Lecture 15: Bandaging & Open Wound Management - LA (Exam 2) Flashcards
How do you notice epithelialization
White rim around the wound
How long can primary closure be held off for
Out to 12 hours
What should be done during initial exam
- Assess blood loss (HR, RR, mem color, CRT)
- Prior treatment/ vax stat
- mechanism of injury
Whats the diff btw/ a sheet metal v. barbed wire injury
Sheet metal is a straight cut while barbed is serrated
When should tetanus toxoid & tetanus anti-toxin be give
- No vax history
- +/- > 12 months
When should a tetanus toxoid booster be given
vax >/= 2 months ago
When is no booster needed
vax < 2 months ago
What is the risk of using tetanus anti-toxin
liver disease
What can be used for px restraint
- Twitch
- Tranquilizers (ace, alpha 2 agonist, & opioids)
What should be figured out during visual assessment
- Wound location (blood supply, synovial structure involvement, & other structures)
- Contamination/infection
what happens if there is foreign material, necrotic tissue, hematoma, ect in the wound
More of a chance for an infection
Explain wound clipping
- Apply sterile lube to wound
- Clip @ least 2 in around the wound
- Use antiseptics (povidone iodine, chlorhexidine, sterile saline)
What position are horses in during suturing
Standing
What ways can you do wound anesthesia w/ equine
- Medications (Lidocaine)
- Local anesthesia (nerve blocks)
What tech should be used for wound anesthesia
- Block away from the wound
- If need to insert the needle @ the cut edge of the tissue instead of adjacent to it
How can the wound be explored
- Digital palpation
- Sterile probe
- Radiographs
How should the wound be lavaged
- 10 - 15 psi
- 18g needle on a 35 ml or 60 ml will get you enough pressure
- Water pick (be careful not to drive debris into the wound)
- Usual norm saline or LRS
What should be done if there is synovial involvement
- Synoviocentesis (sterile prep away from the wound; avoid going through/edema/cellulitis & introducing bacteria)
- Sample the fluid for cytology, total protein, +/- culture
- Pressurize the structure
- Inject antibiotic like amikacin
If the fluid communicates with the joint what will happen
- When the syringe is removed from the needle it will spray out the other side
What are the common ways for wound debridement
- Sharp (Debride most superficial layer w/ scalpel blade)
- Mechanical (Wet to dry bandage before epithelialization has started)
- Autolytic (moist wound healing; WBCs & enzymes degrade necrotic tissue & leave the healthy tissue alone)
List the other debridement options for LA wounds
- Chemical
- Enzymatic
- Biological (sterile magots)
Describe primary wound closure
- Close immediately
- Warn owner of possible dehiscence
- < 12 hours
Describe delayed primary wound closure
- Close after a period of debridement
- w/in 3 to 5 days of injury (before granulation tissue forms)
- Mild/moderate contamination
Describe delayed secondary closure
- Close after granulation tissue is present
- Excise exuberant granulation tissue first
Describe second intention healing
- No closure
- Large wound
- Chronic, contaminated, skin loss
- After granulation is present
What is important when closing wounds w/ drainage
- Impt. to prevent accumulation of exudate in dead space that will compromise closure
What suture materials be used in wound closure
- Min tissue reactivity, sufficient strength
- non absorbable monofilament
- Nylon & polypropylene
What suture pattern should be done in a non tension area
Simple interrupted
What suture pattern should be done in a high tension area
- Vertical mattress
- Near-far-far- near
What should be remembered for suturing wound patterns
- Place .5 cm from wound edge
- Don’t overtighten
What is the difference btw/ the jackson-pratt & the penrose
The penrose must be placed at most ventraol location while the jackson-pratt doesnt
Describe using gauze as wound dressing
- Wet to dry bandages
- For debridement of heavily contaminated & exudative wounds
- Wet gauze w/ saline ( +/- dilute chlorhex or iodine) & place next to the wound under a bandage
Describe using telfa pad as wound dressing
- Surgical wounds or suture wounds
- Non-adherent & non-occulusive
Describe using Hypertonic saline dressing as wound dressing
- Curasalt
- Aggressive wound debridement
- First few days only
Describe using calcium alginate as wound dressing
- Curasorb
- Moderately exudative wounds &/or substantial tissue loss
- Creates a gel that promotes moist wound healing
What are the guideline from bandaging
- Even tension
- Appropriate tension
- Cover the req areas
What is the technique for bandaging
- Counterclockwise on left limbs
- Clockwise on the right limbs
- Start on the medial side of the leg & wrap toward the head
What is the first step of putting on a veterinary bandage
- Start in a clean dry environment
- Wear gloves
- Non-adherent first layer
- Hold in place w/ kling gauze & loosely wrap
What is after the kling gauze
- Add the outer bandage (Thickness is important)
- Disposable options include - sheet cotton, gamgee, combiroll
What is placed after the outer bandage
- Brown gauze
- Wrap it tight (just not to the point to wear it rips)
What is placed after the brown gauze
- Add the vet wrap w/ no wrinkles
- Put on elasticon - lay it on loosely (this keeps debris out of the bandage)
List common bandaging error
- Not enough padding
- Wrapping in the wrong direction
- Uneven pressure
- Uneven swipes
- Poor application
How is a bandage placed over joints
- Can do a stack wrap or center over the joint
- Minimize pressure over boney prominences by figure eighting the bandage or “racing strip” w/ elasticon
- Use gauze pad to the accessory carpal bone & the point of hock
Explain splinting
- Proper padding is very important
- Often made of PVC pipe & duct tape/white tape (not stretchy)
What should be done for a foot bandage
- Wrap tight on the hoof & loose on the skin
- May or may not have padding
- Lots of duct tape on the bottom of the foot
List some complications of bandaging
- Exuberant granulation tissue formation
- Pressure sores can cause wounds & may have white hairs later
- “bandage bows” - extensor or flexor tendon inflammation, no actual disruption of the tendon, b/c of too little padding &/or wrapped too tight
- Dehiscence
- Proud flesh
When is bandaging done in ruminants
- most common for foot procedures
- Wounds
- Padding under splints
When are claw blocks used
- When there are is damage to one claw
- Block goes on the unaffected claw
What are some differences btw/ bandaging ruminants than equine
- Same principles
- watch out for the dew claws - painful w/ to much pressure, avoid wrapping directly over them, use figure 8 tech or use donuts for protection
- Difficult to confine so use lots of duct tape
Describe proud flesh
- Usually in distal limb wounds (carpus/tarsus & below)
- less common in ruminants but can occur
- predisposing factors - bandaging after granulation tissue is present (hypoxia), movement, large wound (second intention healing), bone sequestrum, wound irritation (owner’s wound ointment)
- Treatment - Sharp debridement, topical steroids, & skin grafting
What happens if there is involvement of synovial structures
- Small seemingly innocuous wounds can be very serious
- Requires immediate referral
- Lots of money
- Time is very important (better prognosis if treated early)
What is bone sequestrum
- Dead, infected piece of bone - bacteria from wound & necrosis from damage to blood supply/periosteum)
- Signs - non-healing wound b/c the body sees it as a foreign body
- Typically requires surgical removal
Describe cellulitis
- Severe edema in the limb associated w/ rel small wound
- may just be an abrasion
- Infection of the SubQ tissues
- Severe lameness (lameness @ a walk)
- Req aggressive therapy - systemic antibiotics, anti inflammatories, & bandaging
