Lower Limb Wounds Flashcards
What are your options for a wound management plan?
Primary closure Delayed primary closure Secondary closure Healing by second intention Skin grafting Delayed scar revision
When is delayed primary closure completed?
2-3 days after the injury
When is secondary closure completed?
When granulation tissue is present
What are the 4 main ways lower limb wounds differ from upper body wounds?
- Contraction is limited
- Epithelialization is slower
- Healing is slower
- Exuberant granulation tissue inhibits contraction & epithelialization
True or false:
Myofibroblasts have differing contraction capacities depending on location, whether they are present in upper body or lower limb wounds.
False
Myofibroblasts have the SAME innate contraction capacity.
How do cytokine and growth factor profiles differ between upper body and lower limb wounds?
Upper body: TGF beta levels peak a few days after wounding and then return to baseline
Lower limb: TGF beta levels remain elevated
True or false:
Inflammation does not play factor in the limited capacity of wound contraction on a lower limb.
False
The persistent inflammation towards the lower limb inhibits contraction
True or false:
If it can’t be sutured, a wound should be prepped, lavaged, debrided, and bandaged.
True
What has the ability of debriding a wound by dissolving dead and infected tissue with their proteolytic, digestive enzymes?
Green blow fly larvae
What else can green blow fly larvae do?
- Disinfect
- Stimulate growth
- Dissolve existing biofilm
- Inhibit formation of new biofilm
Which 3 components make up granulation tissue?
- Capillaries
- Fibroblasts
- Collagen fibers
Which type of cells does TGF beta stimulate?
Fibroblasts
Which type of cells form the extracellular matrix of granulation tissue?
Fibroblasts
Where would you rarely find granulation tissue?
Above the carpus and tarsus
Which cell type causes contraction?
Myofibroblasts
What are the 2 causes of exuberant granulation tissue?
- Motion
2. Chronic inflammation
Chronic inflammation causes proliferation and production of what 2 things?
- Proliferation of fibroblasts
2. Formation of extracellular matrix
How long might you leave a foot cast on a horse?
2-3 weeks
In general, periodic application of 0.1% triamcinolone (Panalog) cream does what to a wound?
Decreases inflammation
How does Panalog work?
Selectively decreases release of profibrotic TGF-B1 and TGF-B2 from monocytes and macrophages
On which type of tissue does Panalog work the best?
Immature granulation tissue
Immobilization by cast or splint bandage can prevent __________ and speed up the _____ process.
Immobilization by cast or splint bandage can prevent exuberant granulation tissue and speed up the contraction process.
List all the things a cast does:
- Decrease healing time
- Decrease exuberant granulation tissue
- Speed up contraction
- Decrease TGF beta
- Decrease constant inflammation
Silicone gel dressing prevents exuberant granulation tissue, but how?
Decreases the levels of growth factors, especially TGF beta 1
