Management of Traumatic Wounds: Fundamentals Flashcards
What are the phases of wound healing?
” I demand Rossies Memorize”
- Inflammatory
- Debridement
- Repair
- Maturation/Remodeling phase
The inflammatory phase of wound healing occurs in _____ days
0-5
What occurs during the inflammatory phase of wound healing?
Hemorrhage → Vasoconstriction → Vasodilation → Leukocyte response → PLT activation (clotting)
first 0-5 days of wound
What occurs during the debridement phase of wound healing?
- neuts arrive 1st (within 6hrs) then monocytes (12 hrs) and initiate debridement phase
- develops exudate rich in WBCw, wound fluid, and necrotic tissue
monocytes essential for wound healing (not neuts)
The debridement phase of wound healing occurs in _____ days
1-5
Which of the following is essential for wound healing?
A. Neutrophil
B. Monocytes
C. Lymphocytes
D. Eosinophils
B. Monocytes
Which of the following growth factors does NOT come from macrophages?
A. PFGF
B. EGF
C. KGF
D.PDGF
E. TGF-a/TGF-beta
F. VEGF
C. KGF
F. VEGF
Which of the following stimulates fibroblast and DNA proliferation in the repair phase of wound healing?
A. Neutrophil
B. Lymphocytes
C. Macrophages
D. Eosinophils
C. Macrophages
The repair phase of wound healing occurs in _____ days
3-5 days to 2-4 weeks
What occurs during the repair phase of wound healing?
- macrophages activate fibroblasts → fibroblasts migrate into wound depositing collagen/fibrous tissue → angiogenesis → granulation tissue → epithelialization → wound contraction (simultaneously w/ granulation tissue & epithlialization)
Bright red granulation tissue can be seen in what phase of wound healing?
Repair phase
What bandage should NOT be used in the repair phase of wound healing and why?
Wet to dry bandage - delays re-epithelialization
_____% of the original strength may be regained following a healed wound
80%
What is the golden period when treating wounds?
- 0-6 hrs
- minimal contamination
- insufficient microbial replication to cause infection and can usually manage with primary closure
What is the time frame of a wound to be classified as Class 2?
- 6-12 hrs after wound
What is the time frame of a wound to be classified as Class 3?
> 12 hours of wounding
- likely infection due to time allowed for microbial replication
What is primary closure in wound management?
- Clip, clean, and suture immediately
- Used for Class 1 (0-6hrs) and some Class 2 (6-12hrs) wounds
What does delayed primary closure mean in wound management?
- appositional closure BEFORE granulation tissue develops
- Within 3-5 days of wounding
- Good for Class 2 wounds (6-12hrs)
What does secondary closure mean in wound management?
- appositional closure AFTER granulation tissue develops
- > 3-5 days after wounding
What does second intention healing mean in wound management?
- Healing by contraction/epithelialization (Ex: no surgery)
- Open wound management
What pathogen is the #1 cause of nosocomial infection in vet med?
MRSP (MRSA in human med)
_________ is a newer disinfectant that is green, safe, and effective against MRSP with only a 1 minute contact time
Accelerated hydrogen peroxides (AHP)
As soon as a patient comes in with any wound regardless of cause, what is the first thing that should be done to prevent nosocomial contamination?
Put a bandage over ALL wounds on entry to hospital
How is a wound site aseptically clipped and scrubbed?
- Protect wound by applying sterile lube or saline soaked sponges
- WIDELY clip area
- Chlorhexidine scrub AROUND the wound not in the wound
After the wound area is clipped and scrubbed, what is done next?
LAVAGEEE
What solutions can be used as lavage solutions?
- LRS / 0.9% NaCl
- 0.05% Chlorhexidine solution (NOT SCRUB)
- 0.1% iodine solution
- Tap water
The addition of ____ mLs of 2% Chlorhexidine solution to a 1L bag of sterile saline will produce a solution of 0.05%
25 mLs
( 0.05% x 1000 mL / 2% = 25mLs)
____% Chlorhexidine solution can be used to lavage a wound
0.05%
____% povidone-iodine solution can be used to lavage a wound
0.1%
What is a concern when using chlorhexidine solution to lavage a wound?
Corneal toxicity - don’t use need the eyes!!!
When would povidone-iodine be preferred over chlorhexidine solution when lavaging a wound?
If wound is close to the eyes use iodine
What is the ideal pressure used to lavage a wound, and how can this best be accomplished?
7-8 psi
place 1L bag of saline solution in a pressure bag at cuff pressure of 300 mmHg
GOLD STANDARD technique for lavaging a wound
What is the consequence of lavaging a wound at higher than recommended pressures?
Could cause barotrauma to wound, detrimental to surrounding tissue, forces bacT deeper into wound
What is the consequence of lavaging a wound at lower than recommended pressures?
Can reduce bacterial contamination but not great at REMOVING bacteria and foreign material
True or False: The size of the needle matters when lavaging a wound
FALSE (pressure does tho)
During which stage of wound management should a culture sample be collected?
- Clip, clean, and lavage wound before culture
- Culture after debridement for best sample
- If antimicrobial flush solutions are used, collect sample before to avoid false results
After collecting a culture sample, what indicates ABX should be started?
- If significant contamination suspected
- If muscle/fascia are disturbed
- If animal is immunocompromised
- If evidence of established local/systemic infection
True or False: Pus, exudate, eschar, of heavily fibrous tissue are good samples to collect for culture
FALSE
True or False: Culture the healthiest looking tissue within the wound bed
TRUE
Pending culture results, what is the ABX of choice to start for wound management?
Clavulanic acid
What topical ABX are available for use when managing and treating a wound?
- Triple AB ointment (TAB)
- Silver sulfadiazine
What topical antibiotic is the drug of choice to treat burn wounds?
Silver sulfadiazine (1% cream)
Which of the following topical antibiotic should be used if suspect of pseudomonas spp?
A. Triple AB ointment (TAB)
B. Silver sulfadiazine
B. Silver sulfadiazine
Which bacterial organism causes a yellow-green color change to bandages places over a wound?
pseudomonas spp.
(also produces a grape or tortilla like odor to the bandage)
Debridement is the process of removing dead/damaged tissue. This can be removed by the following mechanisms: List them.
- Surgical excision (Layered vs En bloc)
- Autolytic mechanisms
- Enzymes
- Wet to dry bandages
- Biosurgical methods
What is the main concern when using surgical excision to debride a wound?
Possibility of removing excessive amount of viable tissue
(Avoid excessive debridement of SQ in cats - can delay wound healing)
What is autolytic debridement?
Creating a moist environment to allow endogenous enzymes to dissolve dead tissue
highly selective for devitalized tissue ONLY
Accomplished using hydrophilic, occlusive/semi-occlusive bandages
What is biosurgical debridement?
- Using maggot therapy
- Best for necrotic, infected, or chronic non healing wounds
