large animal wound assessment Flashcards
basic principles of assess a wound
thorough hx
adequate restraint-physical and chemical
local/regional anesthesia
clipping-water soluble gel in wound
cleaning
assessment-depth, structures involved
wounds of head and neck
extensive blood supply and good soft tissue support
lots of imprtant structures may be involved in wound
heavy sedation often necessary
thorough evaluation
dx imaging
wounds over bony surfaces
blood supply becomes an issue when there is not adequate soft tissue to cover a wound
esp if periosteum has been lost
must debride edges
find alternative blood supply
injuries over cannon bone with loss of overlying tissue-difficult!
prone to development of proud flesh
sequestrum make form
Wounds of thorax and abdomen
penetrating wounds may involve the pleural or peritoneal cavities
multiple layers to abdominal wall may shift, obscuring the path of penetration
axillary wounds can result in pneumomediastinum and/or pneumothorax
wounds of extremities
proximal limb has better blood supply and soft tissue support than the distal limb
involvement of deeper structure major concern
movement impairs healing
often highly contaminated
structures to evaluate in distal limb: synovial
metacarpo/tarsophalangeal joint (fetlock)
proximal interphalangeal joint (pastern)
distal interphalangeal joint (coffin)
flexor tendon sheath
navicular bursa
decreases px
structures to evaluate in distal limb: tendons and ligaments
extensor tendons
superficial digital flexor tendon
deep digital flexor tendon
suspensory ligaments
collateral ligaments
ligaments associated wtih navicular bone
px depends on depth of laceration
What is the best way to determine if a synoial structure communicates with a wound?
put a needle into joing distant from wound and pressurize the joint with sterile saline
granulation tissue
should fill in wound until even with edge edge of surrounding skin
epithelialization around the edges
exuberant graulation tissue
proud flesh
particular problem for leg wounds in horses but not ponies
deficient but protracted infl phase
persistent hypoxia from occlusion of microvessels within granulation tissue
rapid and prolonged proliferation of fibroblasts
deficient epithelialization and contraction
debridement
bandaging
penetrating wounds of the foot
street nail
depend on length and orientation of penetrating object, can involve many diff structures: coffin join, navicular bursa, navicular bone, third phalanx, digital cushion, DDFT, ligaments of navicular bone
what would prevent a wound from healing?
ongiong movement at wound site
presence of exuberant granulation tissue
chronically infected granulation tissue
osteomyelitis of underlying bone
presence of sequestrum or foreign body
persistent drainage from a synovial structure
sequestrum
most frequently develops secondary to trauma of canon bone or fx
days to weeks to develop
dx on rad
exploration of wound/draining track, removal of sequestrum and all ofther infeced/abn tissue surrounding it
synovial fistula
persistant draining from a synovial structure
debrie, close the hole in synovial structure, close the skin wound-difficult
