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Equine Medicine and Surgery > Lecture 17: Lacerations and Wound Management > Flashcards

Lecture 17: Lacerations and Wound Management Flashcards

1
Q

Where is the skin thickness on the equine body

A

Mane and tail

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2
Q

Skin tends to be thicker with ___ than young horses

A

Older geldings

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3
Q

Skin is thicker at the ___surface of the legs than the __surface

A

Extensor, surface

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4
Q

Head, neck and body wounds heal better than wounds on __

A

Extremities

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5
Q

Prolonged healing in wounds of the extremities is due to ___ (4)

A
  1. Reduced vascularity
  2. Increased infection
  3. Increased inflammatory response
  4. Reduce regional temperature
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6
Q

Equine cleavage lines are parallel to ___

A

Predominant orientation of collagen fibers

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7
Q

Wounds that are parallel to ___have less tension

A

Cleavage lines/ langer lines of tension

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8
Q

When possible incisions should be made parallel to ___

A

Cleavage lines

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9
Q

Distal limb wounds are below the ___

A

Carpus tarsus

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10
Q

What is the most important step in wound therapy

A

Wound assessment

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11
Q

What are the steps in initial wound preparation

A
  1. Aseptic/sterile conditions (joints) vs simple clean technique
  2. Apply sterile water soluble gel to wound before clipping
  3. Clip hair over and around
  4. Rinse gel and hair from wound with sterile saline
  5. Explore wound
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12
Q

Debridement is an effective way to reduce ___within a wound and minimize ___

A

Bacterial load, necrotic tissue

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13
Q

What is the #1 choice for debridement

A

Sharp

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14
Q

What is the least traumatic debridement technique to tissues

A

Autolytic

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15
Q

What is a major disadvantage to sharp debridement

A

Once tissue is removed, can’t put that back

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16
Q

What is the least traumatic sharp debridement tool and should be used whenever possible

A

Scalpel

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17
Q

What are the two critical components for lavage

A
  1. Solution used
    2, delivery
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18
Q

What solutions are used for lavage

A

Non-cytotoxic solution- saline, vetericyn, lacerum

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19
Q

How do you deliver a lavage

A

Need appropriate pressure and volume without pushing dither into wound—> use 19G needle or Catheter attached to 35mL syringe

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20
Q

What is a wet-to-wet dressing more effective at removing than gauze

A

Necrotic tissue and causes less damage to epithelial cells

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21
Q

What is a wet-to dry dressing

A

Dressing directly on wound bed is moistened with saline, rest of bandage is dry
Absorbent secondary layers pull fluid from primary dressing

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22
Q

What is a disadvantage to wet to dry dressings

A

Primary dressing often dries out between changes, when removed get non-selective debridement

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23
Q

What should chemical debridement be used for

A

Very contaminated wounds because not-selective

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24
Q

What are 2 chemical debridement agents

A

Hydrogen peroxide, hypertonic saline

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25
Q

What is a method of biological debridement

A

Sterile medical grade larvae/maggots

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26
Q

Larvae digest only ___tissue and ___, leaving healthy tissue unharmed

A

Necrotic tissue and pathogenic bacteria

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27
Q

Larval secretions also have ___effects and promote ___

A

Antibacterial, angiogenesis

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28
Q

What is autolytic debridement

A

Leave wound fluid intact with wound bed. WBC’s and enzymes from dead WBC’s affect only necrotic tissue, leave healthy cells intact, reduce bacterial count

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29
Q

Autolytic debridement can only occur in ___wounds

A

Dry

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30
Q

What is contamination of a wound

A

Presence of bacteria in wound without active multiplication or trauma to host

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31
Q

What is colonization of a wound

A

Bacteria are attached to tissue and multiplying but not necessarily causing trauma

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32
Q

What is an infection of a wound

A

Bacteria invade healthy tissue and actively multiply overwhelming host immune response

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33
Q

What is qualitative assessment of bacteria in wounds

A

Determine types of bacteria in wound, sensitivity testing, guides antibiotic decision

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34
Q

Sensitivity testing is especially important for wounds involving ___

A

Synovial structures

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35
Q

Antiseptics are effective against a broad range of bacteria but do not penetrate __and are unlikely to reduce ___in wound bed

A

Necrotic debris, bacterial populations

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36
Q

Antiseptics should be reserved for use on ___, not on ___

A

Normal skin surrounding wound, not on wound bed itself

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37
Q

Topical antimicrobial agents target __

A

Specific bacteria

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38
Q

Blood supply to wound surface is diminished in chronic infections so ___is required

A

Topical antimicrobial

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39
Q

In what stages are wounds best candidates for primary or delayed primary closure

A

Inflammatory or debridement phase, wounds that are clean or clean contaminated

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40
Q

What type of closure is used in new wounds that are clean

A

Primary closure

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41
Q

In primary closure the wound is closed ___ and using strict ___technique

A

Immediately, aseptic

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42
Q

Which closure provides the best functional and cosmetic result

A

Primary closure

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43
Q

Primary closure is acceptable for what types of wounds

A

Minimal tissue loss, minimal bacteria contamination and minimal tension

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44
Q

What suture patterns can be used to reduce tension

A
  1. Near-far-far-near
  2. Interrupted vertical mattress +/-stents
  3. Interrupted horizontal mattress +/- stents
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45
Q

To reduce tension use __diameter suture material

A

Large

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46
Q

Failure to obliterate dead space can lead to ___ which is excellent medium for ___

A

Hematoma/seroma, bacterial growth

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47
Q

What are some ways to close dead space

A
  1. Suture
  2. Meshing the skin
  3. Passive or active drains
  4. Pressure bandages
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48
Q

What is delayed primary closure

A

Wound is initially left open to allow for debridement and reduce bacterial contamination then closed primarily

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49
Q

When would you use primary for delayed primary closure

A

Primary when skin is thin and new wound, delayed when there is granulation tissue, thickening and lots of drainage

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50
Q

Identify which one you would use primary vs delayed primary closure on

A

left: primary (thin)
Right: delayed primary (lots granulation tissue, thick, lots of drainage)

51
Q

When do you use second intention healing

A

Gross contamination and moderate to severe tissue loss makes closure hard

52
Q

How does second intention healing work

A

Heal via contraction, granulation, and epithelialization

53
Q

What is the best closure/healing technique for this wound

A

second intention healing- not enough skin to close

54
Q

The ideal wound dressing keeps the wound bed __ and surrounding skin ___

A

Moist, dry

55
Q

What type of wounds is hypertonic saline wound dressing good for

A

Necrotic and heavily exudative wounds

56
Q

Hypertonic saline is a ___debdridement

A

Non-selective chemical debdridement

57
Q

Hypertonic saline as a wound dressing is food for ___

58
Q

How does Mankua honey work as wound dressing

A

Bacteriocidal and growth factor like effects

59
Q

How do antimicrobial dressings work

A

Suppresses microbial penetration and growth, bacterial death occurs by destabilization and disruption of cytoplasmic membrane

60
Q

T or F: bacteria can become resistant to antimicrobial dressings

61
Q

Hydrogels are good for dry wounds because they __

A

Provide moisture

62
Q

Hydrogels are excellent for promoting ___, ___ and ___

A

Autolytic debridement, WBC migration, and thermal regulation

63
Q

Calcium alginate is best if used during what phase of wound repair

A

Granulating phase

64
Q

How does calcium alginate wound dressing work

A

Calcium in dressing interacts with sodium in wound making an exudate that stimulates myofibroblasts and epithelial cells

65
Q

What important structures are you worried about in head injuries

A

Brain, eyes, ears, paranasal sinuses, salivary ducts, nerves

66
Q

What are the diagnostic aids for head wounds

A

Rads, ultrasound, CT, MRI

67
Q

Always perform a ___ for a head wound

A

Neurological exam

68
Q

If the orbit in involved in head wound determine ___and ___involvement

A

Bone and glove

69
Q

What scrub do you not use for head wounds involving the orbit. What is better option

A

Don’t use chlorine iodine
Use betadine

70
Q

How are eyelids closed

A

Primary closure using small diameter, absorbable sutures in many layers

71
Q

How are ear wounds closed

A

Primary closure

72
Q

What sinuses are affected in head wounds

A

Frontal and maxillary

73
Q

What are two common sequela of head wounds involving paranasal sinuses

A

Bone sequestration and eventual fistula formation

74
Q

What structures do you need to examine for head wounds involving mandible

A

Salivary duct and incisor involvement

75
Q

How can you test for salivary gland involvement in head wound

A

Feed horse and look for saliva coming out of wound

76
Q

How do you tx head wounds involving nares

A

Thorough debridement and use of multiple layers of closure

77
Q

If a nares wound is >7 days old what do you do

A

Heal via second intention

78
Q

Wounds of the thorax should always be examined with ___technique to determine depth

79
Q

For wounds to thorax listen for ___getting sucked into wound during inspiration

80
Q

___antibiotics if pleural penetration

A

Broad spectrum

81
Q

What type of bandage can be applied for thorax wound

A

Stent bandage- sterile towel held on wound with sutures

83
Q

If there is peritoneal penetration of abdomen what do you do and how do you tx

A
  1. Abdominal bandage
  2. Broad spectrum antibiotics
  3. Referral for abdominal explore
84
Q

What is the major side effect of axillary lacerations

A

Subcutaneous emphysema

85
Q

For axillary lacerations wound opens and fills with air when horse moves ___

A

Leg forward

86
Q

For axillary lacerations you examine for __involvement that can lead to ___

A

Thoracic—> pneumothorax

87
Q

How do you tx axillary laceration

A

Pack wound with sling bandage to reduce air accumulation

Limit horses movement

88
Q

How do you determine if synovial structure/joint is involved in wound

A

Place needle into synovial structure at site distant from wound

Distend with sterile saline observe wound for fluid egress

89
Q

If synovial structure is involved what do you do

A
  1. Primary closure if possible
  2. Lavage, IV antibiotics, local intravenous regional perfusion, intra-articular antibiotics, bandaging
90
Q

What is intravenous regional perfusion when tx synovial structure involvement

A

Apply tourniquet above wound, and put in antibiotics so it stays local

91
Q

Heel bulb lacerations can involve everything from __ to ___

A

Skin to coffin joint

92
Q

What are some potential synovial structures involved in heel bulb lacerations

A

DDFT, tendon sheet, and/or coffin joint

93
Q

How do you close heel bulb lacerations with no synovial involvement

A

Delayed primary closure because close to ground and easily contaminated

94
Q

After closure of heel bulb laceration apply __

A

Foot cast, reduce motion

95
Q

Chronic wounds have delayed expression of ___necessary for healing

A

Growth factors (PDGF, FGF)

96
Q

What is the first step in treatment of chronic wounds

A

Preparation- clip hair, lavage, disinfect

97
Q

After you clip and clean chronic wound what do you do next

A

Digital explore- search for foreign material, draining tracts that can cause it to to heal

Radiograph or ultrasound for FB

98
Q

___should be suspected whenever a wound does not heal in anticipated time frame

99
Q

What is surgical tx for chronic wounds

A

Surgical debridement- remove infected tissue and turn chronic wound into acute—> stimulates healing

100
Q

What is a sinus tract

A

“Draining tract” a cavity or channel

101
Q

Is the venous sinus normal or pathological

102
Q

What is a pathological sinus tract

A

Channel that permits escape of pus through skin

103
Q

What is a fistula

A

Abnormal passage or communication between 2 internal organs leading from an organ to the surface of the body

104
Q

What is an entercutaneous fistula

A

Intestine through abdominal wall

105
Q

What is a sinucutaneous fistula

A

Paranasal sinus through skin

106
Q

What is wrong

A

Entercutaneous fistula

107
Q

What is wrong

A

Sinucutaneous fistula

108
Q

Sinus tracts commonly occur secondary to

A

Secondary to trauma and foreign bodies

109
Q

Sinus tracts are frequently associated with a ___

A

Sequestrum

110
Q

What is this

A

Sequestrum

111
Q

What is a Sequestrum

A

Chip of bone that came off parent bone and is dying

112
Q

___ should be suspected any time chronic sinus tract/drainage is encountered

A

Foreign body

113
Q

How do you dx sinus tracts

A

Ultrasound
Radiographs
Positive contrast sonography

114
Q

How do sinus tracts appear on ultrasound

A

Hyperchogenicity and acoustic shadows

115
Q

Radiographs immediately rule out __as cause of sinus tract

A

Metallic FB

116
Q

What do you see on rads with sinus tracts

A

Soft tissue swelling, thickening, gas densities, periosteal reactions

117
Q

What diagnostic tool is useful for identifying radiolucent foreign bodies for sinus tracts

A

Positive contrast- sinography

118
Q

What is treatment for sinus tracts

A

Removal of foreign body, explore tract with probe

119
Q

Sinus tracts can be followed by following ___colored membrane

A

Dark purple

120
Q

If you have sinus tract in head what do you need to consider

A

Dental problem

121
Q

What is this

A

dentigerous cyst/ ear tooth

122
Q

Horse presents with fistulous withers and pole evil what is your most likely differential

A

Brucellosis

123
Q

What are the 3 main strategies for preventing bacterial infection of wounds

A
  1. Effective cleansing and debridement
  2. Appropriate use of dressings/bandages
  3. Appropriate dressing/bandage changing
124
Q

What type of suture is best for wounds

A

Smallest diameter possible, monofilament, absorbable suture with surgeons knots

Equine Medicine and Surgery (27 decks)

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