormal SAA of joint fluid?
hundreds-thousands
what is an abnormal glucose of joint fluid?
50mg/dL less than peripheral & <50mg/dL total
what is primary closure?
immediate suture closure without tension
what wound types are best suited for primary closure?
clean or clean-contaminated wound converted to a clean wound
what is delayed primary closure?
performed 2-5 days after injury before granulation tissue appears - tissue debridement & wound lavage before closure
what wounds are best suited for delayed primary closure?
clean-contaminated or contaminated wound with questionable tissue viability, edema, or skin tension
what is secondary closure?
performed at least 5 days after injury - after granulation tissue appears & epithelialized skin edges are excised at the time of closure
what wounds are best suited for secondary closure?
contaminated or infected wounds
what is second intention healing?
healing by granulation tissue, wound contracture, & epithelialization
what wounds are best suited for second intention healing?
wound tissue that is unsuitable for closure, large skin defects, & extensive tissue devitalization
what halsted’s principles are you thinking of with wound closure?
hemostasis with preservation of blood flow, asepsis/wound cleaning, accurate debridement, tension, compression, & dead space
why is dead space important to consider in wound closure?
wounds do not heal in the absence of ventral/distal drainage
what are your options for addressing dead space?
direct closure, compression, & drains
what are the 4 big treatment options you can pursue when dealing with a chronic wound/granulation tissue?
- sharp excision
- immobilization
- steroids
- silicon bandages
what is sharp excision with a chronic wound?
converting the chronic wound into a healthy, acute wound - start distally & work proximally
for treating a chronic wound, why is immobilization a double-edge sword?
using splints/bandages/casts to prevent excessive motion that leads to granulation tissue but these can cause pressure sores
when may you use steroids in a chronic wound?
angry, exudative wound
what is the downfall of using steroids for a chronic wound?
impedes epithelialization
why are silicon bandages a better alternative to steroids?
they provide peripheral microvascular occlusion but don’t impede epithelialization
what are your big three differentials for a non-healing wound?
- habronemiasis
- cancer - SCC & sarcoids
- pythiosis
