Principles and Management of Wound Healing Flashcards
t/f: you can use chlorohexidine scrub on a wound
F, don’t use scrub its cytotoxic
a horse comes in with a laceration to the lower limb and its toe is off the ground, what structure is involved?
deep digital flexor tendon -> bad prognosis
how should you determine synovial involvement?
obtain a fluid sample for culture and analysis then while the needle is still in synovial structure distend it with contrast, take a rad then distend with sterile saline watching for fluid
acute inflammatory phase
prepares wound for repair with vascular and cellular responses
proliferative phase
characterized by granulation tissue with macrophages, fibroblasts, and new blood vessels. Epithelialization is visible in 4-6 days with the greatest rate of connective tissue accumulation is 7 to 14 days.
remodeling phase
Equilibrium between collagen and destruction. Collagen realignment and cross linking and increased tensile strength occur. It continues for up to 2 years
what might cause delayed wound healing
infection, movement, cell transformation, foreign body/necrotic tissue
delayed primary closure
Initially you treat it as an open would and then do primary closure after 2-4 days. This method has mild/moderate bacterial contamination, minimal tissue loss and minimal tension.
Second intention healing
This is for instances of gross contamination where you let the wound heal via contraction, granulation and epithelialization. The moist wound exudate left in contact with the wound contains cells, enzymes, growth factors, and chemotactic factors.
Extensor tendon lacerations have a __ prognosis while flexor tendon lacerations have a __ prognosis.
Extensor tendon lacerations have a good prognosis while flexor tendon lacerations have a guarded prognosis.
regional antibiotic delivery
administered intravenous, intra-articular or intraosseous at very high concentrations while avoiding systemic toxicity
Graft Physiology timeline
3-4 days: fibroblast migration into graft to form adhesions
9-10 days: graft firmly attached via fibrous adhesions and vessels entering graft
3-4 weeks: ring of epithelium visible
42-56 days: hair growth
what are some causes of graft failure?
- poor recipient bed preparation
- poor graft harvesting technique
- infection
- movement
- hematoma/seroma
- wound exudate
- poor blood supply to graft bed
- tumor transformation
types of island grafts
tunnel, punch and pinch
how should the recipient bed be prepared for a skin graft?
it should be smooth with no infection, no necrotic tissue and bleeds readily
donor site preparation for skin graft
Clip, surgical prep, local anesthesia, rinse with saline (remove residues)
T/F: grafts are tenuous for the first 10 days or more so you should be careful with bandage changes -minimize
T
which type of grafts are the easiest and can be done in the field?
pinch grafts
when should you trim granulation tissue for a graft?
do the day before graftings, otherwise theres too much blood
