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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
Q

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

A

contaminated & dirty wounds

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26
Q

T/F: any kind of wound may be a candidate for second intention healing

A

true

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27
Q

T/F: if the tissue of a wound looks questionable, don’t close it

A

true

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28
Q

what must you assess prior to deciding on type of wound closure?

A

assess tissue viability, blood flow, & amount of contamination present

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29
Q

what is the purpose of using wound dressings?

A

help protect the wound, prevent/control infection, & enhance healing

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30
Q

T/F: moist wound healing has been the standard of care in human medicine since the 1960s

A

true - don’t need to ‘air it out’

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31
Q

what are some contraindications to using sugar in a wound dressing?

A

if there is healthy granulation tissue or epithelial tissue

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32
Q

what are some indications for using sugar in a wound dressing?

A

use in open, contaminated, & infected wounds

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33
Q

why is sugar used as a dressing in wound healing?

A

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

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34
Q

how is sugar used in a wound dressing?

A

place 1cm thick in the wound with frequent bandage changes!!!

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35
Q

why is honey used as a dressing in wound healing?

A

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

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36
Q

why is silver used as a dressing in wound healing?

A

antibacterial for MRSA & pseudomonas, & fungicidal

best in inflammatory/repair phases

DOES NOT DEBRIDE

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37
Q

what wounds are ideal for using silver as a wound dressing?

A

burns, contaminated, & infected wounds

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38
Q

how is silver acticoat used as a wound dressing?

A

moistened with sterile water & covered with semi-occlusive bandage (loban) & isn’t changed for a week

39
Q

where does alginate come from?

A

derived from kelp

40
Q

what is alginate used for in wound dressings?

A

good for debridement & decreasing edema - promotes autolytic debridement

great for inflammatory/repair phases - often combined with silver to get both antibacterial & debridement

41
Q

why is it a benefit that alginate is high in calcium?

A

can active prothrombin in clotting cascade so it is a good option when mild hemostasis is needed

42
Q

what wound type is contraindicated for using hydrogel as a wound dressing?

A

if the wound is infected

43
Q

what is a side effect associated with hydrogel?

A

can lead to the development of exuberant granulation tissue

44
Q

what are the benefits of using hydrogel as a wound dressing?

A

soothing, hydrating option & promotes autolytic debridement

good for using in the inflammatory/repair phase

45
Q

when may you reach for hydrogel for a wound dressing? where would you put it & why?

A

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
Q

what wound dressing option supports healing by second intention?

A

hydrogel

47
Q

what wound dressing option is antibacterial but doesn’t provide debridement?

A

silver

48
Q

what is a wet-to-dry bandage? when is it used?

A

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
Q

why are wet-to-dry bandages not used as often anymore?

A

they are not moist wound healing & are painful for the patient

50
Q

what is vacuum assisted wound closure?

A

use of sub-atmospheric pressure to promote or assist wound healing or remove fluid from a wound site

51
Q

what does vacuum assisted wound closure do?

A

increases blood flow, removes extravascular fluid, increases granulation tissue, speeds wound closure (increases contraction), decreases bacteria in the wound

52
Q

when is vacuum assisted wound closure best used?

A

inflammatory/early repair phase

53
Q

what does vacuum assisted wound closure NOT do?

A

debride the wound

54
Q

what is the definition of failure to heal/chronic wound?

A

wounds that fail to heal after 1 month

55
Q

what are some underlying conditions that result in failure of healing in wounds?

A

metabolic abnormalities/medications

failure in contraction

failure in epithelialization

‘pocket’ wounds - indolent

ongoing infection

56
Q

what is the most important part in approaching a chronic wound? what are some examples of this?

A

need to diagnose the cause of why it isn’t healing

look for excessive tension, motion, endocrine abnormalities, neoplasia, & infection

57
Q

what are some examples of strange bugs often associated with chronic non-healing wounds?

A

nocardia, actinomyces, fungus, oomycetes, & mycoplasma

58
Q

why do we biopsy chronic wounds?

A

submit for histopath to look for neoplasia & send to culture to look for weird bugs or foreign material

59
Q

what are some metabolic abnormalities/medications that may cause chronic wounds?

A

inadequate nutritional support, endocrine disorders, animals on steroids, radiation, & chemo

60
Q

what are some reasons we see failure of wound contraction?

A

excessive tension & restrictive fibrosis (chronic wound with a lot of scar tissue, so there is no pull that happens during wound contracture)

61
Q

how is tension free closure done?

A

pay attention to the lines of tension (tiger stripes)

close parallel with the lines of tension

may use tension relief - releasing incision

62
Q

why do we commonly see failure of epithelialization in chronic wounds?

A

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
Q

what are pocket/indolent wounds?

A

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
Q

what is an infected chronic wound?

A

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
Q

what is a biofilm?

A

community of bacteria within self-produced extracellular polymeric substance including:

polymeric sugars, bacterial proteins, bacterial DNA, & co-opted host substances

66
Q

what attachment sites do we see biofilms on?

A

abiotic surface (metallic implant) - electrostatic interactions between bacteria & material surface

biotic surface (wound surface) - specific receptor-ligand interactions & initial repulsive electrostatic forces

67
Q

what is the pathogenesis of a biofilm?

A

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
Q

what therapy is recommended when treating a chronic wound with a biofilm?

A

sharp debridement

electrical field

MIC is altered - keep this in mind for topical & systemic therapy

VAC/negative pressure bandage

69
Q

how are biofilms prevented?

A

much better hygiene (good hand washing), extreme PPE, protect the wound

70
Q

what is MMP in regards to chronic wounds?

A

matrix metalloproteinase

71
Q

why does it matter that there are increased MMP levels in chronic wounds?

A

it degrades the ECM & growth factors

reduces cell responsiveness in the wound

increases the inflammatory response

& delays wound healing

72
Q

T/F: every bite wound injury requires an exploration

A

true - whether it is done when the animal is awake, under sedation, or under general anesthesia

73
Q

what are some indications for placing a drain into a wound?

A

neck dissection, dog bite wounds, groin dissection, +/- skin flaps & neoplasia

74
Q

what are some disadvantages of placing a drain into a wound?

A

increased risk of infection, erosion of adjacent structures, adhesion to adjacent structures, increased dehiscence, premature loss, drain obstruction, & pain

75
Q

what drain type is never appropriate to place inside the thorax & abdomen?

A

penrose drain

76
Q

how much fluid is produced in a drain per day?

A

1-2ml/kg/day - presence of the drain induces fluid production

77
Q

T/F: the presence of a drain induces fluid production

A

true

78
Q

when do you remove a drain from a wound?

A

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
Q

T/F: when placing a drain, always bandage the exit & prevent the animal from removing the drain themselves

A

true

80
Q

why is the loss of paw pads, especially MC/MT, a serious injury in dogs? what about cats?

A

normal skin in a dog can’t withstand daily physical abuse

may work in sedentary indoor cats

81
Q

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

A

true

82
Q

how can you approach a paw pad injury in the golden period of the wound?

A

lavage, debride, primary closure of SQ & skin - get large bites of tissue & apply a bandage or splint

83
Q

how to do you treat a paw pad injury that is presenting to you some time after the trauma occurred?

A

lavage, debride, & bandage - can do a delayed primary or secondary closure

84
Q

complete loss of all paw pads may require what treatment?

A

limb amputation

85
Q

what are some surgical options for treating an injury of the MC or MT paw pad?

A

digital pad transfer - accessory carpal pad

pad grafting

86
Q

what can you do if there is only single digital pad loss?

A

digit amputation

87
Q

why do we see aural hematomas in companion animals?

A

usually occur secondary to pinna trauma or history of head shaking/scratching from otitis externa

88
Q

what are the goals for treating aural hematomas?

A

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
Q

what is the key in treating biofilms?

A

early intervention with multiple therapies

90
Q

what imaging should you use for dog bite wounds?

A

radiographs depending on the severity of the attack

don’t forget the spine & look to see if air is present in the abdomen

91
Q

T/F: protecting the wound is a big part of therapy for chronic wounds

A

true - #1 is the e-collar

92
Q

what wound closure is usually used for dog bite wounds?

A

delayed primary - manage open for a few days & then close

93
Q

what is the general surgical therapy used for treating aural hematomas?

A

s-incision & then skin is tacked down to underlying cartilage

SA DX & TX II (62 decks)

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