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SA DX & TX II > Exam 2 - Wound Management & Healing > Flashcards

Exam 2 - Wound Management & Healing Flashcards

1
Q

what is the initial management done for a patient that presents with a wound?

A

patient assessment

bandage/cover wounds

analgesics

wound evaluation when patient is stable

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2
Q

what are the 7Cs/ABCs of acute wound management?

A
  1. clip
  2. clean
  3. copiously lavage
  4. cut
  5. cover
  6. coaptation
  7. +/- close & =/- antibiotics
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3
Q

what are the basic acute wound care principles?

A
  1. gloves - exam or sterile depending on the wound
  2. wide clip & copious lavage - don’t want to have to shave every day
  3. debride
  4. ensure adequate perfusion - won’t heal anything if they are shocky
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4
Q

why put lube into a wound?

A

fill with water soluble jelly & then shave the wound - must be water soluble

fur sticks to the jelly & washes away when lavaged

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5
Q

what is the purpose of lavaging a wound?

A

helps to reduce necrotic debris/contaminants & facilitate wound healing process

repeat every time you look at the wound

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6
Q

what liquids will you use for lavaging in acute wound management? what about further in the healing process?

A

tap water is okay to start - high volume of lavage

move away from tap water because it is hypotonic & will cause cell death - looking at saline instead

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7
Q

how much pressure is desired when lavaging a wound?

A

8 PSI

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8
Q

why not use a syringe with a 16G needle for lavaging a wound?

A

generates too much pressure - about ~16 PSI

too much pressure drives contaminants further into the wound - will become edematous

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9
Q

what is the best set-up for lavaging a tiny wound to get the ideal pressure?

A

fluid bag with a pressure thing on top set at 300 mmHg with any size needle attached to the line consistently gave 8 PSI

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10
Q

what does dr. thiemann prefer for lavaging a wound?

A

the thing that looks like a ketchup bottle

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11
Q

T/F: it is okay to use either a chlorhexidine scrub or solution for lavage solution in a wound

A

false - only can use the solution

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12
Q

what concentration of chlorhexidine solution do you want for lavaging a wound?

A

0.5% - need to dilute it, usually sold at 2%

take 25mL & put into 1L saline bottle - gives you the concentration

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13
Q

what solution will you chose for lavaging if there is a wound around an eye?

A

iodine/betadine solution - 1%

or even saline

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14
Q

what are the 4 phases of wound management?

A
  1. coagulation
  2. inflammation/debridement
  3. repair
  4. maturation
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15
Q

how long does each phase of wound healing last?

A
  1. coagulation/hemostasis - seconds to hours
  2. inflammation/debridement - hours to days
  3. repair/proliferative - days to weeks
  4. maturation/remodeling - weeks to months
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16
Q

what is going on in the coagulation/hemostasis phase of wound healing?

A

injury occurs & causes:

  • vasoconstriction
  • platelet aggregation
  • leukocyte migration
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17
Q

what is going on in the inflammatory/debridement phase of wound healing?

A

early - neutrophil chemoattractant release

late - macrophages, phagocytosis & removal of foreign body/bacteria, help signal the repair phase

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18
Q

what is going on in the repair/proliferative phase of wound healing?

A

fibroblast proliferation

collagen synthesis

extra cellular matrix reorganization

angiogenesis

granulation tissue formation

epithelialization

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19
Q

what is going on in the maturation/remodeling phase of wound healing?

A

remodeling

epithelialization

ECM remodeling

increase in tensile strength of the wound

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20
Q

what are some examples of mechanisms of debridement?

A

mechanical - using something to rip off dead tissue

autolytic - help body promote autolysis

enzymatic - least useful

surgical/sharp (layered & en bloc) - usually the go to

layered - cut out the necrotic tissue, look for what is dead/not dead, can be very selective in what you choose to take

en bloc - remove entire wound as if it is a tumor, take entire wound & some fresh healthy tissue, done in places with excessive skin

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21
Q

what is larval therapy? how does it work?

A

FDA approved/insurance covered option for debridement

sterilized maggots are placed into a wound & the wound is debrided when they secrete digestive enzymes into the necrotic tissue & leaves healthy tissue alone

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22
Q

what wounds are ideal candidates for larval therapy?

A

bedsores & diabetic ulcers

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23
Q

what are some examples of wounds in which you may choose primary closure?

A

clean wounds, clean contaminated wounds, & not dog bites/crush wounds

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24
Q

what are some examples of wounds in which you may choose delayed primary closure?

A

clean contaminated & contaminated wounds

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25
what are some examples of wounds in which you may choose secondary closure?
contaminated & dirty wounds
26
T/F: any kind of wound may be a candidate for second intention healing
true
27
T/F: if the tissue of a wound looks questionable, don't close it
true
28
what must you assess prior to deciding on type of wound closure?
assess tissue viability, blood flow, & amount of contamination present
29
what is the purpose of using wound dressings?
help protect the wound, prevent/control infection, & enhance healing
30
T/F: moist wound healing has been the standard of care in human medicine since the 1960s
true - don't need to 'air it out'
31
what are some contraindications to using sugar in a wound dressing?
if there is healthy granulation tissue or epithelial tissue
32
what are some indications for using sugar in a wound dressing?
use in open, contaminated, & infected wounds
33
why is sugar used as a dressing in wound healing?
antibacterial due to the high osmolality decreases edema, increases macrophages which helps to signal the repair phase, & great to use in the inflammatory stage of wound healing
34
how is sugar used in a wound dressing?
place 1cm thick in the wound with frequent bandage changes!!!
35
why is honey used as a dressing in wound healing?
same advantages as sugar - decreases wound pH, H2O2, antibacterial, effective antimicrobial, & best used in the inflammatory/early repair stages USE UNPASTEURIZED pasteurized - doesn't have all the benefits for promote wound healing, only the hyper osmolality
36
why is silver used as a dressing in wound healing?
antibacterial for MRSA & pseudomonas, & fungicidal best in inflammatory/repair phases DOES NOT DEBRIDE
37
what wounds are ideal for using silver as a wound dressing?
burns, contaminated, & infected wounds
38
how is silver acticoat used as a wound dressing?
moistened with sterile water & covered with semi-occlusive bandage (loban) & isn't changed for a week
39
where does alginate come from?
derived from kelp
40
what is alginate used for in wound dressings?
good for debridement & decreasing edema - promotes autolytic debridement great for inflammatory/repair phases - often combined with silver to get both antibacterial & debridement
41
why is it a benefit that alginate is high in calcium?
can active prothrombin in clotting cascade so it is a good option when mild hemostasis is needed
42
what wound type is contraindicated for using hydrogel as a wound dressing?
if the wound is infected
43
what is a side effect associated with hydrogel?
can lead to the development of exuberant granulation tissue
44
what are the benefits of using hydrogel as a wound dressing?
soothing, hydrating option & promotes autolytic debridement good for using in the inflammatory/repair phase
45
when may you reach for hydrogel for a wound dressing? where would you put it & why?
if a dog that was missing comes in & has an older dry wound to help hydrate it - supports healing by second intention only on the wound because it can macerate healthy skin!!!!
46
what wound dressing option supports healing by second intention?
hydrogel
47
what wound dressing option is antibacterial but doesn't provide debridement?
silver
48
what is a wet-to-dry bandage? when is it used?
moisten a 4x4 with sterile saline & bandage with something semi-permeable to the air wait for it to dry & rip it off - mechanical debridement early inflammatory phase
49
why are wet-to-dry bandages not used as often anymore?
they are not moist wound healing & are painful for the patient
50
what is vacuum assisted wound closure?
use of sub-atmospheric pressure to promote or assist wound healing or remove fluid from a wound site
51
what does vacuum assisted wound closure do?
increases blood flow, removes extravascular fluid, increases granulation tissue, speeds wound closure (increases contraction), decreases bacteria in the wound
52
when is vacuum assisted wound closure best used?
inflammatory/early repair phase
53
what does vacuum assisted wound closure NOT do?
debride the wound
54
what is the definition of failure to heal/chronic wound?
wounds that fail to heal after 1 month
55
what are some underlying conditions that result in failure of healing in wounds?
metabolic abnormalities/medications failure in contraction failure in epithelialization 'pocket' wounds - indolent ongoing infection
56
what is the most important part in approaching a chronic wound? what are some examples of this?
need to diagnose the cause of why it isn't healing look for excessive tension, motion, endocrine abnormalities, neoplasia, & infection
57
what are some examples of strange bugs often associated with chronic non-healing wounds?
nocardia, actinomyces, fungus, oomycetes, & mycoplasma
58
why do we biopsy chronic wounds?
submit for histopath to look for neoplasia & send to culture to look for weird bugs or foreign material
59
what are some metabolic abnormalities/medications that may cause chronic wounds?
inadequate nutritional support, endocrine disorders, animals on steroids, radiation, & chemo
60
what are some reasons we see failure of wound contraction?
excessive tension & restrictive fibrosis (chronic wound with a lot of scar tissue, so there is no pull that happens during wound contracture)
61
how is tension free closure done?
pay attention to the lines of tension (tiger stripes) close parallel with the lines of tension may use tension relief - releasing incision
62
why do we commonly see failure of epithelialization in chronic wounds?
lack of a vascular bed/lack of granulation tissue - wounds with exposed bone or tendons (epithelium won't advance over exposed bones/tendon) too much motion!!!!
63
what are pocket/indolent wounds?
failure of epithelialization seen in cats looks like round wound edges where epithelium doesn't advance across must move in new tissue to actual heal the wound
64
what is an infected chronic wound?
prolonged presence of neutrophils in a wound may be a factor in the conversion of acute wounds into non-healing chronic wounds instead of a wound environment that promotes healing, it becomes very inhospitable to the wound
65
what is a biofilm?
community of bacteria within self-produced extracellular polymeric substance including: polymeric sugars, bacterial proteins, bacterial DNA, & co-opted host substances
66
what attachment sites do we see biofilms on?
abiotic surface (metallic implant) - electrostatic interactions between bacteria & material surface biotic surface (wound surface) - specific receptor-ligand interactions & initial repulsive electrostatic forces
67
what is the pathogenesis of a biofilm?
biofilm attaches & is able to share its DNA with other bacteria & then forms the mature slime/matrix that protects itself from antibiotics & raises the MIC needed to treat the problem
68
what therapy is recommended when treating a chronic wound with a biofilm?
sharp debridement electrical field MIC is altered - keep this in mind for topical & systemic therapy VAC/negative pressure bandage
69
how are biofilms prevented?
much better hygiene (good hand washing), extreme PPE, protect the wound
70
what is MMP in regards to chronic wounds?
matrix metalloproteinase
71
why does it matter that there are increased MMP levels in chronic wounds?
it degrades the ECM & growth factors reduces cell responsiveness in the wound increases the inflammatory response & delays wound healing
72
T/F: every bite wound injury requires an exploration
true - whether it is done when the animal is awake, under sedation, or under general anesthesia
73
what are some indications for placing a drain into a wound?
neck dissection, dog bite wounds, groin dissection, +/- skin flaps & neoplasia
74
what are some disadvantages of placing a drain into a wound?
increased risk of infection, erosion of adjacent structures, adhesion to adjacent structures, increased dehiscence, premature loss, drain obstruction, & pain
75
what drain type is never appropriate to place inside the thorax & abdomen?
penrose drain
76
how much fluid is produced in a drain per day?
1-2ml/kg/day - presence of the drain induces fluid production
77
T/F: the presence of a drain induces fluid production
true
78
when do you remove a drain from a wound?
fluid production plateaus!!! dogs may be at risk for seroma formation if drainage is >0.2ml/kg/hr when the drain is removed may also use cytologic evaluation
79
T/F: when placing a drain, always bandage the exit & prevent the animal from removing the drain themselves
true
80
why is the loss of paw pads, especially MC/MT, a serious injury in dogs? what about cats?
normal skin in a dog can't withstand daily physical abuse may work in sedentary indoor cats
81
T/F: paw pads tend not to heal as well as other tissues & don't heal well by second intention, so take large bites of tissue when suturing
true
82
how can you approach a paw pad injury in the golden period of the wound?
lavage, debride, primary closure of SQ & skin - get large bites of tissue & apply a bandage or splint
83
how to do you treat a paw pad injury that is presenting to you some time after the trauma occurred?
lavage, debride, & bandage - can do a delayed primary or secondary closure
84
complete loss of all paw pads may require what treatment?
limb amputation
85
what are some surgical options for treating an injury of the MC or MT paw pad?
digital pad transfer - accessory carpal pad pad grafting
86
what can you do if there is only single digital pad loss?
digit amputation
87
why do we see aural hematomas in companion animals?
usually occur secondary to pinna trauma or history of head shaking/scratching from otitis externa
88
what are the goals for treating aural hematomas?
treat the pinna immediately - this is how you can save the ear to make it look normal remove the blood clot, prevent recurrence, & retain the natural appearance of the ear
89
what is the key in treating biofilms?
early intervention with multiple therapies
90
what imaging should you use for dog bite wounds?
radiographs depending on the severity of the attack don't forget the spine & look to see if air is present in the abdomen
91
T/F: protecting the wound is a big part of therapy for chronic wounds
true - #1 is the e-collar
92
what wound closure is usually used for dog bite wounds?
delayed primary - manage open for a few days & then close
93
what is the general surgical therapy used for treating aural hematomas?
s-incision & then skin is tacked down to underlying cartilage

SA DX & TX II (62 decks)

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