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Intro to Surgery > Lecture 13 - Wound Management & Bandages > Flashcards

Lecture 13 - Wound Management & Bandages Flashcards

1
Q

What are the 4 goals of wound care?

A
  1. Minimize the consequences (prevent loss of life/limb)
  2. Optimize wound healing (prevent infection, cost efficiency)
  3. Minimize scar formation
  4. Restore function
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2
Q

What is a good history question to ask when a horse comes in with a wound/laceration?

A

Is the animal current on tetanus vaccines?

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3
Q

What 3 things should be done when examining a wound?

A
  1. Restraint, sedation
  2. Wear gloves
  3. Control hemorrhage by compression
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4
Q

What things should be assessed in a wound?

A
  1. Tissue trauma
  2. vascular supply
  3. Involvement of other structures (synovial, nerve, tendon/ligament)
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5
Q

Equines often come in with very _____ wounds.

A

contaminated

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6
Q

Equines have a ____ inflammatory response. What are consequences of this?

A

less intense/efficient;

May predispose to infection; soil decreases WBC effectiveness

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7
Q

Ponies heal _____ than horses.

A

faster

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8
Q

What part of the equine body has delayed healing?

A

Wounds on limbs (distal)

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9
Q

What is proud flesh?

A

Exuberant granulation tissue

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10
Q

What might you need to do prior to lavage or treatment of a wound?

A

block (lidocaine, mepivicaine), sedate

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11
Q

How do you properly use a local nerve block?

A

SQ, stay away from laceration edges, upside down “V” or “U”

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12
Q

What are 3 types of debridement that can be used?

A
  1. Sharp
  2. Mechanical
  3. Biological
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13
Q

What can be used for sharp debridement?

A

scalpel, scissors

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14
Q

What can be used for mechanical debridement?

A

Lavage 10-15 psi, wet to dry bandages

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15
Q

What needle/syringe do we want to use for mechanical lavage/debridement?

A

19 ga needle on 35 ml syringe

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16
Q

What can we use for biological debridement?

A

Fly larvae (maggots) sterile, medical grade

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17
Q

What are the 4 categories of wound closure?

A
  1. Primary
  2. Delayed primary
  3. Secondary
  4. Second-intention healing
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18
Q

What closure category does first-intention healing?

A

primary closure

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19
Q

What closure category does third-intention healing?

A

secondary closure

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20
Q

What is primary closure?

A

Immediate closure of viable tissue.

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21
Q

What do you use in primary closure and what is the “golden period”?

A

Suture; 6 hours

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22
Q

With what types of wounds would you do primary closure?

A

Clean and clean-contaminated

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23
Q

Primary closure has the best _____ result and _____ healing.

A

cosmetic, faster

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24
Q

How long after wound occurrence is delayed primary closure done?

A

3-5 days

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25
Q

Delayed primary closure is done before the appearance of _____.

A

granulation tissue

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26
Q

What are the initial steps in delayed primary closure?

A

Open wound management, optimize health, decrease contamination

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27
Q

How long after wound occurrence would you do secondary closure?

A

>5 days

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28
Q

Secondary wound closure is done after apprearance of _____.

A

granulation tissue

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29
Q

What type of wounds are involved in secondary closure?

A

contaminated or dirty wounds

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30
Q

What do you want to do with granulation tissue and skin edges prior to secondary closure?

A

debride it

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31
Q

What occurs in second-intention healing?

A

Wound is allowed to heal by granulation, contraction, and epithelialization.

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32
Q

Under what conditions does second intention healing occur?

A

When there are large defects and you can’t move skin edges together

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33
Q

Second intention healing takes _____ to heal, is _____ cosmetic, and will leave a _____.

A

longer, less, scar

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34
Q

What are two concerns with using suture for closing?

A
  1. It is a foreign body
  2. It can increase infection
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35
Q

What suture is best for buried sutures?

A

Synthetic absorbable suture, monofilament

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36
Q

What is dead space?

A

Abnormal space due to disruption of interstitial connective tissue;

Pocket or cavity in which tissue fluid or blood can accumulate.

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37
Q

Dead space is secondary to _____ and can potentiate _____.

A

tissue loss, infection

38
Q

What 2 things can form in dead space if it is left at closing?

A

seroma, hematoma

39
Q

How can dead space be eliminated?

A

Closed with suture, pressure bandages

40
Q

What are 3 advantages to using drains at closing?

A
  1. Evacuate fluid and debris
  2. Minimize dead space
  3. Prevent accumulation of fluid/debris
41
Q

Drains can result in increased infection if _____ and/or _____.

A

used inappropriately, not removed in a timely fashion

42
Q

What are the 2 types of drains and what are they called?

A
  1. Active (Jackson-Pratt)
  2. Passive (Penrose)
43
Q

What do active/Jackson-Pratt drains do?

A

Create and rely on negative pressure (suction)

44
Q

What do passive/Penrose drains do?

A

Rely on gravity, capillary action

45
Q

What type of drain is preferred and why?

A

Active;

Closed system, decreases ascending infections

46
Q

Where should drains be placed and what should be done after?

A

Should exit at most ventral aspect of the wound;

Covered if possible (SA) so that nothing can get wicked up into the wound

47
Q

Identify this instrument.

A

Penrose drain

48
Q

identify this instrument.

A

Jackson-Pratt drain

49
Q

What is wrong with this drain placement?

A

Skin is not viable

There is no advantage to having an opening at the top of the wound - should have been placed completely at the bottom of the laceration

50
Q

How far from the skin edge and from each other should suture bites be in wound closure?

A

5 mm away from skin edge, 5 mm away from each other

51
Q

What type of suture patterns should be used in wound closure?

A

Appositional (simple interrupted);

Tension (vertical mattress, far-near-near-far, stents)

52
Q

What needs to be ensured when removing non-absorbable suture?

A

Need to remove all suture, not just the knot

53
Q

How long does it take for horses, cats, and dogs to gain strength in the wound after closure?

A

Horses = 10-14 days

Cats = 10-14 days

Dogs = 7-10 days

54
Q

Why should extra care be taken when debriding and closing a wound on a horse?

A

They do not have any extra skin

55
Q

What is important to horse owners regarding wound closure?

A

Cosmetic outcome and function

56
Q

What should be done if barbed wire is involved in a horse wound?

A

Radiograph taken

57
Q

How can we limit motion in horses with a wound?

A
  1. Bandage
  2. Bandage cast
  3. Cast
58
Q

Why should nitrofurazone ointment be avoided in horses?

A

It is toxic to cell health and decreases chances of healing

59
Q

What is a sequestrum?

A

Piece of dead, infected bone that separates from the cortex

60
Q

Having a sequestrum can lead to development of _____.

A

superficial septic osteitis

61
Q

Periosteal trauma leads to _____.

A

vascular stasis

62
Q

When a sequestrum is present, we want to preserve _____ over _____.

A

tissue, bone

63
Q

When should you suspect a sequestrum is present?

A

Non-healing wound associated with lameness, open fracture at initial assessment

64
Q

If a bone sequestrum is suspected, what should be done 12-14 days post injury?

A

Radiograph taken

65
Q

How are bone sequestrums dealt with?

A

Need to be surgically removed (antimicrobials are ineffective)

66
Q

Where are bone sequestrums common?

A

Over regions of limited soft tissue coverage

67
Q

What synovial structures can be affected by wounds?

A

Joint, tendon sheath

68
Q

Wounds are much more _____ if they enter a synovial structure. Why?

A

serious;

Infection, cost, outcome

69
Q

How can we confirm if a wound has entered a synovial structure?

A

Inject sterile saline at remote location, see if it comes out the wound

70
Q

What are foot casts used for?

A

Heel bulb lacerations

71
Q

Foot casts have _____ complications and are _____ to apply.

A

limited, easy

72
Q

How long are foot casts left on for?

A

3 weeks

73
Q

What are the 2 phases of proud flesh?

A
  1. Inefficient inflammatory phase
  2. Excessive proliferation phase (fibroblasts remain active)
74
Q

Proud flesh is the cause and result of _____.

A

delayed wound healing

75
Q

What 2 things does proud flesh cause?

A
  1. Chronic inflammation
  2. Microvascular occlusion

(PMNs higher longer, local hypoxia)

76
Q

What are the 4 goals of managing granulation tissue?

A
  1. Minimizing inflammation
  2. Minimizing motion
  3. Excision
  4. Delayed closure or skin grafting
77
Q

Where should granulation tissue be excised?

A

above skin edges

78
Q

How often should granulation tissue be excised?

A

Every 2 weeks

79
Q

What should you use to excise granulation tissue, where should you start and how do you end?

A

Scalpel blade, start at bottom, use pressure bandage

80
Q

What is one disadvantage of excising granulation tissue?

A

It will bleed a lot

81
Q

What are some material used in bandages?

A
  1. Non-stick adherent dressing
  2. Cotton padding
  3. Brown gauze
  4. Vetrap
  5. Elastikon
82
Q

How much padding should you have in equine bandages?

A

Lots

83
Q

What type of pressure should be in equine bandages?

A

Steady, even pressure throughout

84
Q

How much padding should be left exposed and where?

A

1 inch above and below the bandage

85
Q

You do not want a _____ effect caused by the bandage.

A

tourniquet

86
Q

In what direction should an equine bandage be wrapped?

A

Dorsal to lateral

87
Q

What can happen if an equine bandage is poorly wrapped?

A

Can injure tendons or create scars

88
Q

What can tape be used for in small animal bandages?

A

stirrups

89
Q

What should be left out of a small animal bandage?

A

toes

90
Q

What are the two types of small animal bandages and what are they used for?

A
  1. Light pressure - cover wounds, decrease swelling
  2. Tie-over - areas that are hard to bandage
91
Q

What is a Robert-Jones bandage?

A

Used to decrease swelling, protect fractures;

Should be 3x the width of the limb

92
Q

What is a modified Robert Jones bandage?

A

Similar to a regular RJ but has less padding or smaller layers

Intro to Surgery (36 decks)

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