Open Wound Management

Question 1

in which region of the body do we have increased epithelialization and wound contraction?

Answer 1

axial region

Question 2

in which region of the body do we have increased risk of infection and dehiscence?

Answer 2

appendicular region

Question 3

what are some challenges with equine wound healing?

Answer 3

exuberant granulation tissue
wound expansion

Question 4

what is a difference between horses and ponies with wound healing?

Answer 4

ponies have quicker, more robust inflammatory response: more resistant to infection and better wound contraction

Question 5

how can we classify wounds?

Answer 5

type
thickness
contamination

Question 6

what is a partial thickness wound?

Answer 6

limited to epidermis and dermis
do not penetrate subcutaneous tissue

Question 7

what thickness do abrasions have?

Answer 7

partial

Question 8

what thickness do lacerations have?

Answer 8

partial or full

Question 9

what thickness do avulsions have?

Answer 9

full

Question 10

what causes avulsions?

Answer 10

tissue torn from underlying attachments

Question 11

what is the cause of a puncture?

Answer 11

penetration of sharp object into tissues

Question 12

what is the tissue damage in punctures proportional to?

Answer 12

object velocity

Question 13

for crush wounds, is skin lost at the time of injury?

Answer 13

no

Question 14

when does the extent of the injury in crush wounds become apparent?

Answer 14

may not be apparent for several days

Question 15

what is the thickness of burn wounds?

Answer 15

partial or full

Question 16

what does it mean for a wound to be contaminated?

Answer 16

microorganisms are present but are not replicating

Question 17

what does it mean for a wound to be colonized?

Answer 17

microorganisms are present and replicating but there is not injury to the host

Question 18

what does it mean for a wound to be infected?

Answer 18

microorganisms are present and replicating and there is injury to the host

Question 19

how many organisms per gram of tissue do infected wounds have?

Answer 19

> 10^5 organisms

Question 20

what are some causes of dehiscence?

Answer 20

tension
motion
continued devitalization
infection

Question 21

what is dehiscence?

Answer 21

failure of a repaired wound

Question 22

when does dehiscence occur?

Answer 22

begins at about 5 days after a repair

Question 23

if dehiscence occurs, what should you do?

Answer 23

pursue open wound management

Question 24

what does moist wound healing optimize?

Answer 24

second intention healing

Question 25

what are two big picture things that moist wound healing decreases?

Answer 25

morbidity
cost

Question 26

what should you do when evaluating a wound?

Answer 26

sedation/anesthesia as needed
local anesthesia helpful in large animal
diagnostic imaging
+/- culture

Question 27

what diagnostic imaging can be helpful for evaluating a wound?

Answer 27

radiographs (plain or contrast fistulogram)
ultrasound

Question 28

how do you aseptically prepare a wound?

Answer 28

water-soluble sterile lubricant in wound
clip wide area of hair around wound
prepare skin around wound: antiseptic then saline
drape after

Question 29

what is lavage dependent on?

Answer 29

pressure and volume

Question 30

in what wounds should you use lavage?

Answer 30

all wounds

Question 31

what is debridement?

Answer 31

physical removal of necrotic tissue, foreign material, and microorganisms

Question 32

what are the types of debridement?

Answer 32

surgical
autolytic
enzymatic
bandage
biologic

Question 33

what should you limit your debridement to?

Answer 33

grossly necrotic tissue and debris

Question 34

how does bandage debridement work?

Answer 34

dressing absorbs fluid and adheres to fibrin as it dries
removes debris as bandage is changed

Question 35

what are some disadvantages of bandage debridement?

Answer 35

non-specific: removes healthy cells and beneficial wound fluid
opposes moist wound healing
painful

Question 36

what does autolytic debridement rely on?

Answer 36

moist wound environment

Question 37

what is applied in enzymatic debridement?

Answer 37

exogenous protease enzymes

Question 38

what are the indications for enzymatic debridement?

Answer 38

poor anesthetic candidate
surgical debridement could damage vital structures
stimulate healing in chronic/indolent wounds (horses)

Question 39

what is used in biosurgical debridement?

Answer 39

freshly-emerged sterile larvae of the common green bottle-fly

Question 40

what are the uses of biosurgical debridement?

Answer 40

multi-drug resistant infections
large animal patients

Question 41

when should you not use nitrofurazone?

Answer 41

proliferative and repair phases

Question 42

what does aloe vera stimulate?

Answer 42

fibroplasia

Question 43

what are the uses of the primary layer of a bandage?

Answer 43

debridement
deliver topical medication
absorb wound exudate
promote wound healing
barrier to bacteria

Question 44

what are interactive dressings?

Answer 44

dressings that promote wound healing and affect the wound environment

Question 45

what are the types of adherent dressings?

Answer 45

dry to dry
wet to dry

Question 46

what are the advantages of nonadherent dressings?

Answer 46

promote moist wound environment
painless to remove
less frequent bandage changes
many options

Question 47

what do semi-occlusive nonadherent dressings allow?

Answer 47

excess fluid to drain

Question 48

when are polyurethane dressings used?

Answer 48

exudative wounds during inflammatory phase
wounds in repair phase

Question 49

when should you not use occlusive nonadherent dressings?

Answer 49

infected wounds