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FA2 Principles of Surgery > Lecture 12 9/10/24 > Flashcards

Lecture 12 9/10/24 Flashcards

1
Q

What are the general steps to wound management?

A

-address any life-threatening wounds first
-perform a general patient assessment once stable
-make a diagnostic and treatment plan and estimate

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2
Q

What are the potential components of emergency care and stabilization for patients with wounds?

A

-chemical restraint
-analgesics
-bandage
-fluids for dehydration/shock/blood loss
-topical or systemic antibiotics
-tetanus toxoid in farm animals not recently vaccinated

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3
Q

What are the steps to initial wound care?

A

-sedation + analgesics or anesthesia
-water soluble lubricant in wound
-clip surrounding hair widely
-flush out lube and clipped hair
-remove remaining debris
-cleanse area with antimicrobial scrub/solution
-determine wound extent
-perform tissue culture if infection is suspected

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4
Q

How is wound extent determined?

A

-palpation/probing with fingers or instrument
-infusion of sterile saline into structures of concern to check for wound connections
-radiographs or CT, possibly with contrast

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5
Q

What are the characteristics of wound lavage?

A

-removes bacteria and debris
-mechanically debrides wound
-can be sterile saline or tap water
-effective pressure of 5-10 PSI

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6
Q

What is an appropriate way to flush a wound, and why?

A

-fluid bag in an inflated pressure cuff with an extension set and 16-20 gauge needle
-produces low PSI pressure (4-10) that will not damage the tissue

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7
Q

What are the wound closure options?

A

-primary closure: immediate and complete surgical care
-open wound management followed by delayed primary or secondary closure
-open wound management for second intention healing

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8
Q

When is primary closure chosen?

A

-clean wound less than 6-8 hours hold
-wound fully debrided or resected to become clean
-location where function is mandatory and/or there is good vascularization

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9
Q

When is open wound management followed by delayed primary or secondary closure chosen?

A

-significant contamination/necrosis/infection
-questionable blood supply
-excessive tension in surrounding skin

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10
Q

When is open wound management for second intention healing chosen?

A

when scarring, function, and time to heal are not concerns

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11
Q

What are the benefits of wound debridement?

A

-removes bacteria and foreign material
-removes avascular tissue
-speeds healing

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12
Q

What are the types of wound debridement?

A

-surgical: blade, scissors
-mechanical: lavage, gauze
-biological: maggots
-autolytic: honey, alginates, etc.

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13
Q

What are the potential complications of wound debridement?

A

-pain
-serious hemorrhage
-damage to critical structures
-increased tension if too much skin or muscle is removed

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14
Q

What are the characteristics of primary closure suture and pattern choices?

A

-want absorbable suture for deep, subcutis, and intradermal layers
-want polypropylene or monofilament nylon suture, staples, or skin glue for skin closure
-pattern will vary based on tension

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15
Q

What are the indications for open wound management?

A

-dirty/infected wounds
-questionable blood supply
-insufficient skin for closure
-financial constraints (owners willing to change bandages)

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16
Q

Why is it important to keep a wound moist, but not wet?

A

-decreases inflammation and pain
-promotes WBC and keratinocyte migration
-assists autolytic debridement
-decreases scar formation

17
Q

What is the rate of epithelialization?

A

1mm/day from each direction

18
Q

What are the important characteristics of bite and burn wounds?

A

-damage is more extensive than what is initially visible
-wounds may worsen over the first 7 days
-bite wounds may benefit from surgical opening/exploration
-burn victims should be clipped widely to assess progressive disease
-eschars and dead skin contain bacteria and necrotic tissue and should be removed

19
Q

What is the etiology of proud flesh/exuberant granulation tissue?

A

-open wound management of distal limb wounds in horses
-prolonged inflammation from infection/foreign material
-lack of fibroblast differentiation into myofibroblasts; less contraction
-initiation of keratinocyte migration from tension, motion, hypoxia, and dryness

20
Q

How can proud flesh be prevented?

A

-control infection
-bandage/cast to remove movement only in early phase of wound healing

21
Q

How is proud flesh treated?

A

-resection of granulation bed until level with skin
-caustic agents
-topic glucocorticoids for inflammation
-skin graft to decrease healing time

22
Q

Which dressing is best for each wound type?

A

-effusive: hydrocolloid, foam, gauze
-infected: topical antimicrobials
-necrotic: autolytic moist dressings
-dry/granulating: dressing/bandage that maintains wound bed moisture

23
Q

What are the characteristics of Kerilix AMD roll gauze?

A

-absorbs moderate/high amounts of effusion
-antimicrobial
-wide mesh encourages fluid wicking and increased mechanical debridement

24
Q

What are the characteristics of hydrocolloidal dressing?

A

-contains gelatin, pectin, or methylcellulose
-becomes a gel as it absorbs small/moderate amounts of thin fluid
-may be combined with antimicrobials
-changes once fluid is visible near surface

25
Q

What are the functions of honey?

A

-draws fluid from tissue to decrease edema, keep wound moist, and encourage influx of oxygen and nutrients
-immunomodulatory
-autolytic debridement

26
Q

What are the characteristics of Vet-Aid foam?

A

-antimicrobial
-enzymatic debridement
-keeps wound surface moist
-does not require a bandage

27
Q

What are the characteristics of Algidex?

A

-silver, maltodextrin, and alginate in an absorptive foam
-antimicrobial
-can be worn until dressing is saturated
-good for infected wound that are starting to granulate

28
Q

What are the characteristics of hydrogel dressing?

A

-maintains moisture
-soothing on open wounds
-can improve burn healing
-may absorb thin fluid
-potential antimicrobial based on components

29
Q

What are the characteristics of mupirocin?

A

-topical treatment for MRSA and MRSP
-keeps wound moist
-stimulates proliferation of keratinocytes and production of their growth factors
-resistance can develop

30
Q

What are the characteristics of borate-based absorbable glass?

A

-degrades in body fluid
-promotes angiogenesis, fibroblast proliferation, and collagen deposition
-stimulates epithelial cell migration
-antimicrobial

31
Q

What are the characteristics of adaptic nonadhesive mesh?

A

-protects wound
-maintains moisture
-lasts several days

FA2 Principles of Surgery (16 decks)

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