Principles of wound healing 2

Question 1

Describe an abrasion erosion?

Answer 1

• superficial loss of the surface epithelium without exposure to the underlying dermis and submucosa
• heal by mitotic division
• no need for inflammatory cells, capillaries or contraction

Question 2

Give examples of open wounds

Answer 2

• surgical incision
• laceration
• degloving
• burn
• pressure sore
• puncture

Question 3

Give examples of closed wounds

Answer 3

• Bruising
• Haematoma
• Crush injury

Question 4

Describe an ulcer

Answer 4

Complete loss of surface epithelium with exposure and damage to the underlying tissue

Question 5

Describe a contusion

Answer 5

• Damage occurs primarily to the sub-epithelial tissues

- Produces a characteristic bruise

Question 6

Describe a laceration

Answer 6

Combination of tissue damage and loss extending to any depth below the epithelium

Question 7

How are burns catagorised?

Answer 7

• Type: thermal, chemical, electrical
• Depth: 1st/2nd/3rd/4th degree
• Extent: % total body surface area affected

Question 8

What questions need to be asked in initial wound assessment?

Answer 8

• full medical history
• when did the injury occur
• when was the animal last seen to be normal
• did the owner see the animal sustain the injury
• how did it occur?

Question 9

What are the initial steps of first aid when there is a wound?

Answer 9

• apply pressure if there is haemorrhage
• clinical exam to check no other injuries have been missed
• check cardiovascular status

Question 10

How should an initial wound assessment be carried out?

Answer 10

• Apply sterile gel and clip the wound and around it
• Remove the gel gently and surgically prepare the surrounding skin with antiseptic containing detergent e.g. chlorhexidine, povidone iodine
• Lavage with sterile saline to remove dirt and reduce bacteria

Question 11

Which factors of the wound should be considered/noted in the assessment?

Answer 11

• Location
• Depth
• Direction
• Severity
• Injury to other structures

Question 12

What is the golden period in wound healing?

Answer 12

Maximum of 3-5 hours after injury before bacteria reach a critical level

Question 13

How can bacteria in a wound be treated?

Answer 13

• Flushing and debridement

- Systemic antibiotics

Question 14

Which bacteria needs to be considered in horses with wounds?

Answer 14

Tetanus

- need to make sure the horse is fully vaccinated otherwise they must be given a tetanus antitoxin and vaccination

Question 15

Describe the 3 main steps of surgical management of contaminated and infected wounds

Answer 15

• Lavage: dilution is the solution
• Debridement: get rid of the dead
• Wound closure: decide if suitable for primary / second intention healing

Question 16

What is first intention, primary closure?

Answer 16

Wound is closed immediately and completely using strict aseptic technique

Question 17

What conditions are required for wounds to heal by first intention?

Answer 17

• Minimal bacterial contamination
• Devitalised tissues, foreign bodies and blood clots have been removed through debridement
• No dead space / ischaemia / haematomas

Question 18

What is second intention wound healing?

Answer 18

Occurs when a wound cannot heal by first intention: Infection, severe soft tissue damage
- Regular wound care required (Dressings, bandaging & debridement)

Question 19

What is third intention wound healing?

Answer 19

• Delayed primary closure
• The wound is treated initially as an open wound: allows tissue debridement and reduces bacterial contamination
• The wound is then closed and allowed to heal by primary intention

Question 20

What is involved in the aftercare of surgical wounds?

Answer 20

• Antibiotics: may or may not be required
• NSAIDs: reduce inflammation & provide analgesia
• +/- application of devices to prevent self-trauma e.g. buster collar
• Patients may require rest e.g. lead walking exercise only / stable rest
• Skin sutures generally removed 10-14 days post-surgery