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2025 - Intro to Surgery 737A > Exam 2: Lecture 12: Open Wound Management > Flashcards

Exam 2: Lecture 12: Open Wound Management Flashcards

1
Q

When should wounds be covered with a clean, dry bandage?

A

-Immediately after injury
-When the animal is brought for treatment

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2
Q

What should happen before further wound management than a clean, dry bandage is taken?

A

-Life-threatening injuries should be treated & the animal’s condition stabilized

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3
Q

What are the 9 fundamentals of wound management?

A
  1. Temporarily cover the wound to prevent further trauma & contamination
  2. Assess the traumatized animal & stabilize its condition
  3. Clip & aseptically prepare the area around the wound
  4. Culture the wound
  5. Debride dead tissue & remove foreign debris from wound
  6. Lavage wound thoroughly
  7. Provide wound drainage
  8. Promote healing by stabilizing & protecting cleaned wound
  9. Perform appropriate wound closure
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4
Q

What should happen to open or superficial wounds when appropriate during stabilization?

A

-Bandages should be removed
-Wound assessed & classified

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5
Q

How are wounds classified?

A

-Contaminated or Infected vs. Class 1-3
-Type of wound

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6
Q

What is the “Golden Period” when talking about wounds?

A

-First 6-8 hours between wound contamination at injury & bacterial multiplication to greater than 10^5 CFU per gram of tissue

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7
Q

When is a wound classified as infected rather than contaminated?

A

A wound is classified as infected rather than contaminated when bacterial numbers exceed 10^5 CFU per gram of tissue

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8
Q

How do infected wounds look?

A

-Often grossly dirty & covered with a thick, viscous exudate

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9
Q

What is contamination?

A

-Presence of microbes on a surface

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10
Q

What is colonization?

A

-Surface microorganisms are replicating

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11
Q

What is infection?

A

-Invasion & replication of microbes within the tissue

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12
Q

How do we calculate microbial burden?

A

-(Number of microorganisms x virulence) / Host resistance

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13
Q

What are the 3 main wound classifications?

A

-Class 1
-Class 2
-Class 3

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14
Q

What is Class 1 wound contamination?

A

-0-6 hours old
-Minimal contamination & tissue trauma

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15
Q

What is Class 2 wound contamination?

A

-6-12 hours old
-Microbial levels may not have reached critical level consistent with development of infection

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16
Q

What is Class 3 wound contamination?

A

-Older than 12 hours
-Microbial levels may have reached critical level consistent w/ development of infection

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17
Q

What are the different types of wounds?

A

-Abrasion
-Puncture wound
-Laceration
-Avulsion or Degloving Injury
-Thermal burn
-Decubital Ulcers

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18
Q

What are abrasions?

A

-Superficial & involve destruction of varying depths of skin by friction from blunt trauma or shearing forces
-Sensitive to pressure or touch & bleed minimally

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19
Q

How do abrasions heal?

A

-Heal rapidly by re-epithelialization

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20
Q

What are puncture wounds?

A

-Characterized by small skin opening with deep tissue contamination & damage
-Wound depth & width vary depending on object creating wound

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21
Q

The extent of tissue damage caused by puncture wounds is directly proportional to

A

-Missile velocity

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22
Q

What can be embedded in puncture wounds?

A

-Pieces of hair, skin, & debris

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23
Q

What are the mechanisms of injury for puncture wounds?

A

-Penetrating foreign objects (ex: stick, wire, bone)
-Bite wounds
-Gunshot injuries

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24
Q

What type of wound is shown?

A

-Puncture wound

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25
Q

What are lacerations?

A

-Created by tearing, which damages skin & underlying tissue (muscles, tendons)
-Lacerations may be superficial or deep & have irregular edges
-Typically, minimal peripheral trauma to the wound edges

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26
Q

What type of injury?

A

-Laceration

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27
Q

What are avulsions or degloving injuries?

A

-Characterized by tearing of tissues from their attachments & the creation of skin flaps
-Exposed wound bed
-Common on distal limbs

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28
Q

When are avulsion injuries called degloving injuries?

A

-Avulsion injuries on limbs w/ extensive skin loss are called degloving injuries

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29
Q

What is anatomic degloving?

A

-Skin & various levels of underlying tissue are torn off the limb

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30
Q

What is physiologic degloving?

A

-Skin surface is intact but separated or avulsed from underlying subcutaneous tissue & blood supply

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31
Q

What does physiologic degloving result in?

A

-Delayed necrosis of the skin

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32
Q

What type of injury is this?

A

-Avulsion or degloving injury

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33
Q

What are thermal burns?

A

-May be partial or full-thickness
-Caused by heat or chemicals

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34
Q

What are the mechanisms of injury for thermal burns?

A

-Fire
-Cage dryers
-Heating pads
-Heat lamps
-Hot liquids
-Malicious incidents

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35
Q

What type of injury is this?

A

-Thermal burns

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36
Q

Deep & extensive burn injuries may cause systemic compromise due to

A

-Severe fluid loss
-Electrolyte loss
-Protein loss

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37
Q

What risk is high in thermal burns?

A

-risk of infection & sepsis is high

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38
Q

Strict classification of burns is no longer in favor due to

A

-Delayed microvascular damage

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39
Q

What are crush injuries?

A

-Can be a combination of other types of wounds w/ extensive damage & contusions to skin & deeper tissue

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40
Q

What are decubital ulcers?

A

-Result of compression of skin & soft tissues between a bony prominence & a hard surface
-May extend into deeper soft tissue & bone

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41
Q

What do decubital ulcers result in?

A

-Skin loss over the bony prominence

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42
Q

When are decubital ulcers often seen?

A

-Often seen in recumbent animals

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43
Q

What are common sites for decubital ulcers?

A

-Greater trochanter
-Lateral elbow
-Lateral hock

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44
Q

What are the 4 types of wound closure?

A

-Primary Wound Closure (First Intention Healing)
-Delayed Primary Closure
-Healing By Contraction & Epithelialization (Second Intention Healing)
-Secondary Closure (Third Intention Healing)

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45
Q

What wound closure occurs in most surgical wounds?

A

-Primary wound closure (First intention healing)

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46
Q

What is primary wound closure (first intention healing)?

A

-Wound edges are apposed & allowed to heal by first intention

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47
Q

What is primary wound closure (first intention healing) indicated in?

A

(Class 1 & some Class 2)
-Clean sharply incised wounds
-Minimal trauma
-Minimal contamination
-Within hours of injury

48
Q

What is delayed primary closure?

A

-Appositional closure within 3-5 days
-Before granulation tissue has been produced in wound bed

49
Q

Delayed primary closure is indicated in

A

(Class 2 Wounds)
-Mildly contaminated
-Minimal trauma
-Require some cleansing, debridement, & open management before closure

50
Q

What is healing by contraction & epithelialization (second intention healing)?

A

-Wound left open to heal by contraction & epithelialization
-Eventually produces continuous epithelial surface

51
Q

What is healing by contraction & epithelialization (second intention healing) indicated for?

A

-Dirty wounds
-Contaminated wounds
-Traumatized wounds
(where cleansing & debridement are necessary, but primary or delayed closure is prohibited)

52
Q

What do you have to do for healing by contraction & epithelialization (second intention healing)?

A

-Continually assess to see if secondary closure should be used to expedite the process

53
Q

What is secondary closure (third intention healing)?

A

-Appositional closure more than 3-5 days after wounding
-Granulation tissue has formed in the wound bed

54
Q

What is secondary closure (third intention healing) indicated in?

A

-Severely contaminated
-Severely traumatized
-Infected

55
Q

What does development of granulation tissue in the wound bed in secondary closure (third intention healing) provide?

A

-A microbial resistant, vascular substrate that facilitates healing

56
Q

How is secondary closure (third intention healing) closed?

A

-Closure is performed over the granulation tissue
-Some debridement may be necessary to facilitate closure

57
Q

What type of wound closure is done before granulation tissue has been produced in wound bed?

A

-Delayed primary closure

58
Q

What type of wound closure may be inefficient & fail to produce a functional outcome?

A

-Healing by contraction & epithelialization (second intention healing)

59
Q

What type of wound closure allows for third intention healing?

A

-Secondary closure

60
Q

What are we trying to accomplish with immediate wound closure?

A

-Reduce microbial burden
-Prevent further contamination

61
Q

What immediate wound care is done in initial unstable patient?

A

-Copious irrigation (even w/ tap water) (solution to pollution is dilution)
-Coverage of wound w/ antimicrobial agent
-Area surrounding wound should be widely clipped & prepped
-Bandage to protect wound

62
Q

What is often required for immediate wound inspection & care?

A

-Anesthesia

63
Q

What wounds should be cultured after initial inspection?

A

-Severely contaminated or infected wounds

64
Q

How can you protect the wound from clipped hair and detergents?

A

-Applying a sterile, water-soluble lubricant (K-Y Jelly) or by placing saline-soaked sponges in the wound & covering w/ sterile pad or towel
-Hair can be clipped from wound margin w/ scissors dipped in mineral oil to prevent hair from falling into wound

65
Q

How can we temporarily close a wound?

A

-Sutures
-Towel clamps
-Staples
-Michel clips

66
Q

What scrubs are used to prepare the clipped skin around the wound?

A

-Providone-iodine or chlorhexidine gluconate skin scrubs

67
Q

Why do we not use antiseptic scrubs to prepare clipped skin around the wound?

A

-Detergents in antiseptic scrubs cause irritation, toxicity & pain in exposed tissue & may potentiate wound infection

68
Q

____ is very damaging to exposed tissue and should be used only on intact skin

A

alcohol

69
Q

What is the preferred lavage solution for initial wound management?

A

Sterile isotonic saline or a balanced electrolyte solution (lactated Ringer’s solution)

70
Q

What lavage solution is effective and less detrimental than distilled or sterile water?

A

-Tap water

71
Q

What does wound irrigation do?

A

-Wound lavage reduced bacterial numbers mechanically by loosening and flushing away bacteria & associated necrotic debris

72
Q

What can facilitate lavage?

A

Use of noncytotoxic wound cleansers
-Applied to loosen debris & soften necrotic tissue during bandage changes

73
Q

What do noncytotoxic wound cleansers do to facilitate lavage?

A

-Act as surfactant, disrupting ionic bonding of particles & organisms to the wound & allowing them to be easily rinsed off w/ saline or balanced electrolyte solutions

74
Q

What can you put into the lavage solution to reduce bacterial numbers, but what can this also cause?

A

Antibiotics or antiseptics (e.g. chlorhex or iodine)
-These agents may damage tissue
-Antiseptics have little effect on bacteria in established infections

75
Q

Which is preferred, lavaging or scrubbing the wound with sponges?

A

Lavaging is preferred to scrubbing the wound w/ sponges
-Sponges inflict tissue damage that impairs wound’s ability to resist infection & allows residual bacteria to elicit inflammatory response

76
Q

What is the most consistent delivery method for wound irrigation?

A

-Most consistent delivery method to generate 7-8 psi is a 1-liter bag of fluid within a cuff pressurized to 300 mmHg

77
Q

What is higher pressure (70 psi) wound irrigation and what can it do?

A

-Generated by pulsatile lavage instruments & more effective in reducing bacterial numbers & removing foreign debris & necrotic tissue
-MAY: drive bacteria & debris into loose tissue planes, damage underlying tissue, reduce resistance to infection

78
Q

Why is debridement important?

A

-Healing is delayed if necrotic tissue is left in wound
-Devitalized tissue is removed from wound by devridement

79
Q

What does debridement involve?

A

Removal of dead or damaged tissue, foreign bodies, & microorganisms that compromise local defense mechanisms & delay healing

80
Q

What is the goal of debridement?

A

To obtain fresh clean wound margins & wound bed for primary or delayed closure

81
Q

In debridement, how is devitalized tissue removed?

A

-Surgical excision
-Autolytic mechanisms
-Enzymes
-Wet-dry bandages
-Biosurgical methods

82
Q

The extent of devitalized tissue is usually obvious within _____ hours of injury

A

-48

83
Q

During surgical debridement, how should devitalized tissue be surgically excised?

A

-In layers beginning at the surface & progressing to the depths of the wound

84
Q

How is surgical debridement done?

A

-Sharp dissection
-Electrosurgery
-Laser

85
Q

What must be preserved during surgical debridement?

A

-Bones
-Tendons
-Nerves
-Vessels

86
Q

How should muscle be surgically debrided?

A

-Until it bleeds & contracts w/ appropriate stimuli

87
Q

Extensive surgical debridement of ____ should be avoided because it may delay wound healing (particularly in cats)

A

subcutaneous tissue

88
Q

______ ______ should be liberally excised in surgical debridement b/c it is easily devascularized & harbors bacteria

A

Contaminated fat

89
Q

_____ ____ should be spared in surgical debridement to maintina the viability of overlying skin

A

Cutaneous vessels

90
Q

If sufficient healthy tissue surrounds the wound & vital structures can be preserved, what is an alternative to surgical debridement?

A

-Entire wound can be excised en bloc

91
Q

What is the danger of surgical debridement?

A

-Removal of excessive amount of possibly viable tissue

92
Q

With penetrating wounds or punctures, it may be necessary to ______ to assess the extent of injury and allow debridement

A

-May be necessary to enlarge the wound

93
Q

When should wounds be closed after surgical debridement?

A

-When it appears healthy or when a bed of healthy granulation tissue has formed, unless wound closure by contraction & epithelialization is anticipated

94
Q

What is autolytic debridement?

A

-Much slower process
-Accomplished through creation of moist wound environment to allow endogenous enzymes to dissolve nonviable tissue
-Often preferred over surgical or bandage debridement in wounds w/ questionable viability

95
Q

How is autolytic debridement accomplished?

A

-With hydrophilic, occlusive, or semiocclusive bandages (allow wound fluid to remain in contact w/ nonviable tissue)

96
Q

What happens to dressings that are allowed to dry on the wound, such as wet-to-dry bandages or dry-to-dry bandages?

A

-Adhere to wound surface & pull debris & strip superficial layers off the wound bed when removed

97
Q

In addition to mechanical debridement, what do wet-to-dry wound dressings also do?

A

-Provide adequate wound protection & coverage
-Maintain moist wound environment
-Absorb moderate amounts of wound exudates

98
Q

When are bandage (mechanical) debridement dressings most effective?

A

-In early stages of wound healing or in management of wound infection

99
Q

What is enzymatic debridement used as & what needs to happen for it to produce the desired effect?

A

-Adjunct to wound lavage & surgical debridement
-Enzymes must remain in contact w/ wound for adequate time to produce desired effect

100
Q

Enzymatic debridement beneficial in what patients?

A

-Patients that are poor anesthetic risks
-Patients when surgical debridement may damage healthy tissue necessary for reconstruction

101
Q

What can happen with enzymatic debridement?

A

-Local tissue irritation may occur

102
Q

What is biosurgical debridement?

A

-Maggot therapy using greenbottle fly larvae
-Sterile medicinal maggots are bred specifically for biosurgery

103
Q

When is biosurgical debridement (maggot therapy) best suited?

A

-To necrotic, infected, or chronic nonhealing wounds

104
Q

What type of wounds typically benefit from antibiotic therapy?

A

-Severely contaminated, crushed, or infected wounds, or wounds older than 6-8 hours

105
Q

How should antibiotics be selected for wound antibiotic therapy?

A

-Antibiotic selection should ultimately be based on culture & susceptibility testing

106
Q

What topical antimicrobials and antibiotics should not be used in wounds?

A

-Powders b/c they act as foreign bodies

107
Q

What type of antibiotics are preferred for open wounds?

A

-Topical rather than systemic antibiotics

108
Q

What is important to note about triple antibiotic ointment in wound healing?

A

-The ointments is more effective for preventing infections than for treating them

109
Q

What is the drug of choice to treat burn wounds?

A

-Silver sulfadiazine

110
Q

What does silver sulfadiazine do?

A

-Effective against most gram + and gram - bacteria & most fungi
-Serves as antimicrobial barrier
-Can penetrate necrotic tissue
-Enhances wound epithelialization

111
Q

What is nitrofurazone?

A

-Broad-spectrum antibacterial & hydrophilic properties
-Little effect against Pseudomonas spp.
-Hydrophilic properties

112
Q

What is gentamicin sulfate?

A

-Espeically effective in controlling Gram-negative bacterial growth
-Often used before & after grafting and for wounds that have not responded to triple antibiotic ointment

113
Q

What does cefazolin do for wound healing?

A

-Effective antimicrobial against gram-positive and some gram-negative organisms
-Topical cefazolin provides high levels of antibiotic in wound fluid

114
Q

When should honey be used in wound healing?

A

-Should be used early in the course of wound healing and discontinued once a healthy granulation bed is present

115
Q

Why would we use sugar in wound healing?

A

Has similar hypertonic effects to honey and
-Attracts macrophages
-Accelerates sloughing of devitalized tissue
-Provides cellular energy source
-Promotes formation of healthy granulation bed

116
Q

What are the benefits of *vacuum assisted closure?

A

-Increased rate of granulation
-Accelerated healing times
-Wound cleaning
-Improved blood flow
-Reduced edema

117
Q

What is shown here?

A

-Vacuum assisted closure

2025 - Intro to Surgery 737A (19 decks)

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