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Surgery > Lower Limb Wounds > Flashcards

Lower Limb Wounds Flashcards

1
Q

What are your options for a wound management plan?

A 
Primary closure
Delayed primary closure
Secondary closure
Healing by second intention
Skin grafting
Delayed scar revision
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2
Q

When is delayed primary closure completed?

A

2-3 days after the injury

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3
Q

When is secondary closure completed?

A

When granulation tissue is present

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4
Q

What are the 4 main ways lower limb wounds differ from upper body wounds?

A
  1. Contraction is limited
  2. Epithelialization is slower
  3. Healing is slower
  4. Exuberant granulation tissue inhibits contraction & epithelialization
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5
Q

True or false:

Myofibroblasts have differing contraction capacities depending on location, whether they are present in upper body or lower limb wounds.

A

False

Myofibroblasts have the SAME innate contraction capacity.

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6
Q

How do cytokine and growth factor profiles differ between upper body and lower limb wounds?

A

Upper body: TGF beta levels peak a few days after wounding and then return to baseline

Lower limb: TGF beta levels remain elevated

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7
Q

True or false:

Inflammation does not play factor in the limited capacity of wound contraction on a lower limb.

A

False

The persistent inflammation towards the lower limb inhibits contraction

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8
Q

True or false:

If it can’t be sutured, a wound should be prepped, lavaged, debrided, and bandaged.

A

True

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9
Q

What has the ability of debriding a wound by dissolving dead and infected tissue with their proteolytic, digestive enzymes?

A

Green blow fly larvae

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10
Q

What else can green blow fly larvae do?

A
  1. Disinfect
  2. Stimulate growth
  3. Dissolve existing biofilm
  4. Inhibit formation of new biofilm
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11
Q

Which 3 components make up granulation tissue?

A
  1. Capillaries
  2. Fibroblasts
  3. Collagen fibers
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12
Q

Which type of cells does TGF beta stimulate?

A

Fibroblasts

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13
Q

Which type of cells form the extracellular matrix of granulation tissue?

A

Fibroblasts

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14
Q

Where would you rarely find granulation tissue?

A

Above the carpus and tarsus

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15
Q

Which cell type causes contraction?

A

Myofibroblasts

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16
Q

What are the 2 causes of exuberant granulation tissue?

A
  1. Motion

2. Chronic inflammation

17
Q

Chronic inflammation causes proliferation and production of what 2 things?

A
  1. Proliferation of fibroblasts

2. Formation of extracellular matrix

18
Q

How long might you leave a foot cast on a horse?

A

2-3 weeks

19
Q

In general, periodic application of 0.1% triamcinolone (Panalog) cream does what to a wound?

A

Decreases inflammation

20
Q

How does Panalog work?

A

Selectively decreases release of profibrotic TGF-B1 and TGF-B2 from monocytes and macrophages

21
Q

On which type of tissue does Panalog work the best?

A

Immature granulation tissue

22
Q

Immobilization by cast or splint bandage can prevent __________ and speed up the _____ process.

A

Immobilization by cast or splint bandage can prevent exuberant granulation tissue and speed up the contraction process.

23
Q

List all the things a cast does:

A
  1. Decrease healing time
  2. Decrease exuberant granulation tissue
  3. Speed up contraction
  4. Decrease TGF beta
  5. Decrease constant inflammation
24
Q

Silicone gel dressing prevents exuberant granulation tissue, but how?

A

Decreases the levels of growth factors, especially TGF beta 1

25
Q

In which type of injuries are osseous sequestrations most common?

A

Avulsion injuries to the extremities

26
Q

What 2 factors are required for sequestration?

A

Ischemia
&
Bacteria

27
Q

What 4 signs suggest a superficial septic cortical osteitis?

A
  1. Lameness
  2. Excessive exudate
  3. Purple granulation tissue
  4. Necrotic tracts
28
Q

When should you radiograph a limb when managing an exposed bone?

A

12-14 days

29
Q

True or false:

Small osseous sequestrum fragments can be dissolved by lysozymes or osteoclastic resorption on their surface but the process is slow.

A

True

30
Q

True or false:

You can treat osseous sequestrum with antibiotics.

A

FALSE

Systemic antibiotics are no value in treatment of a sequestrum

31
Q

What is the treatment of choice for an osseous sequestrum?

A

Surgical removal

32
Q

What might an x-ray show when a joint injury has occurred?

A

Air in the joint

33
Q

How do you treat joint injuries?

A

Apply sterile bandage and refer as soon as possible

Surgery (15 decks)

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