large - treatment options for wounds

Question 1

what are you itital thoughts about these two wounds?

Answer 1

Image A
chronic wound - chronic granulation tissue
bone exposure

Image B
Acute
Bone exposure
Close to carpus
Carpal-metacarpal joint may be associated here
What other structures are involved

Question 2

what are you thoughts about treatment options for this wound?

Answer 2

Although a lot of trauma here, primary closure could be possible due to little cell death.

Management approach probably need referral treatment, close to synovial structure
Contamination risk is high – typically requires lavage

Question 3

what are you thoughts about treatment options for this wound?

Answer 3

more chronic wound with lots of necrosis. not possible to perform pirmary closure

Management approach probably need referral treatment, close to synovial structure
Contamination risk is high – typically requires lavage

Question 4

what is the primary issue with primary closure of LA wounds?

Answer 4

tension - mattress suture pattern to combat this

Question 5

what technique has been used to close this wound?

Answer 5

horizontal mattress patterns with a stent/quill to distribute tension
Drip tubing 1cm in length, threaded with suture material

Question 6

what occurs in secondary closure? what is the first step?

Answer 6

wound is left to allow for:
Inflammatory process results in inc WBC to remove bacteria and necrotic tissue

Debridement is first consideration (accelerates wound healing process)

End result occurs faster by bringing proliferation stage of wound healing in earlier

Question 7

what is lay primary closure?

Answer 7

intermediate process which is referal based. natural debridment process followed by closure

Question 8

what is needed if LA wounds with large dead spaces?

Answer 8

need bangages and drains
Drains allow a portal for fluid and inflammatory exudate
Accelerates debridement phase
Passive drains:
Latex Penrose drain
Two incisions not related to the wound
Located in most dependent part
Fluid moves by capillary action into bandage material

Question 9

in LA wounds what can be an issue caused by granulation tissue formation?

Answer 9

Granulation / exuberant tissue = proud flesh (stands taller than the skin surface)
* Stops epithelization which can only occur from wound periphery
* Granulation tissue does not have good nerve supply so can be trimmed back to skin surface to allow epithelial cells to migrate over the wound bed
Scalpel blade used to trim
Causes hemorrhage - due to good blood supply - need to protect rest of leg from this as horse will fill the blood runnign over surface of the leg and dislike this

Question 10

how can skin grafting be done in LA?

Answer 10

• punch grafting
• pinch grafting
  easy to perform in standing horse
  Cost effective means for wound management
  Moderation sedation required
  Wound bed free of infection and devitalized tissue, with good vascular supply is critical for success