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Surgery 1 (SAB) > Lecture 15: Bandaging & Open Wound Management - LA > Flashcards

Lecture 15: Bandaging & Open Wound Management - LA Flashcards

1
Q

How do you notice epithelialization

A

White rim around the wound

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2
Q

How long can primary closure be held off for

A

Out to 12 hours

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3
Q

What should be done during initial exam

A
  • Assess blood loss (HR, RR, mem color, CRT)
  • Prior treatment/ vax stat
  • mechanism of injury
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4
Q

Whats the diff btw/ a sheet metal v. barbed wire injury

A

Sheet metal is a straight cut while barbed is serrated

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5
Q

When should tetanus toxoid & tetanus anti-toxin be give

A
  • No vax history
  • +/- > 12 months
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6
Q

When should a tetanus toxoid booster be given

A

vax >/= 2 months ago

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7
Q

When is no booster needed

A

vax < 2 months ago

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8
Q

What is the risk of using tetanus anti-toxin

A

liver disease

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9
Q

What can be used for px restraint

A
  • Twitch
  • Tranquilizers (ace, alpha 2 agonist, & opioids)
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10
Q

What should be figured out during visual assessment

A
  • Wound location (blood supply, synovial structure involvement, & other structures)
  • Contamination/infection
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11
Q

what happens if there is foreign material, necrotic tissue, hematoma, ect in the wound

A

More of a chance for an infection

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12
Q

Explain wound clipping

A
  • Apply sterile lube to wound
  • Clip @ least 2 in around the wound
  • Use antiseptics (povidone iodine, chlorhexidine, sterile saline)
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13
Q

What position are horses in during suturing

A

Standing

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14
Q

What ways can you do wound anesthesia w/ equine

A
  • Medications (Lidocaine)
  • Local anesthesia (nerve blocks)
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15
Q

What tech should be used for wound anesthesia

A
  • Block away from the wound
  • If need to insert the needle @ the cut edge of the tissue instead of adjacent to it
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16
Q

How can the wound be explored

A

*Digital palpation
* Sterile probe
* Radiographs

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17
Q

How should the wound be lavaged

A
  • 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
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18
Q

What should be done if there is synovial involvement

A
  • 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
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19
Q

If the fluid communicates with the joint what will happen

A
  • When the syringe is removed from the needle it will spray out the other side
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20
Q

What are the common ways for wound debridement

A
  1. Sharp (Debride most superficial layer w/ scalpel blade)
  2. Mechanical (Wet to dry bandage before epithelialization has started)
  3. Autolytic (moist wound healing; WBCs & enzymes degrade necrotic tissue & leave the healthy tissue alone)
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21
Q

List the other debridement options for LA wounds

A
  • Chemical
  • Enzymatic
  • Biological (sterile magots)
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22
Q

Describe primary wound closure

A
  • Close immediately
  • Warn owner of possible dehiscence
  • < 12 hours
23
Q

Describe delayed primary wound closure

A
  • Close after a period of debridement
  • w/in 3 to 5 days of injury (before granulation tissue forms)
  • Mild/moderate contamination
24
Q

Describe delayed secondary closure

A
  • Close after granulation tissue is present
  • Excise exuberant granulation tissue first
25
Q

Describe second intention healing

A
  • No closure
  • Large wound
  • Chronic, contaminated, skin loss
  • After granulation is present
26
Q

What is important when closing wounds w/ drainage

A
  • Impt. to prevent accumulation of exudate in dead space that will compromise closure
27
Q

What suture materials be used in wound closure

A
  • Min tissue reactivity, sufficient strength
  • non absorbable monofilament
  • Nylon & polypropylene
28
Q

What suture pattern should be done in a non tension area

A

Simple interrupted

29
Q

What suture pattern should be done in a high tension area

A
  • Vertical mattress
  • Near-far-far- near
30
Q

What should be remembered for suturing wound patterns

A
  • Place .5 cm from wound edge
  • Don’t overtighten
31
Q

What is the difference btw/ the jackson-pratt & the penrose

A

The penrose must be placed at most ventraol location while the jackson-pratt doesnt

32
Q

Describe using gauze as wound dressing

A
  • 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
33
Q

Describe using telfa pad as wound dressing

A
  • Surgical wounds or suture wounds
  • Non-adherent & non-occulusive
34
Q

Describe using Hypertonic saline dressing as wound dressing

A
  • Curasalt
  • Aggressive wound debridement
  • First few days only
35
Q

Describe using calcium alginate as wound dressing

A
  • Curasorb
  • Moderately exudative wounds &/or substantial tissue loss
  • Creates a gel that promotes moist wound healing
36
Q

What are the guideline from bandaging

A
  • Even tension
  • Appropriate tension
  • Cover the req areas
37
Q

What is the technique for bandaging

A
  • Counterclockwise on left limbs
  • Clockwise on the right limbs
  • Start on the medial side of the leg & wrap toward the head
38
Q

What is the first step of putting on a veterinary bandage

A
  • Start in a clean dry environment
  • Wear gloves
  • Non-adherent first layer
  • Hold in place w/ kling gauze & loosely wrap
39
Q

What is after the kling gauze

A
  • Add the outer bandage (Thickness is important)
  • Disposable options include - sheet cotton, gamgee, combiroll
40
Q

What is placed after the outer bandage

A
  • Brown gauze
  • Wrap it tight (just not to the point to wear it rips)
41
Q

What is placed after the brown gauze

A
  • Add the vet wrap w/ no wrinkles
  • Put on elasticon - lay it on loosely (this keeps debris out of the bandage)
42
Q

List common bandaging error

A
  • Not enough padding
  • Wrapping in the wrong direction
  • Uneven pressure
  • Uneven swipes
  • Poor application
43
Q

How is a bandage placed over joints

A
  • 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
44
Q

Explain splinting

A
  • Proper padding is very important
  • Often made of PVC pipe & duct tape/white tape (not stretchy)
45
Q

What should be done for a foot bandage

A
  • 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
46
Q

List some complications of bandaging

A
  • 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
47
Q

When is bandaging done in ruminants

A
  • most common for foot procedures
  • Wounds
  • Padding under splints
48
Q

When are claw blocks used

A
  • When there are is damage to one claw
  • Block goes on the unaffected claw
49
Q

What are some differences btw/ bandaging ruminants than equine

A
  • 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
50
Q

Describe proud flesh

A
  • 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
51
Q

What happens if there is involvement of synovial structures

A
  • Small seemingly innocuous wounds can be very serious
  • Requires immediate referral
  • Lots of money
  • Time is very important (better prognosis if treated early)
52
Q

What is bone sequestrum

A
  • 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
53
Q

Describe cellulitis

A
  • 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

Surgery 1 (SAB) (16 decks)

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