Open Wound Management Flashcards
in which region of the body do we have increased epithelialization and wound contraction?
axial region
in which region of the body do we have increased risk of infection and dehiscence?
appendicular region
what are some challenges with equine wound healing?
exuberant granulation tissue
wound expansion
what is a difference between horses and ponies with wound healing?
ponies have quicker, more robust inflammatory response: more resistant to infection and better wound contraction
how can we classify wounds?
type
thickness
contamination
what is a partial thickness wound?
limited to epidermis and dermis
do not penetrate subcutaneous tissue
what thickness do abrasions have?
partial
what thickness do lacerations have?
partial or full
what thickness do avulsions have?
full
what causes avulsions?
tissue torn from underlying attachments
what is the cause of a puncture?
penetration of sharp object into tissues
what is the tissue damage in punctures proportional to?
object velocity
for crush wounds, is skin lost at the time of injury?
no
when does the extent of the injury in crush wounds become apparent?
may not be apparent for several days
what is the thickness of burn wounds?
partial or full
what does it mean for a wound to be contaminated?
microorganisms are present but are not replicating
what does it mean for a wound to be colonized?
microorganisms are present and replicating but there is not injury to the host
what does it mean for a wound to be infected?
microorganisms are present and replicating and there is injury to the host
how many organisms per gram of tissue do infected wounds have?
> 10^5 organisms
what are some causes of dehiscence?
tension
motion
continued devitalization
infection
what is dehiscence?
failure of a repaired wound
when does dehiscence occur?
begins at about 5 days after a repair
if dehiscence occurs, what should you do?
pursue open wound management
what does moist wound healing optimize?
second intention healing
what are two big picture things that moist wound healing decreases?
morbidity
cost
what should you do when evaluating a wound?
sedation/anesthesia as needed
local anesthesia helpful in large animal
diagnostic imaging
+/- culture
what diagnostic imaging can be helpful for evaluating a wound?
radiographs (plain or contrast fistulogram)
ultrasound
how do you aseptically prepare a wound?
water-soluble sterile lubricant in wound
clip wide area of hair around wound
prepare skin around wound: antiseptic then saline
drape after
what is lavage dependent on?
pressure and volume
in what wounds should you use lavage?
all wounds
what is debridement?
physical removal of necrotic tissue, foreign material, and microorganisms
what are the types of debridement?
surgical
autolytic
enzymatic
bandage
biologic
what should you limit your debridement to?
grossly necrotic tissue and debris
how does bandage debridement work?
dressing absorbs fluid and adheres to fibrin as it dries
removes debris as bandage is changed
what are some disadvantages of bandage debridement?
non-specific: removes healthy cells and beneficial wound fluid
opposes moist wound healing
painful
what does autolytic debridement rely on?
moist wound environment
what is applied in enzymatic debridement?
exogenous protease enzymes
what are the indications for enzymatic debridement?
poor anesthetic candidate
surgical debridement could damage vital structures
stimulate healing in chronic/indolent wounds (horses)
what is used in biosurgical debridement?
freshly-emerged sterile larvae of the common green bottle-fly
what are the uses of biosurgical debridement?
multi-drug resistant infections
large animal patients
when should you not use nitrofurazone?
proliferative and repair phases
what does aloe vera stimulate?
fibroplasia
what are the uses of the primary layer of a bandage?
debridement
deliver topical medication
absorb wound exudate
promote wound healing
barrier to bacteria
what are interactive dressings?
dressings that promote wound healing and affect the wound environment
what are the types of adherent dressings?
dry to dry
wet to dry
what are the advantages of nonadherent dressings?
promote moist wound environment
painless to remove
less frequent bandage changes
many options
what do semi-occlusive nonadherent dressings allow?
excess fluid to drain
when are polyurethane dressings used?
exudative wounds during inflammatory phase
wounds in repair phase
when should you not use occlusive nonadherent dressings?
infected wounds
