Lecture 12 9/10/24 Flashcards
What are the general steps to wound management?
-address any life-threatening wounds first
-perform a general patient assessment once stable
-make a diagnostic and treatment plan and estimate
What are the potential components of emergency care and stabilization for patients with wounds?
-chemical restraint
-analgesics
-bandage
-fluids for dehydration/shock/blood loss
-topical or systemic antibiotics
-tetanus toxoid in farm animals not recently vaccinated
What are the steps to initial wound care?
-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
How is wound extent determined?
-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
What are the characteristics of wound lavage?
-removes bacteria and debris
-mechanically debrides wound
-can be sterile saline or tap water
-effective pressure of 5-10 PSI
What is an appropriate way to flush a wound, and why?
-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
What are the wound closure options?
-primary closure: immediate and complete surgical care
-open wound management followed by delayed primary or secondary closure
-open wound management for second intention healing
When is primary closure chosen?
-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
When is open wound management followed by delayed primary or secondary closure chosen?
-significant contamination/necrosis/infection
-questionable blood supply
-excessive tension in surrounding skin
When is open wound management for second intention healing chosen?
when scarring, function, and time to heal are not concerns
What are the benefits of wound debridement?
-removes bacteria and foreign material
-removes avascular tissue
-speeds healing
What are the types of wound debridement?
-surgical: blade, scissors
-mechanical: lavage, gauze
-biological: maggots
-autolytic: honey, alginates, etc.
What are the potential complications of wound debridement?
-pain
-serious hemorrhage
-damage to critical structures
-increased tension if too much skin or muscle is removed
What are the characteristics of primary closure suture and pattern choices?
-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
What are the indications for open wound management?
-dirty/infected wounds
-questionable blood supply
-insufficient skin for closure
-financial constraints (owners willing to change bandages)
Why is it important to keep a wound moist, but not wet?
-decreases inflammation and pain
-promotes WBC and keratinocyte migration
-assists autolytic debridement
-decreases scar formation
What is the rate of epithelialization?
1mm/day from each direction
What are the important characteristics of bite and burn wounds?
-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
What is the etiology of proud flesh/exuberant granulation tissue?
-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
How can proud flesh be prevented?
-control infection
-bandage/cast to remove movement only in early phase of wound healing
How is proud flesh treated?
-resection of granulation bed until level with skin
-caustic agents
-topic glucocorticoids for inflammation
-skin graft to decrease healing time
Which dressing is best for each wound type?
-effusive: hydrocolloid, foam, gauze
-infected: topical antimicrobials
-necrotic: autolytic moist dressings
-dry/granulating: dressing/bandage that maintains wound bed moisture
What are the characteristics of Kerilix AMD roll gauze?
-absorbs moderate/high amounts of effusion
-antimicrobial
-wide mesh encourages fluid wicking and increased mechanical debridement
What are the characteristics of hydrocolloidal dressing?
-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
What are the functions of honey?
-draws fluid from tissue to decrease edema, keep wound moist, and encourage influx of oxygen and nutrients
-immunomodulatory
-autolytic debridement
What are the characteristics of Vet-Aid foam?
-antimicrobial
-enzymatic debridement
-keeps wound surface moist
-does not require a bandage
What are the characteristics of Algidex?
-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
What are the characteristics of hydrogel dressing?
-maintains moisture
-soothing on open wounds
-can improve burn healing
-may absorb thin fluid
-potential antimicrobial based on components
What are the characteristics of mupirocin?
-topical treatment for MRSA and MRSP
-keeps wound moist
-stimulates proliferation of keratinocytes and production of their growth factors
-resistance can develop
What are the characteristics of borate-based absorbable glass?
-degrades in body fluid
-promotes angiogenesis, fibroblast proliferation, and collagen deposition
-stimulates epithelial cell migration
-antimicrobial
What are the characteristics of adaptic nonadhesive mesh?
-protects wound
-maintains moisture
-lasts several days
