Lecture 11 - Basic Wound Care and Skin Grafting Flashcards

1
Q

What does DIMES stand for?

A

debride, infection, moisture, edge protection, and support

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2
Q

What are the types of debridement?

A

surgical, autolytic, enzymatic, mechanical, and biosurgical

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3
Q

What is surgical debridement?

A

when devitalized tissues are removed with sharp dissection

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4
Q

What is removed during surgical debridement?

A

fat, fascia, skin, and muscle

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5
Q

In surgical debridement you want a ______ edge.

A

bleeding

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6
Q

What is surgical debridement often combined with?

A

autolytic debridement

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7
Q

What is osteostixis/forage?

A

the use of small pins to penetrate bone that is exposed

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8
Q

What does osteostixis/forage promote?

A

vascular medullary canal communication with the wound bed

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9
Q

Osteostixis/forage enhances _____.

A

healing

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10
Q

When is autolytic debridement preferred?

A

with tissue viability

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11
Q

What type of dressings do you use with autolytic debridement?

A

hydrophilic, occlusive dressings

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12
Q

What is enzymatic debridement?

A

enzyme agents are applied topically to dissolve collagenous tissue and cause superficial sloughing of debris

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13
Q

What is enzymatic debridement an adjunct to?

A

lavage and surgical debridement

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14
Q

What enzymes are used for enzymatic debridement?

A

trypsin, collagenase, papain, and urea

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15
Q

What is enzymatic debridement used for?

A

chronic, nonhealing, indolent wounds

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16
Q

If wet-to-dry dressings are done, how long are they usually done for?

A

1-2 days

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17
Q

Wet-to-dry dressings and enzymatic debridement are both ________ debridement.

A

nonselective

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18
Q

What are the risks that accompany wet-to-dry dressings?

A

they can leave lint/fiber in the wound and they inhibit epithelialization

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19
Q

What are some forms of biosurgical debridement?

A

maggots and leeches

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20
Q

If you use a maggot for biosurgical debridement, how many do you put per cm squared of wound surface area?

A

5-10 larva

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21
Q

What do you cover the maggots with in biosurgical debridement?

A

dacron chiffon dressing

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22
Q

What do maggots do in biosurgical debridement?

A

they secrete enzymes that dissolve necrotic tissue

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23
Q

What can be the negatives to using maggots for biosurgical debridement?

A

they can destroy healthy epithelium if not careful or be irritating to the patient

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24
Q

What do leeches do in biosurgical debridement?

A

they can improve skin perfusion

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25
Q

What are leeches used for in biosurgical debridement?

A

venous insufficiency and to salvage skin flaps and grafts

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26
Q

What is the goal of moist wound healing?

A

to keep the wound exudate on the wound bed

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27
Q

What type of debridement does moist wound healing allow for?

A

autolytic debridement

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28
Q

What does moist wound healing promote?

A

granulation tissue formation and epithelialization

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29
Q

What does moist wound healing prevent?

A

desiccation and tissue devitalization

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30
Q

What does moist wound healing limit?

A

infection

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31
Q

What are some things used for inflammation/debridement?

A

hypertonic saline and TenderWet

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32
Q

What are some things used for inflammation/early repair?

A

sugar, honey, alginate, hydrogel, hydrocolloid, and foam

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33
Q

What does hypertonic saline do?

A

its osmotic gradient lyses and destroys bacteria

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34
Q

What does hypertonic saline reduce?

A

edema

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35
Q

What does hypertonic saline remove?

A

exudate and debris

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36
Q

When is hypertonic saline used?

A

in heavily exudative, necrotic, and infected wounds

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37
Q

What can happen if hypertonic saline is left on for too long?

A

it can dehydrate viable tissue

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38
Q

What is TenderWet?

A

hypertonic Ringer’s solution

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39
Q

Is sugar hypertonic or hypotonic?

A

hypertonic

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40
Q

What does sugar do in wounds?

A

dehydrates bacteria to inhibit growth

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41
Q

What does sugar enhance?

A

granulation formation and epithelialization

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42
Q

How do you apply sugar on wounds?

A

1cm thick on the wound surface with an absorbent bandage

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43
Q

What can sugar be combined with for an antimicrobial effect?

A

betadine solution

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44
Q

When is sugar used and in what type of wounds is it used in?

A

in the inflammatory phase in exudative wounds

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45
Q

What does honey do in wounds?

A

its hyperosmolarity decreases edema and inflammation, and enhances debridement

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46
Q

What does honey promote?

A

granulation and epithelialization

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47
Q

What does honey have that makes it antimicrobial?

A

it releases a small amount of hydrogen peroxide and methylglyoxal

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48
Q

What is honey used for?

A

inflammatory and early repair

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49
Q

What are some types of honey that is used in wound healing?

A

manuka honey and medihoney

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50
Q

What is alginate?

A

polysaccharide fibers that are in sheets or rope

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51
Q

What type of agent is alginate?

A

a hemostatic agent

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52
Q

What does alginate form?

A

hydrophilic gel-like substance on the wound

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53
Q

What does alginate maintain?

A

moisture - it absorbes 20-30x its weight

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54
Q

What can alginate supply?

A

calcium, zinc, manganese, and silver

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55
Q

When is alginate used?

A

for early inflammation, heavy exudate wounds, deep wounds, and after surgical debridement

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56
Q

When can alginate dehydrate a wound?

A

if there is not enough exudate

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57
Q

What is polyurethane foam?

A

an absorbaent, nonirritating synthetic polymer

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58
Q

What does polyurethane foam maintain?

A

moisture with wound surface

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59
Q

What can polyurethane foam slow?

A

granulation tissue formation

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60
Q

What does polyurethane foam promote?

A

epithelialization

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61
Q

What does polyurethane foam provide?

A

thermal insulation

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62
Q

What is a negative of using polyurethane foam?

A

it can dessicate tissues if they are non-exudative

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63
Q

What is polyurethane foam used for?

A

repair phase mostly, moderate exudative wounds depending on the product

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64
Q

What is hydrocolloid?

A

sheet, paste, or powder that turns into gel with absorption

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65
Q

What does hydrocolloid promote?

A

autolytic debridement, granulation tissue formation, and epithelialization

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66
Q

What can hydrocolloid inhibit?

A

wound contraction and promote excess granulation tissue

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67
Q

When do you want to avoid using hydrocolloid?

A

in infected wounds

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68
Q

What is hydrocolloid used for?

A

inflammatory or repair phase with low-to-moderate exudate

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69
Q

What is hydrogel?

A

gel, impregnated guaze or sheets up to 95% water

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70
Q

What type of dressing is hydrogel?

A

hydrophilic

71
Q

What can happen if hydrogel is not cut to the size of a wound?

A

it can macerate the wound edges

72
Q

What is hydrogel used for?

A

inflammatory and early repair with minimally exudative wounds to promote autolytic debridement and over granulation tissue to promote epithelialization and contraction

73
Q

What are some antimicrobial dressings?

A

triple antibiotic ointment, silver, tris hydroxynethyl aminomethane buffer, and hyperosmotic dressings

74
Q

What are some examples of triple antibiotic ointment?

A

bacitracin, neomycin, and polymyxin

75
Q

Triple antibiotic ointment is more effective at ______.

A

prevention

76
Q

How is silver used as an antimicrobial dressing?

A

silver sulfadiazine cream, nanoparticle or impregnated-dressings

77
Q

What is silver effective against?

A

broad-spectrum antibacterial and antifungal

78
Q

What does silver enhance?

A

epithelialization

79
Q

What is tris hydroxymethyl aminomethane buffer good for?

A

pseudmonas

80
Q

Tris hydroxymethyl aminomethane buffur has antimicrobial properties of ______.

A

EDTA

81
Q

What is the purpose of nonadherent dressings?

A

to prevent adhesion of the bandage

82
Q

What do nonadherent dressings allow for?

A

exudate transfer to overlying bandage

83
Q

What are nonadherent dressings used for?

A

the repair phase, over grafts or sutured wounds

84
Q

What are some examples of nonadherent dressings?

A

petroleum-gauze and tefla pads

85
Q

Semiocclusive dressings are _______ so they don’t ______ exudate.

A

waterproof; absorb

86
Q

What is a negative to using semiocclusive dressings?

A

they may trapwound fluid and promote bacterial growth

87
Q

What are semiocclusive dressings used for?

A

partial thickness wounds or suture wounds

88
Q

What are some examples of semiocclusive dressings?

A

Opsite, Tegaderm, bioguard, and primapore

89
Q

What is negative pressure wound therapy?

A

vacuum assisted closure that uses subatmospheric pressure across the wound

90
Q

What does negative pressure wound therapy do to the wound?

A

improved wound perfusion, decreased edema, decreased bacterial colonizaiton

91
Q

What does negative pressure wound therapy stimulate?

A

granulation tissue - removes wound exudate

92
Q

What does negative pressure wound therapy expedite?

A

contraction and epithelialization

93
Q

When is negative pressure wound therapy used?

A

in deep wounds, chronic wounds, infected wounds, and adjunct to skin flap or graft

94
Q

How often is negative pressure wound therapy changed?

A

every 3-5 days

95
Q

What must be considered for wound closure?

A
  1. size and shape of the wound
  2. anatomic location
  3. chronicity
  4. wound bed condition
  5. state of the periwound skin
  6. animal health and stability
  7. the owner
  8. surgeon ability and expertise
96
Q

What are the goals for reconstruction?

A
  1. minimize tension and motion
  2. return function to the area
  3. to ensure final outcome is free of ongoing morbidity
97
Q

What are the options for wound closure?

A

direct apposition, tension-relieving techniques, skin flap development, free skin grafts, second intention wound healing, and combination

98
Q

What are some examples of skin grafts?

A

random pattern flap, axial pattern flap, free skin graft, microvascular free graft, and composite graft

99
Q

What vessels does the random pattern flab use?

A

subdermal plexus

100
Q

What vessels does the axial pattern flap use?

A

direct cutaneous artery

101
Q

How are subdermal plexus flaps made/executed?

A

epidermis and dermis is detached from the surrounding skin, stretched and rotated

102
Q

What are subdermal plexus flaps limited by?

A

skin tension, mobility, and elasticity

103
Q

How is an advancement flap used/executed?

A

adjacent, loose, elastic skin used to slide into the defect

104
Q

What are some examples of advancement flaps?

A

H-plasty and scrotal flap

105
Q

How is the rotational flap used/executed?

A

it is developed and pivoted over a defect with a common border; can be bilateral

106
Q

When is a rotational flap used?

A

to close circular or triangular defects

107
Q

How is a transitional flap used/executed?

A

rectangular local pedicle brings additional skin, developed 90 degrees of long axis of defect

108
Q

How is the size of a transitional flap determined?

A

it should be the same width as the defect, the length is equal to defect from the pivot point

109
Q

What are some examples of transitional flaps?

A

Z-plasty, elbow fold flap, and flank fold flap

110
Q

How is an interpolation flap used/executed?

A

rectangular pedicle is rotated into nearby vs. adjacent defect

111
Q

What is an interpolation flap modified from?

A

a transposition flap without a common border

112
Q

In the interpolation flap, the length must include the _____ ___ ______.

A

inverting skin segment

113
Q

What is an example of an interpolation flap?

A

lip-to-lid flap

114
Q

What skin is used for a distant flap?

A

skin that is not adjacent to the wound

115
Q

What is required for a distant flap?

A

a staged procedure

116
Q

What are some examples of a distant flap?

A

pouch, tube flaps

117
Q

What are axial pattern flaps based upon?

A

specific direct cutaneous artery and veins

118
Q

Axial pattern flaps can be rotated up to _____ degrees.

A

180

119
Q

When are axial pattern flaps usually used?

A

to bridge an incision with primary closure of the donor bed

120
Q

When are axial pattern flaps more likely to fail?

A

if it exceeds the length recommendation

121
Q

What is considered the most difficult flap?

A

the omocervical flap

122
Q

What vessels are involved in the omocervical flap?

A

cervical cutaneous branch, omocervical artery and vein

123
Q

Where is the omocervical flap used?

A

in the head, neck, face, ear, palate, cervical, shoulder, and axillary defects

124
Q

What vessels are involved with the thoracodorsal flap?

A

cutaneous branch, thoracodorsal artery and vein

125
Q

Where are thoracodorsal flaps used?

A

thoracic, shoulder, forelimb, and axillary defects

126
Q

What vessels are involved with the dorsal deep circumflex iliac flap?

A

deep circumflex iliac artery and vein and dorsal branch

127
Q

Where are dorsal deep circumflex iliac flaps used?

A

ipsilateral flank, lateral lumbar, pelvic, area over greater trochanter, lateromedial thigh defect

128
Q

What is the easiest and most consistent flap?

A

the caudal superficial epigastric flap

129
Q

What vessels are associated with the caudal superficial epigastric flap?

A

external pudendal artery and vein

130
Q

Where are caudal superficial epigastric flaps used?

A

in the caudal abdomen, flank, inguinal, preputial, perineal, thigh, and stifle defects

131
Q

What vessels are associated with cranial superficial epigastric flaps?

A

short cutaneous branch, cranial superficial epigastric artery and vein

132
Q

When are cranial superficial epigastric flaps used?

A

sternal defects

133
Q

What vessels are associated with reverse saphenous conduit flaps?

A

saphenous arteries and medial saphenous veins

134
Q

Where are reverse saphenous conduit flaps used?

A

distal limb and tarsal region

135
Q

What vessels are associated with the caudal auricular flap?

A

sternocleidomastoideus branch, caudal auricular artery and vein

136
Q

Where are caudal auricular flaps used?

A

neck, face, dorsal head, and ear reconstruction

137
Q

What are lateral caudal flaps associated with?

A

tail amputation

138
Q

What vessels are associated with lateral caudal flaps?

A

right and left lateral caudal artery and vein, and branches of caudal gluteal artery and vein

139
Q

Where are lateral caudal flaps used?

A

perineal and caudodorsal pelvic defects

140
Q

What vessels are associated with the superficial temporal flap?

A

superficial temporal artery

141
Q

Where are superficial temporal flaps used?

A

maxillofacial, medial eyelid, and palate defect

142
Q

What vessels are associated with the angularis oris flap?

A

angularis oris artery and vein

143
Q

Where are angularis oris flaps used?

A

palate, face, and nasal reconstruction

144
Q

What do composite flaps incorporate?

A

underlying structures with overlying skin

145
Q

What are some examples of composite flaps?

A

myocutaneous flap (latissimus dorsi flap) and mucocutaneous flap (lip-to-lid and labial advancement flap)

146
Q

What are free skin grafts classified by?

A

thickness, donor, mesh vs. non-meshed, and type

147
Q

What are the thickness types of free skin grafts?

A

full and partial thickness

148
Q

what are the donor types of free skin grafts?

A

autograft, allograft, and xenografts

149
Q

What are the different types of free skin grafts?

A

sheet graft and island grafts

150
Q

The thinner the graft the _____ success for ______.

A

greater; success

151
Q

The thicker the graft the ____ the ______ _____.

A

better; cosmetic result

152
Q

What parts of the skin are used in ‘full thickness’ skin grafts?

A

epidermis and entire dermis

153
Q

What parts of the skin are used in ‘partial thickness’ skin grafts?

A

epidermis and portion of dermis

154
Q

Recipient beds are NOT what?

A

irregular surfaces, directly over bone, tendon, and ligament, irradiated tissues, avascular tissues, or infected or hypertrophic granulation tissue

155
Q

Recipient beds ARE what?

A

acute wounds and healthy bed of granulation tissue

156
Q

When harvesting skin what must you keep in mind?

A

that the skin is similar thickness and the hair contour, color, and growth pattern is the same

157
Q

How do you get the moroccan leather appearace when harvesting donor skin?

A

remove all SQ fat

158
Q

What does engraftment mean?

A

to take

159
Q

What are the steps of engraftment?

A

adherence, plasmatic imbibition, inosculation, revascularization, and reinnervation

160
Q

What occurs in phase I of adherence?

A

adhesion between fibrin strands on exposed graft surface to recipient bed

161
Q

What occurs in phase II of adherence?

A

conversion to fibrous adhesion

162
Q

How long does it take for phase II of adherence to occur?

A

begins at 72 hours and is completed by 10 days

163
Q

What occurs during plasmatic imbibition?

A

graft vessels dilate and pull in cells and fluid via capillary action

164
Q

What is inosculation?

A

anastamosis of graft vessels with recipient vellses

165
Q

When does inosculation begin?

A

at 48-72 hours

166
Q

When does normal flow in inosculation return?

A

by 5-6 days

167
Q

What is the scaffolding for inosculation made out of?

A

fibrin network

168
Q

How long does it take for lymphatic drainage to return in skin grafts?

A

4-5 days

169
Q

How long does it take for reinnervation to return in skin drafts?

A

3-4 weeks

170
Q

Through the engraftment process what does the graft look like at 2 days, 2-4 days, 3-5 days, and 7-8 days?

A

first 2 days - pale
days 2-4 - purpule
days 3-5 - lighter red
days 7-8 - red to pink if surviving

171
Q

If a skin graft is white to tan what does that indicate?

A

avascular necrosis

172
Q

If a skin graft is black what does that indicate?

A

dry ischemic necrosis

173
Q

What are major causes for failure of engraftment?

A

motion, lifting from the recipient bed (due to hematoma, seroma, or exudate), or infection