LASx Exam 1: Wound Management

Question 1

T/F: The golden period of wounds in horses is the period of

time where there is less than 10^5 bacteria per gram of tissue

Answer 1

FALSE! THERE IS NO GOLDEN PERIOD IN EQUINE WOUNDS!

Question 2

What type of closure have you done if you close a wound 2 to 5 days after injury, but before granulation tissue production?

Answer 2

Delayed primary closure

Question 3

What type of closure have you done if you close a wound 5 or more days after injury, and granulation tissue is present?

Answer 3

Secondary closure

Question 4

T/F: Epithelialization starts IMMEDIATELY after wounding

Answer 4

TRUE

Question 5

Collagen deposition begins ______ days after wounding

Answer 5

2 - 3 days

Question 6

What is angiogenesis initiated by?

Answer 6

Decreased oxygen tension

Increased lactate

Decreased pH in the wound

Question 7

The final scar after wounding is ______% weaker than original

Answer 7

15 - 50 % weaker

Question 8

What is the best type of debridement in equine patients?

Answer 8

Sharp and autolytic

Question 9

What is the best thing to use for wound lavage?

Answer 9

SALINE! (not dilute antiseptics)

Question 10

T/F: Nitrofurazone is a good topical agent for treatment of wounds

Answer 10

FALSE! It is carcinogenic

Question 11

_______ is the most common hypertonic saline dressing and

is used for exudative or necrotic wounds

Answer 11

CURASALT

Question 12

What is the best antimicrobial dressing for post-op wounds

to prevent infection

Answer 12

KERLIX AMD

Question 13

What is the active antimicrobial agent of Kerlix AMD?

Answer 13

Polyhexamethylene Biguanide (PHMB)

Question 14

T/F: Corticosteroids are good for reducing granulation tissue

formation in acute wounds

Answer 14

FALSE! NEVER USE CORTICOSTEROIDS

Question 15

In the equine there are differences in healing based on

wound locations.

BODY wounds are more efficient at contraction ( ____ mm/day)

and

LIMB wounds are slow at contraction ( ____ mm/day)

Answer 15

Body (1 mm/day)

Limb (0.2 mm/day)

Question 16

The best way to close a distal limb wound is with

___________ closure

Answer 16

PRIMARY closure (and tight bandages)

Question 17

How do you treat proud flesh of a distal limb wound?

Answer 17

Resection + bandage + delayed secondary closure +/- skin grafts

Question 18

Why does proud flesh occur?

Answer 18

Inefficient protracted inflammatory phase results in

excessive proliferation phase

Question 19

T/F:

You must anesthetize when removing proud flesh

Answer 19

FALSE- exuberant granulation tissue is void of nervous tissue- it is just fibroblasts and capillaries and is not painful

Question 20

What is the most important step in skin grafting?

Answer 20

Granulation bed preparation!

Determines if the graft will fail or not

Question 21

What is the most common bacteria with granulation tissue

and grafting?

Answer 21

Pseudomonas

Question 22

What is the most effective topical Abx therapy

against pseudomonas- the most common bacteria with

granulation tissue and skin grafting?

Answer 22

TICARCILLIN

Question 23

A skin graft that remains connected to the donor site is called a

Answer 23

pedicle graft

Question 24

This type of graft requires a dermatome

Answer 24

Split-thickness graft

Question 25

What are the two steps that occur during revascularization

of a new graft and when do they occur?

Answer 25

Inosculation - 48 hours

Neovascularization - 4 - 5 days

Question 26

In a horse, where do you harvest tissue for a punch graft?

Answer 26

Under the mane or the ventrolateral abdomen.

Must excise SQ fascia and fat!

Question 27

For a punch graft, recipient holes are placed _____ mm apart

in a symmetrical pattern, and recipient holes

must be _______ than the donor holes

Answer 27

6 mm apart

Recipient holes must be smaller than the donor holes

Question 28

T/F:

Full thickness sheet grafts resist trauma better than split thickness

grafts, but are much more fragile

Answer 28

TRUE

Question 29

What is the purpose of meshing sheet grafts?

Answer 29

Allow the graft to cover a wound larger than itself AND

PREVENT FLUID from disrupting graft from fibrinous and vascular attachments

Question 30

T/F:

Clean, healthy granulation tissue is needed at the

recipient site of a free graft

Answer 30

TRUE

Question 31

Which topical Abx do you use 24 - 48 hours prior to

grafting on the recipient site?

Answer 31

TICARCILLIN

Question 32

Which two bacterias can infect a wound at much lower

concentrations in the horse?

Answer 32

B-hemolytic strep and pseudomonas