small principles of wound healing and management

Question 1

name the 5 types of common wounds in small animal practice

Answer 1

• Abrasion
• Avulsion
• Incision
• Laceration
• Puncture

Question 2

define abrasion, and give an example

Answer 2

loss of epidermis and some dermis - blunt trauma/ shearing

Question 3

define avulsion, and give an example

Answer 3

tearing of tissue from attachments (no loss of skin):
on limbs - degloving injury

Question 4

define incision

Answer 4

created by sharp object - minimal trauma

Question 5

define laceration

Answer 5

tearing of wound creating irregular defect

Question 6

define puncture

Answer 6

penetrating wound
- superficial damage may be minimal
- deep damage may be substantial

Question 7

what is the blood supply ot the skin?

Answer 7

epidemis, dermis and hypogdermis are vascularised via the subdermal plexus
the dermis is supplied by termial branches of direct cutaneous supply that sits withing the panniculus and subcutis

Question 8

what is the implication of the subdermal plexus in surgery?

Answer 8

need to be aware of its location when moving the skin and hypodermis (cutaneous muscle)

Question 10

what is the first step in wound management

Answer 10

Assessment of the patient
* Other injuries
* Life-threatening complications
* Stabilise
Examine the wound
* Consider the requirement for sedation / local or general anaesthesia

Question 11

state the steps of the wound assesment cascade

Answer 11

• type of wound
• wound age
• level of contamination
• lavage +/- debridement
• management

Question 12

what are you thinking/looking at when you asses the type of wound?

Answer 12

• Degree of tissue damage
• Depth of wound
• Vital structures (bones, joints, nerves, tendons)
• ‘Tip of the iceberg’ (e.g. bite wounds)

Question 13

what are you thinking about when you ask about the wound age?

Answer 13

golden period (6 - 8hours) time untreated effects contamination vs infection

Question 14

what are you thinking/looking at when you consider the level of contamination of a wound?

Answer 14

• Foreign material
• Devitalised tissue
• Bacterial innoculum (bite vs. clean glass)
• Takes into account the age and nature of the wound

Question 15

what are the steps of decontaination/lavage of wounds?

Answer 15

• Gross contamination – tap water
• Then copious sterile Lactated Ringers (Hartmann’s)
• 35ml/60ml syringe, 18G needle = 7-8 psi (higher pressure through needle)
• No added antiseptics

Question 17

how are wounds debrided?

Answer 17

with dressings (to draw our contamiants) or surgical

Question 18

what are the three priciples of wound mangement (think closure)?

Answer 18

• Primary intention (delayed primary intention)
• Second intention healing – takes time…
• Third intention (secondary closure)

Question 19

wound healing

what is primary intention?

Answer 19

close the wound straight away

Question 20

wound healing

what is third intention

Answer 20

dress the wound to allow for debridment and then close it surgically

Question 21

wound healing

what is second intention?

Answer 21

allow the wound to heal on its own with no surgical closure - healing via epithelialsation on contration)

Question 22

why is adressing a wound within 6-8 hours the golden period?

Answer 22

6-12 hours bacteria divide
>12 hours bacterial invasion

Question 23

what factors impact the golden period of wound management?

Answer 23

• vascular supply (reduced ability to fight infection)
• devitalised tissue (increased bacterial growth)
• FB (reduced ability to fight infection)
• type of contamination - soil better than organic debris, clean glass cut vs bite wound
• type of bacteria

Question 24

what are the three goals of wound management?

Answer 24

• promote healing
• convert contaminated to clean
• control infection