Lecture 13 - Wound Management & Bandages Flashcards
1
Q
What are the 4 goals of wound care?
A
- Minimize the consequences (prevent loss of life/limb)
- Optimize wound healing (prevent infection, cost efficiency)
- Minimize scar formation
- Restore function
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?
3
Q
What 3 things should be done when examining a wound?
A
- Restraint, sedation
- Wear gloves
- Control hemorrhage by compression
4
Q
What things should be assessed in a wound?
A
- Tissue trauma
- vascular supply
- Involvement of other structures (synovial, nerve, tendon/ligament)
5
Q
Equines often come in with very _____ wounds.
A
contaminated
6
Q
Equines have a ____ inflammatory response. What are consequences of this?
A
less intense/efficient;
May predispose to infection; soil decreases WBC effectiveness
7
Q
Ponies heal _____ than horses.
A
faster
8
Q
What part of the equine body has delayed healing?
A
Wounds on limbs (distal)
9
Q
What is proud flesh?
A
Exuberant granulation tissue
10
Q
What might you need to do prior to lavage or treatment of a wound?
A
block (lidocaine, mepivicaine), sedate
11
Q
How do you properly use a local nerve block?
A
SQ, stay away from laceration edges, upside down “V” or “U”
12
Q
What are 3 types of debridement that can be used?
A
- Sharp
- Mechanical
- Biological
13
Q
What can be used for sharp debridement?
A
scalpel, scissors
14
Q
What can be used for mechanical debridement?
A
Lavage 10-15 psi, wet to dry bandages
15
Q
What needle/syringe do we want to use for mechanical lavage/debridement?
A
19 ga needle on 35 ml syringe
16
Q
What can we use for biological debridement?
A
Fly larvae (maggots) sterile, medical grade
17
Q
What are the 4 categories of wound closure?
A
- Primary
- Delayed primary
- Secondary
- Second-intention healing
18
Q
What closure category does first-intention healing?
A
primary closure
19
Q
What closure category does third-intention healing?
A
secondary closure
20
Q
What is primary closure?
A
Immediate closure of viable tissue.
21
Q
What do you use in primary closure and what is the “golden period”?
A
Suture; 6 hours
22
Q
With what types of wounds would you do primary closure?
A
Clean and clean-contaminated
23
Q
Primary closure has the best _____ result and _____ healing.
A
cosmetic, faster
24
Q
How long after wound occurrence is delayed primary closure done?
A
3-5 days
25
Delayed primary closure is done before the appearance of \_\_\_\_\_.
granulation tissue
26
What are the initial steps in delayed primary closure?
Open wound management, optimize health, decrease contamination
27
How long after wound occurrence would you do secondary closure?
\>5 days
28
Secondary wound closure is done after apprearance of \_\_\_\_\_.
granulation tissue
29
What type of wounds are involved in secondary closure?
contaminated or dirty wounds
30
What do you want to do with granulation tissue and skin edges prior to secondary closure?
debride it
31
What occurs in second-intention healing?
Wound is allowed to heal by granulation, contraction, and epithelialization.
32
Under what conditions does second intention healing occur?
When there are large defects and you can't move skin edges together
33
Second intention healing takes _____ to heal, is _____ cosmetic, and will leave a \_\_\_\_\_.
longer, less, scar
34
What are two concerns with using suture for closing?
1. It is a foreign body
2. It can increase infection
35
What suture is best for buried sutures?
Synthetic absorbable suture, monofilament
36
What is dead space?
Abnormal space due to disruption of interstitial connective tissue;
Pocket or cavity in which tissue fluid or blood can accumulate.
37
Dead space is secondary to _____ and can potentiate \_\_\_\_\_.
tissue loss, infection
38
What 2 things can form in dead space if it is left at closing?
seroma, hematoma
39
How can dead space be eliminated?
Closed with suture, pressure bandages
40
What are 3 advantages to using drains at closing?
1. Evacuate fluid and debris
2. Minimize dead space
3. Prevent accumulation of fluid/debris
41
Drains can result in increased infection if _____ and/or \_\_\_\_\_.
used inappropriately, not removed in a timely fashion
42
What are the 2 types of drains and what are they called?
1. Active (Jackson-Pratt)
2. Passive (Penrose)
43
What do active/Jackson-Pratt drains do?
Create and rely on negative pressure (suction)
44
What do passive/Penrose drains do?
Rely on gravity, capillary action
45
What type of drain is preferred and why?
Active;
Closed system, decreases ascending infections
46
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
47
Identify this instrument.
Penrose drain
48
identify this instrument.
Jackson-Pratt drain
49
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
50
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
51
What type of suture patterns should be used in wound closure?
Appositional (simple interrupted);
Tension (vertical mattress, far-near-near-far, stents)
52
What needs to be ensured when removing non-absorbable suture?
Need to remove all suture, not just the knot
53
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
54
Why should extra care be taken when debriding and closing a wound on a horse?
They do not have any extra skin
55
What is important to horse owners regarding wound closure?
Cosmetic outcome and function
56
What should be done if barbed wire is involved in a horse wound?
Radiograph taken
57
How can we limit motion in horses with a wound?
1. Bandage
2. Bandage cast
3. Cast
58
Why should nitrofurazone ointment be avoided in horses?
It is toxic to cell health and decreases chances of healing
59
What is a sequestrum?
Piece of dead, infected bone that separates from the cortex
60
Having a sequestrum can lead to development of \_\_\_\_\_.
superficial septic osteitis
61
Periosteal trauma leads to \_\_\_\_\_.
vascular stasis
62
When a sequestrum is present, we want to preserve _____ over \_\_\_\_\_.
tissue, bone
63
When should you suspect a sequestrum is present?
Non-healing wound associated with lameness, open fracture at initial assessment
64
If a bone sequestrum is suspected, what should be done 12-14 days post injury?
Radiograph taken
65
How are bone sequestrums dealt with?
Need to be surgically removed (antimicrobials are ineffective)
66
Where are bone sequestrums common?
Over regions of limited soft tissue coverage
67
What synovial structures can be affected by wounds?
Joint, tendon sheath
68
Wounds are much more _____ if they enter a synovial structure. Why?
serious;
Infection, cost, outcome
69
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
70
What are foot casts used for?
Heel bulb lacerations
71
Foot casts have _____ complications and are _____ to apply.
limited, easy
72
How long are foot casts left on for?
3 weeks
73
What are the 2 phases of proud flesh?
1. Inefficient inflammatory phase
2. Excessive proliferation phase (fibroblasts remain active)
74
Proud flesh is the cause and result of \_\_\_\_\_.
delayed wound healing
75
What 2 things does proud flesh cause?
1. Chronic inflammation
2. Microvascular occlusion
(PMNs higher longer, local hypoxia)
76
What are the 4 goals of managing granulation tissue?
1. Minimizing inflammation
2. Minimizing motion
3. Excision
4. Delayed closure or skin grafting
77
Where should granulation tissue be excised?
above skin edges
78
How often should granulation tissue be excised?
Every 2 weeks
79
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
80
What is one disadvantage of excising granulation tissue?
It will bleed a lot
81
What are some material used in bandages?
1. Non-stick adherent dressing
2. Cotton padding
3. Brown gauze
4. Vetrap
5. Elastikon
82
How much padding should you have in equine bandages?
Lots
83
What type of pressure should be in equine bandages?
Steady, even pressure throughout
84
How much padding should be left exposed and where?
1 inch above and below the bandage
85
You do not want a _____ effect caused by the bandage.
tourniquet
86
In what direction should an equine bandage be wrapped?
Dorsal to lateral
87
What can happen if an equine bandage is poorly wrapped?
Can injure tendons or create scars
88
What can tape be used for in small animal bandages?
stirrups
89
What should be left out of a small animal bandage?
toes
90
What are the two types of small animal bandages and what are they used for?
1. Light pressure - cover wounds, decrease swelling
2. Tie-over - areas that are hard to bandage
91
What is a Robert-Jones bandage?
Used to decrease swelling, protect fractures;
Should be 3x the width of the limb
92
What is a modified Robert Jones bandage?
Similar to a regular RJ but has less padding or smaller layers
