Lacerations & Wound Management

Question 1

Is skin thicker in younger or older horses?

Answer 1

older

Question 2

Is skin thicker at extensor surface or flexor surface of legs?

Answer 2

thick at extensor surface

Question 3

Wound that are parallel to what lines heal best?

Answer 3

equine cleavage lines

Question 4

where is a distal limb wound?

Answer 4

below carpus and tarsus

Question 5

where do equine cleavage lines run?

Answer 5

parallel to long axis of legs, head, and torso and perpendicular to long axis of neck and flank

Question 6

where should incisions be made in relation to cleavage lines?

Answer 6

parallel

Question 7

what are things to consider when having a distal limb wound?

Answer 7

tension
close to ground
synovial structure

Question 8

why do most repaired wounds fail?

Answer 8

improper assessment & preparation

Question 9

Describe initial preparation for wounds

Answer 9

order important

Question 10

what is the purpose of debridement?

Answer 10

effective way to reduce bacterial load within a wound and minimize necrotic tissue

Question 11

what are the advantages and disadvantages of sharp debridement?

Answer 11

advantage - least traumatic
disadvantage - when tissue is removed cannot be put back (be conservative)

Question 12

what tools are considered sharp debridement?

Answer 12

scalpel, scissors, and lasers

Question 13

which sharp debridement is the least traumatic and should be used?

Answer 13

scalpel

Question 14

what are the methods of mechanical debridement?

Answer 14

woven gauze, lavage, wet to wet dressings, wet to dry dressings

Question 15

what should be used when lavage?

Answer 15

solution - non-cytotoxic cleansing solution
delivery - 19G, 10-15 psi (don’t want high pressure to push it further into tissue)

Question 16

when should chemical debridement be used?

Answer 16

reserved for very contaminated wounds, non-selective

Question 17

what is used for chemical debridement?

Answer 17

hydrogen peroxide
hypertonic saline

Question 18

what is used for biological debridement?

Answer 18

sterile medical grade larvae (maggots)

Question 19

what do maggots digest?

Answer 19

necrotic tissue & pathogenic bacteria, healthy tissue is unharmed

Question 19

which is more effective at removing necrotic tissue?

Question 20

what is the least traumatic method of debridement?

Answer 20

autolytic debridement

Question 21

what is autolytic debridement? what type of wounds can it only occur in?

Answer 21

leave wound fluid in contact with wound bed
only in moist wounds

Question 21

define contamination

Answer 21

Question 22

define colonization

Answer 22

Question 23

define infection

Answer 23

Question 24

what does a qualitative assessment in wounds do?

Answer 24

determine type of bacteria in wound guide antibiotic decision

Question 25

what does a quantitative assessment in wounds do?

Answer 25

bacterial counts considered when wound is not progressing as anticipated

Question 26

when do you use an antiseptic?

Answer 26

used for normal skin surrounding wound and not on wound bed itself

Question 27

when do you use a topical antimicrobial agent?

Answer 27

BS to wound surface diminished (chronic infections), based on culture/sensitivity or judgement on most likely bacteria to be found in wound

Question 28

match the wound healing phases with the wound classifications

Answer 28

Question 29

what wounds are best candidates for primary or delayed primary closure?

Answer 29

early stages (inflammatory or debridement phase) and clean or clean contaminated

Question 30

List the wound closure techniques

Answer 30

primary closure, delayed primary closure, second intention, skin grafting, combinations

Question 31

The type of closure used depends on the following...

Answer 31

what caused the wound, time from injury, degree of contamination, extent of injury, potential dead space, surgical skills

Question 32

what type of wounds can get primary closure?

Answer 32

minimal tissue loss, minimal bacterial contamination, and minimal tension on wound edges after closure

Question 33

Define primary closure

Answer 33

wound is closed immediately and completely using strict aseptic technique

Question 34

How do you reduce tension in a wound?

Answer 34

suture patterns: near-far-far-near, interrupted vertical or horizontal mattress with stents use large diameter suture material undermine wound edges

Question 35

What can failure to obliterate dead space lead to?

Answer 35

hematoma/seroma development > excellent medium for bacterial growth

Question 36

How can you close dead space?

Answer 36

suture, meshing skin, passive or active drains, pressure bandages

Question 37

what is delayed primary closure?

Answer 37

wound initially left open to allow for debridement and reduce bacterial contamination then closed primarily

Question 38

what is delayed primary closure useful in managing?

Answer 38

contaminated wounds

Question 39

what closure method would you use?

Answer 39

Question 40

what is second intention healing?

Answer 40

heal via contraction, granulation, and epithelialization

Question 41

when is second intention healing used?

Answer 41

gross contamination and moderate to severe tissue loss makes closure difficult

Question 42

When do you use a wound dressing?

Answer 42

open wound changes as it heals - different dressings for different stages

Question 43

Describe ideal wound dressing

Answer 43

keeps wound bed moist and surrounding skin dry manage amount of exudate while making sure wound does not dry out

Question 44

what is the benefit of head wounds?

Answer 44

extensive vascular supply good soft tissue support

Question 45

what do you always do with a head wound?

Answer 45

neurologic exam

Question 46

what diagnostic aids do you use for head wounds?

Answer 46

radiographs, ultrasound, computed tomography, MRI

Question 47

what are the important structures to consider in head wounds?

Answer 47

brain, eyes, ears, paranasal sinuses, salivary ducts, nerves

Question 48

what cannot be used to clean the orbit?

Answer 48

chlorhexidine - can cause corneal damage, use betadine

Question 49

when dealing with eyelides how should lacerations be closed? why?

Answer 49

small diameter absorbable suture in many layers provides more stability in high motion area without adding foreign body volume to wound

Question 50

How should ear wounds be addressed?

Answer 50

closed primarily

Question 51

what is very important for thorax wounds?

Answer 51

use aseptic techniques to determine their depth

Question 52

when do you use a stent bandage?

Answer 52

thorax wound prevents air from getting sucked into it

Question 53

what should you listen for with a thorax wound?

Answer 53

air getting sucked into wound during inspiration

Question 54

what do you do for a wound with pleural penetration?

Answer 54

broad-spectrum antibiotics and referral