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VMS 3010 > Problem wounds and drains > Flashcards

Problem wounds and drains Flashcards

1
Q

What are the patient factors that affect wound healing?

A
  • poor nutrition/ malnourishment
  • Concurrent disease
  • Immunosuppressive drugs/ chemotherapy
  • Wound interference
  • Cats take longer than dogs
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2
Q

What are the wound factors that affect wound healing?

A
  • Blood Supply
  • Infection/ Contamination
  • Perfusion
  • Tissue variability
  • Neoplasia
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3
Q

What factors lead to disrupted wounds?

A
  • Wound tension
  • Infection
  • Haematoma or seroma
  • Suturing nonviable tissue
  • Wound molestation
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4
Q

What are halsteads 7 principles?

A
  • Gentle tissue handling
  • Meticulous haemostasis
  • Preservation of blood supply
  • Strict aseptic technique
  • Tension free closure
  • Accure apposition of tissues
  • Eliminate dead space
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5
Q

How do you prevent decubital ulcers?

A
  • Turn recumbant dogs every 1-4 hours
  • Meticulous nursing
  • Treat underlying condition
  • Relieve pressure (donut dressing, splints)
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6
Q

How do you prevent bandage sores?

A
  • Proper bandage placement and monitoring
  • Careful padding over bony prominences
  • care with rigid fixation
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7
Q

What are the common entry points of foreign bodies and penetrating wounds?

A
  • Interdigital
  • Ear canal
  • Conjunctiva
  • Oropharynx
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8
Q

What does the cat bite abscess look like?

A
  • Puncture wounds
  • Clinical infection in the majority of cases
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9
Q

How does a cat bite abscess present?

A
  • 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
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10
Q

How do you treat abscessation?

A
  • Antibiotics do not penetrate pus
  • lance, drain, flush, place drain
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11
Q

what bacteria may be found in a cat bite abscess

A
  • pasteurella
  • staph
  • strep
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12
Q

What is an acute oropharyngeal penetrating trauma?

A
  • 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
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13
Q

What is a chronic oropharyngeal penetrating trauma?

A

> 7 days before presentation
* more common
* systemically well
* recurrent cervical or submandibular swelling or discharging sinus

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14
Q

What is the purpose of surgical drains?

A
  • 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

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15
Q

What are open passive drains?

A
  • Penrose
  • Capillary action
  • Gravity
  • Drainage along the outside of tube
  • High surface area to volume ratio
  • Fenestration contraindicated
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16
Q

What is the advantage to a penrose drain?

A
  • Inexpensive
  • Soft/Malleable
  • Low tissue trauma
17
Q

What is the disadvantage to a penrose drain?

A
  • 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
18
Q

How do you place a penrose drain?

A
  • 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
19
Q

How does a closed suction drain work?

A
  • Tubing and suction device/ vaccuum
  • Fenestrations
  • Airtight cavity
  • Less risk of contamination
20
Q

What is the advantage of an active closed suction drain?

A
  • 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
21
Q

What is the disadvantage of an active closed suction drain?

A
  • Loss of vaccuum if wound is not airtight
  • Occlusion by clots
  • Premature removal by patients
  • Often requires a buster collar
22
Q

How do you place a closed suction drain?

A
  • 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
23
Q

How do you activate stuction in a drain?

A
  • 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
    *
24
Q

How do you maintain an active suction drain?

A
  • Monitor and record fluid
  • Empty drain at least once daily or when it is half full
25
Q

How do you remove a passive drain?

A
  • 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
26
Q

How do you remove an active drain?

A
  • 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
27
Q

When is ingress/ egress drain replacement used?

A
  • 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
28
Q

Name 4 complications of drains

A
  • Increased risk of wound contamination
  • Patient interference
  • Drainage failure
  • Potential for neoplasia seeding
29
Q

What is a bivalve cast

A

Cast that has been split into two-
helps relieve pressure

30
Q

How will paw pad wounds eventually heal?

A
  • Heal by granulation
  • Owner needs to tolerate socks/ bandages to keep the wound clean
31
Q

What does an acute oropharyngeal trauma look like?

A

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

32
Q

What does a chronic oropharyngeal trauma look like?

A

> 7 days before presentation
* more common
* systemically well
* recurrent cervical or submandibular swelling or discharging sinus

33
Q

How would you diagnose an acute oropharyngeal stick injury?

A

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

34
Q

How would you diagnose a chronic oropharyngeal stick injury

A

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

35
Q

When should you remove a passive drain?

A

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

36
Q

When should you remove an active drain?

A

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

37
Q
A

VMS 3010 (102 decks)

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