Lecture 13 - Wound Management & Bandages Flashcards
What are the 4 goals of wound care?
- Minimize the consequences (prevent loss of life/limb)
- Optimize wound healing (prevent infection, cost efficiency)
- Minimize scar formation
- Restore function
What is a good history question to ask when a horse comes in with a wound/laceration?
Is the animal current on tetanus vaccines?
What 3 things should be done when examining a wound?
- Restraint, sedation
- Wear gloves
- Control hemorrhage by compression
What things should be assessed in a wound?
- Tissue trauma
- vascular supply
- Involvement of other structures (synovial, nerve, tendon/ligament)
Equines often come in with very _____ wounds.
contaminated
Equines have a ____ inflammatory response. What are consequences of this?
less intense/efficient;
May predispose to infection; soil decreases WBC effectiveness
Ponies heal _____ than horses.
faster
What part of the equine body has delayed healing?
Wounds on limbs (distal)
What is proud flesh?
Exuberant granulation tissue
What might you need to do prior to lavage or treatment of a wound?
block (lidocaine, mepivicaine), sedate
How do you properly use a local nerve block?
SQ, stay away from laceration edges, upside down “V” or “U”
What are 3 types of debridement that can be used?
- Sharp
- Mechanical
- Biological
What can be used for sharp debridement?
scalpel, scissors
What can be used for mechanical debridement?
Lavage 10-15 psi, wet to dry bandages
What needle/syringe do we want to use for mechanical lavage/debridement?
19 ga needle on 35 ml syringe
What can we use for biological debridement?
Fly larvae (maggots) sterile, medical grade
What are the 4 categories of wound closure?
- Primary
- Delayed primary
- Secondary
- Second-intention healing
What closure category does first-intention healing?
primary closure
What closure category does third-intention healing?
secondary closure
What is primary closure?
Immediate closure of viable tissue.
What do you use in primary closure and what is the “golden period”?
Suture; 6 hours
With what types of wounds would you do primary closure?
Clean and clean-contaminated
Primary closure has the best _____ result and _____ healing.
cosmetic, faster
How long after wound occurrence is delayed primary closure done?
3-5 days
Delayed primary closure is done before the appearance of _____.
granulation tissue
What are the initial steps in delayed primary closure?
Open wound management, optimize health, decrease contamination
How long after wound occurrence would you do secondary closure?
>5 days
Secondary wound closure is done after apprearance of _____.
granulation tissue
What type of wounds are involved in secondary closure?
contaminated or dirty wounds
What do you want to do with granulation tissue and skin edges prior to secondary closure?
debride it
What occurs in second-intention healing?
Wound is allowed to heal by granulation, contraction, and epithelialization.
Under what conditions does second intention healing occur?
When there are large defects and you can’t move skin edges together
Second intention healing takes _____ to heal, is _____ cosmetic, and will leave a _____.
longer, less, scar
What are two concerns with using suture for closing?
- It is a foreign body
- It can increase infection
What suture is best for buried sutures?
Synthetic absorbable suture, monofilament
What is dead space?
Abnormal space due to disruption of interstitial connective tissue;
Pocket or cavity in which tissue fluid or blood can accumulate.
Dead space is secondary to _____ and can potentiate _____.
tissue loss, infection
What 2 things can form in dead space if it is left at closing?
seroma, hematoma
How can dead space be eliminated?
Closed with suture, pressure bandages
What are 3 advantages to using drains at closing?
- Evacuate fluid and debris
- Minimize dead space
- Prevent accumulation of fluid/debris
Drains can result in increased infection if _____ and/or _____.
used inappropriately, not removed in a timely fashion
What are the 2 types of drains and what are they called?
- Active (Jackson-Pratt)
- Passive (Penrose)
What do active/Jackson-Pratt drains do?
Create and rely on negative pressure (suction)
What do passive/Penrose drains do?
Rely on gravity, capillary action
What type of drain is preferred and why?
Active;
Closed system, decreases ascending infections
Where should drains be placed and what should be done after?
Should exit at most ventral aspect of the wound;
Covered if possible (SA) so that nothing can get wicked up into the wound
Identify this instrument.
Penrose drain
identify this instrument.
Jackson-Pratt drain
What is wrong with this drain placement?
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
How far from the skin edge and from each other should suture bites be in wound closure?
5 mm away from skin edge, 5 mm away from each other
What type of suture patterns should be used in wound closure?
Appositional (simple interrupted);
Tension (vertical mattress, far-near-near-far, stents)
What needs to be ensured when removing non-absorbable suture?
Need to remove all suture, not just the knot
How long does it take for horses, cats, and dogs to gain strength in the wound after closure?
Horses = 10-14 days
Cats = 10-14 days
Dogs = 7-10 days
Why should extra care be taken when debriding and closing a wound on a horse?
They do not have any extra skin
What is important to horse owners regarding wound closure?
Cosmetic outcome and function
What should be done if barbed wire is involved in a horse wound?
Radiograph taken
How can we limit motion in horses with a wound?
- Bandage
- Bandage cast
- Cast
Why should nitrofurazone ointment be avoided in horses?
It is toxic to cell health and decreases chances of healing
What is a sequestrum?
Piece of dead, infected bone that separates from the cortex
Having a sequestrum can lead to development of _____.
superficial septic osteitis
Periosteal trauma leads to _____.
vascular stasis
When a sequestrum is present, we want to preserve _____ over _____.
tissue, bone
When should you suspect a sequestrum is present?
Non-healing wound associated with lameness, open fracture at initial assessment
If a bone sequestrum is suspected, what should be done 12-14 days post injury?
Radiograph taken
How are bone sequestrums dealt with?
Need to be surgically removed (antimicrobials are ineffective)
Where are bone sequestrums common?
Over regions of limited soft tissue coverage
What synovial structures can be affected by wounds?
Joint, tendon sheath
Wounds are much more _____ if they enter a synovial structure. Why?
serious;
Infection, cost, outcome
How can we confirm if a wound has entered a synovial structure?
Inject sterile saline at remote location, see if it comes out the wound
What are foot casts used for?
Heel bulb lacerations
Foot casts have _____ complications and are _____ to apply.
limited, easy
How long are foot casts left on for?
3 weeks
What are the 2 phases of proud flesh?
- Inefficient inflammatory phase
- Excessive proliferation phase (fibroblasts remain active)
Proud flesh is the cause and result of _____.
delayed wound healing
What 2 things does proud flesh cause?
- Chronic inflammation
- Microvascular occlusion
(PMNs higher longer, local hypoxia)
What are the 4 goals of managing granulation tissue?
- Minimizing inflammation
- Minimizing motion
- Excision
- Delayed closure or skin grafting
Where should granulation tissue be excised?
above skin edges
How often should granulation tissue be excised?
Every 2 weeks
What should you use to excise granulation tissue, where should you start and how do you end?
Scalpel blade, start at bottom, use pressure bandage
What is one disadvantage of excising granulation tissue?
It will bleed a lot
What are some material used in bandages?
- Non-stick adherent dressing
- Cotton padding
- Brown gauze
- Vetrap
- Elastikon
How much padding should you have in equine bandages?
Lots
What type of pressure should be in equine bandages?
Steady, even pressure throughout
How much padding should be left exposed and where?
1 inch above and below the bandage
You do not want a _____ effect caused by the bandage.
tourniquet
In what direction should an equine bandage be wrapped?
Dorsal to lateral
What can happen if an equine bandage is poorly wrapped?
Can injure tendons or create scars
What can tape be used for in small animal bandages?
stirrups
What should be left out of a small animal bandage?
toes
What are the two types of small animal bandages and what are they used for?
- Light pressure - cover wounds, decrease swelling
- Tie-over - areas that are hard to bandage
What is a Robert-Jones bandage?
Used to decrease swelling, protect fractures;
Should be 3x the width of the limb
What is a modified Robert Jones bandage?
Similar to a regular RJ but has less padding or smaller layers
