questions Flashcards
All the following except one are important surgical principles used to avoid impaired wound repair (select the INCORRECT technique/action which you would want to avoid). When debriding a wound:
Perform a thorough debridement and remove all foreign material
Be meticulous with hemostasis to avoid hematoma and seroma formation without compromising vascular supply
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
Minimize tension (mechanical stress) on wound edges
Minimize dead space
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
With regard to wound debridement, which is FALSE?
Autolytic wound debridement is accomplished by providing a moist wound environment, which allows wound fluid containing endogenous enzymes and growth factors to remain in contact with the wound
An advantage of biosurgical debridement (medicinal maggot application) is that when used appropriately it is capable of both removing necrotic tissue and stimulating granulation tissue formation
The use of scissors is preferred to scalpel during surgical debridement
Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin
The use of scissors is preferred to scalpel during surgical debridement (scalpel preferred!)
Which is TRUE regarding the development of wound healing complications?
Any degree of contamination with microorganisms will lead to development of chronic wound
Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management
Wound contraction never leads to contracture
Geriatric patients and young puppies are equally susceptible to wound healing complications
Bandages and splints should always be avoided due to concern that they may compromise vascular supply
Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management
Regarding epithelialization, which is FALSE?
In partial thickness wounds, the process begins almost immediately from wound margins and existing epidermal appendages
Is inhibited by a moist, sterile environment
Occurs along suture tracts and can cause/incite inflammatory reaction if sutures are not removed in an appropriate time frame
Is independent of wound contraction
Central scar epithelium is thinner and more fragile than normal epithelium
Is inhibited by a moist, sterile environment (epithelial migration facilitated by moist, sterile environment)
Which of the following is FALSE regarding epithelialization of wounds?
In partial thickness wounds, re-epithelialization may occur both from the wound edges as well as from existing epidermal appendages
Re-epithelialization is dependent on contraction
Epithelialization may occur along suture tracks with subsequent keratinization
Keratinocyte migration ceases due to contact inhibition
Re-epithelialization may be incomplete in large wounds
Re-epithelialization is dependent on contraction (epithelialization independent of contraction!)
Which is INCORRECT regarding angiogenesis during wound repair?
The earliest phase involves endothelial cell migration rather than cell division
It is initially stimulated by low oxygen tension
Capillary loops are initially open but are replaced by closed arcades
It is stimulated by a variety of cytokines including basic FGF and VEGF
Occurs in the epithelial layer
Occurs in the epithelial layer
With regard to wound strength and extracellular matrix deposition in the wound, which is FALSE?
The greatest change in wound strength occurs in the repair/proliferative phase
If given long enough (years), a wound will eventually attain preinjury strength
The ratio of Types III:I collagen decreases over time
Orientation of wound fibers is originally vertical but the orientation changes to horizontal in response to tension
The provisional wound matrix is comprised of fibrin, fibronectin, and hyaluronic acid
If given long enough (years), a wound will eventually attain preinjury strength
Which cell type is NOT found in granulation tissue?
Vascular endothelial cells
Myofibroblasts
Macrophages
Keratinocytes
Fibroblasts
Keratinocytes
Which of the following statements regarding granulation tissue is FALSE?
It protects the wound bed (provides coverage)
It provides a barrier for infection
It typically begins to appear approx 3-5 days post wounding
It appears as a thin, pale tan tissue in the wound
It provides a scaffold for epithelial cell (keratinocyte) migration
It appears as a thin, pale tan tissue in the wound (red, shiny, fleshy)
Which is INCORRECT regarding the inflammatory/debridement phase of wound repair>
Occurs after granulation tissue has filled the wound bed
Corresponds to the lag phase of wound repair
Macrophages, platelets, mast cells, and eosinophils are all cells that migrate into the wound bed during this phase and secrete substances which promote later angiogenesis during the repair process
Vasodilation follows initial vasoconstriction during the vascular phase
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
Occurs after granulation tissue has filled the wound bed (inflammatory phase first)
Identify the TRUE statement regarding the inflammatory/debridement phase of wound repair:
Occurs after granulation tissue has filled the wound bed (happens first)
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
Corresponds to the log phase of wound repair because of significant increase in wound strength attained during this phase (repair/proliferative phase = log phase)
Vasoconstriction follows initial vasodilation during the vascular phase (initial vasocontriction followed by vasodilation)
None of the above
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
With respect to the hypodermis and cutaneous circulation, which of the following statements is true?
The cutaneous circulation in the dog is identical to that found in people
In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus
The middle and superficial plexi lie within the epidermis
Capillary loops of the subpapillary/superficial plexi are better developed in dogs and cats compared to primates and pigs
The hypodermis is considered the deepest layer of skin but does not contribute significantly to skin function
In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus (must go between the subdermal plexus/panniculus muscle and the underlying skeletal muscle)
All the following except one are important surgical principles used to avoid impaired wound repair (select the INCORRECT technique/action which you would want to avoid). When debriding a wound:
Perform a thorough debridement and remove all foreign material
Be meticulous with hemostasis to avoid hematoma and seroma formation without compromising vascular supply
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
Minimize tension (mechanical stress) on wound edges
Minimize dead space
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
With regard to wound debridement, which is FALSE?
Autolytic wound debridement is accomplished by providing a moist wound environment, which allows wound fluid containing endogenous enzymes and growth factors to remain in contact with the wound
An advantage of biosurgical debridement (medicinal maggot application) is that when used appropriately it is capable of both removing necrotic tissue and stimulating granulation tissue formation
The use of scissors is preferred to scalpel during surgical debridement
Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin
A significant disadvantage of mechanical (bandage) debridement is that it traumatizes healthy tissue (is non-selective)
The use of scissors is preferred to scalpel during surgical debridement (scalpel preferred!)
A dog with a common bile duct obstruction that needs surgery:
a.
Should be anesthetized with drugs metabolized by the liver
b.
Requires only a complete blood count before the procedure
C.
Is not a candidate for general anesthesia
d. Should have coagulation screen before surgery
e. Should not be given vitamin K before surgery.
d. Should have coagulation screen before surgery
