Intro to equine wound management Flashcards
What are the types and definitions of wounds that affect horses?
Abrasions - partial thickness
Laceration - full thickness
Puntures/penetrating wounds
what are the 4 stages of wound healing?
describe each stage, including timing
-
Haemostasis
- Initial vasoconstriction
- First 5-10 minutes
- Bleeding stops
- Clot forms over the wound
-
Inflammation
- 1-3 days after injury
- NTP & MCP start clean up process (natural debridement)
- Slough & exudate produced
-
Proliferation
- True healing phase
- Filling of the wound bed with healing tissue (fibroblasts)
- Few days- weeks
- Healthy blood supply forms at wound edge
- Wound contracts
-
Remodelling
Scar maturity- 2 weeks - two years
- Long process
- Ensure strength, integrity and function of new tissue
- Collagen laid down
What steps can be taken during the inflammation phase to make wound healing faster?
- Debridement
- Irrigation
- Good haemostasis
- Adequate drainage
What are the 4 substeps of the proliferation phase?
(i) Fibroplasia
(ii) Angiogenesis
(iii) Epithelialisation
(iv) Contraction
What factors inhibit epithelialisation during proliferation?
At what rate do flank and limb wounds heal?
desiccation of the wound surface
exuberant granulation tissue
repeated dressing changes
Slow compared to other species:
flank wounds: rate of 0.2mm/day
limb wounds: rate of 0.09mm/day
When does the contraction phase of the proliferation stage of wound healing occur and how long does it last?
How does it help the wound?
Starts week 2 after wounding, Continues for several weeks
Very important, especially in horses
* Accelerates closure
* Increase cosmesis of scar
* Less need for epithelialization
what is the aim of management of equine wounds?
Full epithelialisation without scar formation
In as minimal time as possible
Without recurrence or risk of breakdown
And
As cost effectively as possible
what factors inhibit the healing of equine wounds?
- Infection
- Movement
- Foreign Bodies
- Necrotic Tissue
- Continued Trauma
- Poor blood supply
- Poor oxygen supply
- Poor nutrition & health status (cushings or on steroids)
- Local factors (size and location of wound)
- Iatrogenic factors
- Genetic factors
- Cell transformation
What is the alternative name for Exubereant granulation tissue?
What issues does this cause for the wound and what its this caused buy?
How can this be treated?
‘Proud Flesh’ (new tissue extends beyond the surface of the wound edges)
* Interrupts progression of healing as wound can’t epithelialise and contract
Factors that contribute:
* Contamination /Infection /Inflammation /Movement
* Common on lower limbs (below carpus & tarsus)
treatment:
* Surgical excision (scalpel)
* Aneural but will bleed (a lot)
* Skin grafts if large area
What is the difference between wound healing in horses and ponies?
In ponies:
* 1st & 2nd intention healing more rapid
* Quicker & more intense inflammatory response
* more resistant to infection
* Greater contraction due to higher number of leukocytes recruited
* Less wound dehiscence
* Fewer bone sequestrae
* Less exuberant granulation tissue due to more intense & less prolonged inflammatory phase
Can synoviocentesis be used to assessed wounds?
Aim: to confirm or exclude communication with wound
- Synovial Structures may have multiple approaches
- Identification of landmarks important
- Sterile Preparation & Strict Asepsis
- Fluid aspiration for WCC and TP analysis
- Approach from site distant from wound NOT through wound
- pressure test - look for fluid coming out of wound when fluid injected into synovial structure
Why do you need to assess wound depth with every wound?
to check for communication with synovial structures as synovial sepsis can be life threatening
* Probe all wounds to determine depth / direction / involvement of associated structures
* Assess lameness & check if any pain relief has already been given
what are the signs of synovial sepsis?
- Signs of synovial sepsis can include:
- Wound overlying a synovial structure
- Swollen & painful synovial structure
- Fluid leaking from wound overlying a synovial structure
- Severe lameness*
*not if synovial structure is open/draining and can be masked by NSAIDs
How do you prepare an equine wound?
- Restraint & Sedation
- Clipping
- 5-10cm area around wound should be clipped
- Clippers clean
- Blades sharp & lubricated
- Wound hydrogel applied to prevent hair contamination of wound bed
Where can antiseptics be used with regards to wounds?
- Antiseptics reserved for around wound
- Ensure correct concentrations
0.05% chlorhexidine (gluconate) 4%
* Superior antibacterial activity than povidone iodine
0.1-0.2% povidone iodine
* Inactivated by organic material
* Evidence for dilute povidone iodine use in severely contaminated wounds
