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Small Animal Surgery > Management of Traumatic Wounds > Flashcards

Management of Traumatic Wounds Flashcards

1
Q

What are 2 general classifications of traumatic wounds?

A
  • Penetrating (open)

- Non-penetrating (closed)

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2
Q

What are 4 classifications of operative wounds?

A
  • Clean
  • Clean-contaminated
  • Contaminated
  • Dirty
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3
Q

Open traumatic wounds should initially be considered what?

A

Contaminated

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4
Q

What are 7 common wound etiologies?

A
  • Lacerations
  • Bite wounds
  • Degloving injuries
  • Sinus tracts
  • Burns
  • Toxins
  • Non-healing wounds
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5
Q

How does the healing of superficial wounds differ in dogs and cats?

A

Granulation tissue takes longer to form in cats.

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6
Q

Which suture material would be most appropriate for an open wound?
Why?

A
  • Absorbable monofilament

- Less risk of bacteria

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7
Q

What type of a wound can result from shearing forces which sever cutaneous vessels supplying the skin?

A

Degloving injury

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8
Q

With what type of degloving injury is the skin devitalized but still in place?

A

Physiologic degloving injuries

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9
Q

With what type of degloving injury is the skin avulsed from underlying tissue?

A

Anatomic degloving injuries

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10
Q

What type of degloving injuries are more common in dogs and cats?

A

Combined degloving and crush injuries

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11
Q

What color does skin turn if it is dead?

A

Black

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12
Q

Once skin that has been left on starts to do what, it is time to remove it?

A

Skin starting to slough

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13
Q

What are 2 types of missile wounds?

A
  • Arrow wounds

- Gunshot wounds

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14
Q

What should the owner be told to do with an arrow wound?

A

Leave it in and cut the shaft off if possible.

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15
Q

Is removal of all lead fragments necessary?

A

No

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16
Q

When is removal of all lead fragments important?

A

When the injury involves a joint.

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17
Q

What are 3 main categories of burns?

A
  • Thermal
  • Chemical
  • Electrical
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18
Q

What are 3 types of hot liquid burns?

A
  • Water (steam)
  • Grease
  • Wax
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19
Q

What are 3 main types of thermal burns?

A
  • House fires
  • Hot liquids
  • Direct contact
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20
Q

What are 3 possible sources of direct contact burns?

A
  • Heating pads
  • Heat lamps
  • Exhaust pipes
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21
Q

What are 4 aspects of assessing a burn patient?

A
  • Cause
  • Concurrent injury
  • Extent of burn
  • Depth of burn
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22
Q

What are 2 categories based on depth of burn?

A
  • Partial thickness

- Full thickness

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23
Q

What are 2 ways to evaluate the percent total body surface area with determining the extent of a burn?

A
  • Rule of 9s

- Calculate

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24
Q

What are 4 aspects of burn wound management?

A
  • Fluid resuscitation
  • Smoke inhalation
  • Wound management
  • Nutritional support
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25
Q

What are 3 problems seen with smoke inhalation?

A
  • Direct heat injury
  • Carbon monoxide
  • Inhaled toxins
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26
Q

What can be a problem with large burns?

A

Hypovolemia

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27
Q

What are 4 components of initial burn management?

A
  • Cool injured tissue
  • Topical treatment
  • Analgesics
  • Fluid resuscitation
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28
Q

Which 2 topical treatments for burns work together in a synergistic manner?

A
  • Aloe vera

- Silver sulfadiazine

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29
Q

Topical treatments for burns delay development of infection under what?

A

Under eschar (hard crust/scab)

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30
Q

Fluid resuscitation should be considered with what percentage of total body surface area?

A

Greater than 15% TBSA

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31
Q

When should wound debridement be done with burns?

A

Early

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32
Q

What is NPWT stand for?

How is it closed?

A
  • Negative pressure wound therapy

- Vacuum-assisted closure (VAC)

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33
Q

If there is hair remaining in a wound and it sticks pretty tight, what type of indicator is this for tissue survival?

A

Tissue will probably survive.

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34
Q

What percentage TBSA burns are usually easily managed?

A

Less than 15%

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35
Q

What percentage TBSA burns may require extensive treatment?

A

Greater than 15% to less than 50%

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36
Q

What percentage TBSA burns are often associated with significant complications and prolonged treatment?

A

Greater than 50%

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37
Q

What are 6 possible causes of non-healing wounds?

A
  • Foreign bodies
  • Immunodeficiency
  • Pathogens
  • Concurrent disease
  • Nutritional status
  • Drugs
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38
Q

What are 2 types of foreign bodies that should be removed?

A
  • Porous materials

- Organic materials

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39
Q

What are 4 types of foreign body materials that are relatively inert unless contaminated?

A
  • Glass
  • Gravel
  • Pellets (steel, lead)
  • Carbon material
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40
Q

Sinus tracts are most commonly caused by what?

A

Plant material foreign bodies

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41
Q

Plant material foreign bodies can migrate a significant distance causing a draining tract that is lined by what?

A

Granulation tissue

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42
Q

Antibiotic administration with sinus tracts will cause what?

What will happen once antibiotics are discontinued?

A
  • “Pseudo” healing with antibiotic administration

- Draining tracts will reappear when antibiotics are discontinued.

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43
Q

How quickly does sinus tract healing take place once the foreign body is removed?

A

Heals rapidly

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44
Q

What is not necessary if foreign body can be identified and removed?

A

Complete excision of draining tract is not necessary.

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45
Q

A communication between the mesothelial surface and the skin is known as what?

A

Sinus

46
Q

A communication between 2 epithelial surfaces is known as what?

A

Fistula

47
Q

Fistulas are lined by what?

A

Epithelium

48
Q

What are 2 types of draining tracts?

A
  • Sinus

- Fistula

49
Q

Which type of draining tract is often associated with foreign body migration?

A

Sinus draining tract

50
Q

What are 4 forms of diagnostics used to look for foreign bodies?

A
  • Radiographs
  • Contrast studies
  • Ultrasound
  • CT/MRI
51
Q

You are most likely to detect a foreign body with which type of diagnostic tool?

A

Ultrasound

52
Q

What can be done to a foreign body sinus tract prior to surgery?
Why is this done?

A
  • Instill dilute methylene blue.

- Makes following the tract easier.

53
Q

What are 3 possible sources of contamination in a traumatic wound?

A
  • Endogenous flora
  • Accident site
  • Hospital
54
Q

What are 3 factors influencing the development of wound infection?

A
  • Number and type of bacteria
  • Host defense mechanisms
  • Exogenous factors
55
Q

How long does the time from contamination until bacteria invade and replicate to >10^5/gm of tissue?
What is this known as?

A
  • Generally 6-8 hours

- “Golden period”

56
Q

What are 2 possible exogenous factors that can influence the development of a wound infection?

A
  • Foreign bodies

- Soil infection potentiating factors

57
Q

Negatively charged particles with large surface area involved in wounds are known as what?

A

Infection potentiating factors

58
Q

What are 2 things infection potentiating factors do?

A
  • Inhibits phagocytosis and bacterial killing

- Binds to positively charged antibiotics

59
Q

Infection potentiating factors can be found in what?

A

Clays and organic soil components

60
Q

What are 3 examples of infection potentiating factors?

A
  • Montmorillinite
  • Kaolinite
  • Illite
61
Q

Infection potentiating factors can reduce the number of bacteria required to cause infection to what?

A

As few as 100

62
Q

Initial management of traumatic wounds includes what 3 aspects?

A
  • Physical examination
  • Protect wound with bandage to prevent further contamination
  • Avoid temptation to “take a peek”
63
Q

What should be done prior to administering pain medications when evaluating patients with traumatic wounds?

A

Check neurologic status of limb injuries.

64
Q

What should limb wounds be assessed for?

A

Orthopedic injuries

65
Q

What type of wounds should be explored when the patient is stable?

A

Abdominal wounds

66
Q

What should be considered with penetrating thoracic wounds?

A

Consider etiology and exam findings.

67
Q

What are 2 things that are done after thoroughly examining the wound?

A
  • Debridement

- Wound lavage

68
Q

What are 4 examples of minimum precautions to take when evaluating a wound?

A
  • Temporarily close or pack wound
  • Clip and prep surrounding skin
  • Caps, masks, gloves
  • Ideally, complete aseptic technique
69
Q

Up to what percent of bacteria can be removed with wound lavage?

A

Up to 90%

70
Q

You should use what quantity of fluid with what amount of pressure for wound lavage?

A
  • Large quantities

- Moderate pressure

71
Q

What are 2 types of fluid used for wound lavage?

A
  • Saline

- Balanced electrolyte solution +/- antiseptics

72
Q

What is typically used to perform wound lavage?

A

18-20 G needle and syringe that fits comfortably in hand

73
Q

Povidone-Iodine needs to be diluted to what ratio?

Why do you need to dilute the iodine?

A
  • 1:10 or less

- In order to free the iodine from the molecules they are bound to.

74
Q

Povidone-Iodine has residual activity for how long?

A

4-6 hours

75
Q

What are 2 disadvantages to Povidone-Iodine use?

A
  • Forms inactive complexes with organic matter

- Systemic absorption leading to toxicity

76
Q

What type of activity does Chlorhexidine have?

A

Broad-spectrum activity

77
Q

What is the dilution level needed for chlorhexidine?

What is the percentage of the solution?

A
  • 1:40 Dilution

- 0.05% solution

78
Q

What is used to dilute chlorhexidine?

What should NOT be used?

A
  • Sterile irrigating water

- Distilled water

79
Q

What are 3 advantages to chlorhexidine use?

A
  • Activity less affected by organic matter
  • Long residual action
  • Side-effects uncommon
80
Q

How long does the first dose of chlorhexidine typically last?
Does repeated use make the DOA longer or shorter?

A
  • 8-12 hours

- Longer after repeated use

81
Q

Chlorhexidine diluted in what type of solution will begin to form what within hours?

A
  • Polyionic solution

- Form a precipitate, a chlorhexidine chloride salt

82
Q

At typical dilutions of chlorhexidine, adequate antibacterial activity is maintained for approximately how long?

A

2 weeks

83
Q

Does the chlorhexidine chloride salt precipitate seen with chlorhexidine solution interfere with wound healing?

A

Does not appear to interfere with wound healing.

84
Q

Removal of devitalized tissue and foreign bodies is known as what?

A

Debridement

85
Q

What are 5 potential methods of debridement?

A
  • Surgical
  • Autolytic
  • Chemical
  • Mechanical
  • Biosurgical
86
Q

What is the most commonly used method of surgical debridement?

A

Layered surgical debridement

87
Q

Complete excision of a wound as with tumor excision is called what?

A

“En bloc”

88
Q

What are 4 indications for the use of chemical debridement?

A
  • Poor anesthetic risks
  • Minimal debridement of open wounds is necessary
  • When surgical debridement may damage important structures
  • Adjunct to other methods
89
Q

What are 4 examples of chemical debridement solutions?

A
  • Granulex
  • Trypsin
  • Castor Oil
  • Balsam of Peru
90
Q

When the devitalized tissue and foreign bodies get trapped in the primary bandage layer, this is known as what type of debridement?

A

Mechanical debridement

91
Q

Mechanical debridement is primarily indicated for what type of wounds?

A

Wounds in the lag phase with heavy contamination or thick viscous exudate.

92
Q

What is a disadvantage of mechanical debridement?

A

Not as tissue friendly as moisture retentive dressings or the use of enzymatic agents.

93
Q

What are 4 forms of mechanical debridement?

A
  • Wet-to-dry
  • Dry-to-dry
  • Wide mesh gauze
  • Adjunct to surgical/enzymatic debridement
94
Q

Doing what to dressing at removal with warm solutions helps the dressing release from the wound improving patient comfort?

A

Rehydrating

95
Q

When should adherent dressings (wet-to-dry or dry-to-dry) be discontinued?
What are indicated at this point until wound closure is performed?

A
  • Once the wound bed is healthy.

- Non-adherent, moisture retentive dressings.

96
Q

What can be used after surgical debridement to promote more rapid granulation tissue formation with acute wounds?

A

Negative wound pressure therapy

97
Q

What can be used to improve local environment to enhance second intention healing with chronic wounds?

A

Negative wound pressure therapy

98
Q

Is constant or intermittent suction better when using vacuum assisted closure?

A

Constant

99
Q

When does negative pressure wound therapy with vacuum assisted closure work best?

A

When used on wounds in late lag (debridement) phase or early proliferative phase of wound healing.

100
Q

What are 6 benefits of vacuum-assisted closure?

A
  • Increased tissue blood flow
  • Decreased interstitial edema
  • Decreases bacterial burden in wound
  • May help remove inflammatory cytokines from wound
  • accelerated granulation tissue formation
  • Less frequent bandage changes
101
Q

What is a non-woven felt-like material derived from seaweed that is extremely hydrophilic?
Fluid absorption converts the felt to what?

A
  • Calcium alginate

- A gel

102
Q

Calcium alginate aids in what?

A

Hemostasis

103
Q

What are 3 indications for the use of topical wound medications and dressings?

A
  • Moderate to heavily exudative wounds in early stages of healing
  • Wound adequately debrided but not amenable for closure
  • Less painful to change than gauze dressings
104
Q

What are 4 actions of honey on a wound?

A
  • Cleanses wound
  • Hygroscopic
  • Promotes granulation tissue formation
  • Antibacterial/antifungal
105
Q

The antibacterial effect of sugar is primarily due to what?

A

Osmolality

106
Q

What are 3 other actions of sugar in a wound?

A
  • Cleanses wound
  • Reduces edema
  • Promotes granulation tissue formation
107
Q

How does sugar promote granulation tissue formation?

A

Attracts macrophages

108
Q

What is a D-glucose polysaccharide that comes in a hydrophilic soluble powder?

A

Maltodextrin

109
Q

Hydrocolloid or polyurethane occlusive dressings are examples of what type of dressing?

A

Moisture retentive dressings

110
Q

What type of dressings are better than adherent dressings for wounds in late debridement/proliferative phase?
Why?

A
  • Moisture retentive dressings

- They optimize the body’s inherent wound healing abilities.

111
Q

Moisture retentive dressings help to maintain the normal physiologic ratios of what 4 factors?

A
  • Proteases
  • Protease inhibitors
  • Growth factors
  • Cytokines

Small Animal Surgery (9 decks)

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