Problem wounds and drains Flashcards
What are the patient factors that affect wound healing?
- poor nutrition/ malnourishment
- Concurrent disease
- Immunosuppressive drugs/ chemotherapy
- Wound interference
- Cats take longer than dogs
What are the wound factors that affect wound healing?
- Blood Supply
- Infection/ Contamination
- Perfusion
- Tissue variability
- Neoplasia
What factors lead to disrupted wounds?
- Wound tension
- Infection
- Haematoma or seroma
- Suturing nonviable tissue
- Wound molestation
What are halsteads 7 principles?
- Gentle tissue handling
- Meticulous haemostasis
- Preservation of blood supply
- Strict aseptic technique
- Tension free closure
- Accure apposition of tissues
- Eliminate dead space
How do you prevent decubital ulcers?
- Turn recumbant dogs every 1-4 hours
- Meticulous nursing
- Treat underlying condition
- Relieve pressure (donut dressing, splints)
How do you prevent bandage sores?
- Proper bandage placement and monitoring
- Careful padding over bony prominences
- care with rigid fixation
What are the common entry points of foreign bodies and penetrating wounds?
- Interdigital
- Ear canal
- Conjunctiva
- Oropharynx
What does the cat bite abscess look like?
- Puncture wounds
- Clinical infection in the majority of cases
How does a cat bite abscess present?
- Rapid occuring swelling
- Ruptured/ burst and presented for wound
- Systemically unwell
- Lameness, not using the limb/ tail
- May occur in areas where it is difficult to get drainage naturally
How do you treat abscessation?
- Antibiotics do not penetrate pus
- lance, drain, flush, place drain
what bacteria may be found in a cat bite abscess
- pasteurella
- staph
- strep
What is an acute oropharyngeal penetrating trauma?
- within 7 days of presentation
- oral pain, dysphagia and dyspnoea, submandibular and cervical swelling, abscesses, pain
on opening of the mouth, - pyrexia
- Injury observed or knowledge of stick catching/carrying
What is a chronic oropharyngeal penetrating trauma?
> 7 days before presentation
* more common
* systemically well
* recurrent cervical or submandibular swelling or discharging sinus
What is the purpose of surgical drains?
- Tissue apposition and obliteration of dead space
- Removes fluid that provides media for bacterial growth
- Relieves pressure that can affect tissue perfusion
- Removes inflammatory mediators, bacteria, necrotic tissue, foreign material
Drains themselves incite an inflammatory response
What are open passive drains?
- Penrose
- Capillary action
- Gravity
- Drainage along the outside of tube
- High surface area to volume ratio
- Fenestration contraindicated
What is the advantage to a penrose drain?
- Inexpensive
- Soft/Malleable
- Low tissue trauma
What is the disadvantage to a penrose drain?
- Cannot quantify fluid production
- Not useful when large volume drainage is required
- Requires gravity
- Cannot use in the thoracic cavity
- More risk of ascending infection
How do you place a penrose drain?
- Proximal end placed deep in the wound/ dead space
- Exit via a stab incision adjacent to the wound
- Distal end secured to skin with single SI suture through the drain
- Cover with dressing
- Must not exit through the incision
- Do not use for flushing
- Need to clean regularly
How does a closed suction drain work?
- Tubing and suction device/ vaccuum
- Fenestrations
- Airtight cavity
- Less risk of contamination
What is the advantage of an active closed suction drain?
- More effective fluid removal
- Reduced risk of ascending infection
- Easily portable
- Doesnt require a lot of dressing
- Can collect and record fluid
- Constant suction decreases occlusion
What is the disadvantage of an active closed suction drain?
- Loss of vaccuum if wound is not airtight
- Occlusion by clots
- Premature removal by patients
- Often requires a buster collar
How do you place a closed suction drain?
- Inside to outside
- Choose a drain exit site
- Tunnel to site with forceps
- Incise skin over forceps
- Grasp tubing from inside wound and pull outwards with forceps
- Fenestarted portion of tubing should be dependent
- Purse string suture and finger trap
- Attach grenade
How do you activate stuction in a drain?
- Wait 4-6 hours post op
- Compress the grenade with evacuation port open
- Release compression to create negative pressure
- Cover the exit site with adhesive bandaging
*
How do you maintain an active suction drain?
- Monitor and record fluid
- Empty drain at least once daily or when it is half full
How do you remove a passive drain?
- when fluid production has slowed or hasn’t changed for several days
- ~2-5 days
- if ingress/egress then cut one end prior to pulling the drain to avoid contaminating the wound
- If there is an anchoring suture, this is cut and the drain pulled out in one smooth motion
How do you remove an active drain?
- when fluid production is <2-4 mls/kg/24hr
- most 2-5 days but can be longer
- Cutting finger-trap and gently remove
- Measure the drain to ensure complete
- Leave exit hole to heal by 2nd intention
When is ingress/ egress drain replacement used?
- To be used in inguinal or axillary region
- To prevent suction drawing bacteria into drain
- To remove pull one end slightly out and cut the ‘dirty’ end off (using gloved
hands) - Let the freshly cut end go back into the wound
- Pull the full drain out by the remaining piece sticking out
Name 4 complications of drains
- Increased risk of wound contamination
- Patient interference
- Drainage failure
- Potential for neoplasia seeding
What is a bivalve cast
Cast that has been split into two-
helps relieve pressure
How will paw pad wounds eventually heal?
- Heal by granulation
- Owner needs to tolerate socks/ bandages to keep the wound clean
What does an acute oropharyngeal trauma look like?
within 7 days of presentation
* oral pain, dysphagia and dyspnoea, submandibular and cervical swelling, abscesses, pain
on opening of the mouth,
* pyrexia
* Injury observed or knowledge of stick catching/carrying
What does a chronic oropharyngeal trauma look like?
> 7 days before presentation
* more common
* systemically well
* recurrent cervical or submandibular swelling or discharging sinus
How would you diagnose an acute oropharyngeal stick injury?
Examination of oral cavity and pharynx
* Identify site of injury and retrieve foreign material
* Cervical and thoracic radiographs
* Soft tissue swelling, loss of detail, gas between tissue planes/ subcutaneously
* Pneumomediastinum if oesophageal perforation
* To prevent chronic fistuloustracts surgically explore via ventral midline approach, inspect dorsal
* oesophagus for tears
How would you diagnose a chronic oropharyngeal stick injury
recurrent cervical swellings and discharging sinuses
* original injury often unknown
* difficult to treat
* meticulous exploration of tracts and debridement of all diseased tissue
* remove all the diseased tissue and hopefully the foreign material with it
When should you remove a passive drain?
when fluid production has slowed or hasn’t changed for several days
* ~2-5 days
* if ingress/egress then cut one end prior to pulling the drain to avoid contaminating the wound
* If there is an anchoring suture, this is cut and the drain pulled out in one smooth motion
When should you remove an active drain?
when fluid production is <2-4 mls/kg/24hr
* most 2-5 days but can be longer
* Cutting finger-trap and gently remove
* Measure the drain to ensure complete
* Leave exit hole to heal by 2nd intention
