Surgery Flashcards
X-ray production
Electrons with high potential from cathode to anode, when they reach the anode an x-ray is produced
Variability in tissues absorption of X-rays- contrast and 2-D image
If more radiation absorbed- whiter– RADIOPAQUE
If more radiation just passed through- darker – RADIOLUCENT
Best quality image if the x-ray beam is perpendicular to the plate
Most radiopaque to most radioluscent
Metal
Bone
Soft tissue, fat, water
gas
KV
Energy of electrons
penetrating ability
mAs
amount of radiation produced over a set time i.e the number of electrons
Contrast
Types of x-rays
Conventional
Computed- phosphor plate
Digital/direct
Indications for taking x-rays
orthopedic:
Lameness
Obvious lesions e.g when there is swelling
Pre-purchase
Non-orthopedic:
Head- teeth and sinuses
Thorax
Abdomen
Basic principles of interpretation- orientate the radiographs in a standard fashion
Dorsal/cranial to the left on laterals
Medial to the left on DP’s (dorsoproximalis)
Left side to the right for head DP’s
What are pyhses?
usually in young horses, separate centres of ossification
Describing lesions
Active: smooth, regular and well-defined
benign, long-standing lesions usually
Estimating how long the lesion has been present
Osteophyte formation- 3 weeks
Incomplete fissure fractures- may take weeks to appear
Bone growth
Wolff’s law- bone models due to the stress applied to it
X-rays detect changes in mineralization- but not the early stages
Increased bone production-
more radiopaque
cortical thickening- e.g bucked shin in race
New bone
Periosteum- on the outside of the bone
Endosteum- on the inside of the bone
From infection, inflamm, neoplasia etc
Sclerosis
Densification– more radiopaque
Often within trabecular pattern
stress- osteomyelitis
protect a weakened area- OCLL
Focal new bone formation
Osteophyte- at edges of articular cartilage and periarticular new bone
Entheseophyte- where tendons, ligaments and joint capsules attach
Sometimes hard to differentiate the 2
Demineralization– general
Thinning of cortices and more obvious trabecular pattern
Radiographic overexposure
Disuse osteopenia- healing of fractured
Demineralization- focal
Chronic prolif synovitis
cysts: subchondral bone cyst, osseous cyst like lesion
Fractures
Location
Complete/incomplete
Displaced/non-displaced
Articular/non-articular
Physitis
growing horses
irregularity between the epiphyseal and metaphyseal margins of growth plate
Soft tissue swelling
(separate centres of ossification)
OCD= osteochondrosis dessecans
developmental disease
stifle and hock
osteochondral fragments
irregular joint surface (flattening) e.g in the fetlock the sagittal ridge of the canon bone
subchondral bone luscent but may be surrounded by increased opacity
secondary remodelling of joint surfaces
Osteoarhtritis
Not to be mixed up with synovitis- no bone involvement, here the bone is involved
Periarticular osteophyte formation, and soft tissue swelling
Subchondral bone lysis/sclerosis– more luscent
Narrowing of joint space
Capsule distension
Osseous cyst like lesions
Contrast radiography
Radiodense material
To check if a wound has travelled to synovia or to check communication between synovial cavities
Standard views for lameness diagnosis
1.LM
Straight limb, beam parallel with heel bulbs, at region of the navicular bone
2.Dpa
Foot on block, pulled forward, horizontal beam at right angle to heel bulbs
3.DPrPaDiO of pedal phalanx
Upright pedal view- hoof wall is vertical on the block
Standing on a block
4. DPrPaDiO of navicular bone
foot slightly pulled forward on the block
5.PaPrPaDiO= skyline of the navicular bone
Standard view for laminitis
LM
Problems associated withe the navicular bone
Along the distal border there are radiolusecnt zones- if these are more pronounced- this is clinically more significant
Modelling at insertion of the CSL
Periarticular new bone formation
Flexor cortex defect
What structures does navicular disease involve
Navicular bursa DDF Distal sesamoidean impar ligament Collateral ligaments of the navicular bone Chondrosesamoidean ligaments
Abnormalities of the distal phalanx
Sagital fracture Parasagital fracture OCLL Keratoma Infectious osteitis
Laminitis
The distal phalanx should be parallel with the dorsal hoof wall
There is rotation/ sinking
Dorsal hoof wall thickness- less than 20mm
Radioluscent line- serum/necrotic tissue
Fractures of the fetlock
- Traumatic/stress: proximal phalanx- short incomplete or sagittal
- Condylar: race and endurance, usually medially
- Prox sesamoid bones: race
- Sesamoiditis- abnormal thickening of vascuclar channels
Problems occurring at the carpus
Sclerosis/ fractures: third carpal bone usually
Osteoarthritis
Osteochondroma
Elbow
Olecranon fracture
Osseous cyst like lesions of the radius
Shoulder
Fracture of greater tubercle of humerus
Fracture of supraglenoid tubercle
Osteoarthritis
Technique for radiographing the neck
From occipital to T1/T2
Rope headcollar
Sedation
Horse standing square, neck has to be 100% straight
Lateral lateral images, take at least 4
Oblique-articular processes of the joints
Common findings of the neck
Caudal cerv vertebra- enlargement of the articular processes
Pain- nerve root compression
ataxia- SC compression- abnormal sagittal diameter ratios
C5-C6 and C6-C7 is very common
Myelography of the neck
Contrast medium into the vertebral canal at the atlantooccipial fissure
Latero-latero and dorso-ventral images
Abnormalities of the fetlock (hindlimb)
OCD Osteoarthritis Deformed sesamoid bone Superchondylar lysis Very low position of the proximal sesamoid bones
Abnormalities of the metatarsal region
normal- almost uniform opacity
Patchy opacity
Marked entheseous reaction
Splint bones are very susceptible- especially IV- kicks!
Sequestrum (piece of bone separated due to necrosis)
Abnormalities of the hock
Frequent cause of hindlimb lameness
Osteoarthritis in distal tarsal joints and tarscocrural joint
Trauma- kicks- especially of lat malleolus
OCD:
-distal intermediate ridge of tibia
-trochlear ridges of tallus (lat>med)
-med malleolus
At sustentaculum tali: septic tenosynovitis of tarsal sheath- new bone formation and sequester formation
Abnormalities of the stifle
OCD- lateral trochlear ridge of the femur
Osteoarthritis- osteophytes
Calcinosis circumseptica
Radiography of the back
Use portable machine, DR system to get the spinous processes
Take 9-11 images
Latero-latero for DSP’s and vertebral bodies
Ventral to dorsal oblique views for articular process joints
What is the most common cause of backpain in the horse?
Impinging “kissing” dorsal spinous processes
Open magnet for the adult horse (MRI)
0.27 tesla where the horse can walk in Bony and soft tissue structures Thin slices in 3D Differences in signal intensity- hypo/hyperintense T1 weighted T2 weighted Fat-supressed
Very time consuming- usually done on the foot
Computer tomography (CT)
“3-D x-ray” uses x-rays to build cross sectional images
Good for neck
Marked based on HU scale (Hounsfield unit) which measures radiodensity
Low density is hypoattenuating:
-air, water– edema and necrosis
High density is hyperattenuating:
-bone, hyperaemia, recent bleeding, contrast
Contrast enhanced CT-
iodine based used to enhance soft tissue lesions and to assess angiogenesis
Contrast arthrography- used because there is such little contrast between soft tissue and cartilage
Scintigraphy
Detection of gamma rays
Tc99m methylene diphosphanate (radiopharmaceutical) binds to hydroxyapatite of the bone but its uptake depends on osteoblastic activity and perfusion
Most NB indication: when suspect stress fractures in racehorses, also exertional rhabdomyolysis
Interpretation: when there is increased uptake it appears dark
Orthopedic US
Lameness
Stronger returning echo- brighter
Weaker returning echo- darker
Linear abdominal macroconvex probes
Clip horse- air
PRP-Platelet rich plasma
Autograft
Centrifuge 2 fractions
Over: thrombocyte and WBC rich
Under: RBC rich
Centrifuge to activate the alphagranules in the thrombocytes- release of growth factors
US of the shoulder
Cranial to caudal scanning
Weightbearing position
5-10MHz
Radiology of the head- techniques
Use tranquilizers Large size cassettes and imaging plates Right and left laterolateral Dorsoventral and ventrodorsal (similar to neck and back) Obliques Collimation, cassetteholder Ropehalter
Radio of cranium
LL: 5cm caud to the orbit
VD: beam centred at the larynx
Obliques: TMJ
Cranium of mature vs young horses
Young still have sutures and a more domed cranium
Mature:
ventrally: TMJs. proc. coronoideus, zygomatic arch
petrous temporal bones
attachment of the nuchal ligament
rostral to the cranial cavity: ethmoid turbinate where the caud part is more opaque, and rostral part is superimposed over the maxillary sinus
dorsal to ethmoid is the frontal sinus
ventral to the ethmoid is the guttural puch, larynx and pharynx
Dentigerous cyst: fluid btw reduced enamel epitherlium and crown of an unerupted tooth
Radio of paranasal sinuses and maxilla
LL: beam halfway btw orbit and opening of infraorbital canal
VD: beam btw ventral rami of mandible, at level of caud border
DV: beam sagittal plane, btw orbit and for. infraorbitale
Significant pathologies of the head
Sinusitis
PEH- proliferative ethmoid hematoma
Cyst
Trauma- fractures
Radio of thorax
High output x-ray unit Leave gap between patient and casette Short exposure Full INspiration LL views: fields- dorsocaud, ventrocaud, dorsocran, ventrocran
Patterns of lung disease
Interstitial Vascular Bronchial Alveolar Cavitary pulmonary lesions Pulmonary masses Pleuropneumonia Pneumothorax Pneumomediastinum Tracheal collapse/ stenosis RAO Pneumonia- eosinophilic, bacterial and aspiration
Vascular lung disease
vessels within the interstitium
changes the shape of pulmonary arteries and veins
congenital heart disease or inflamm lung disease
Radio of the abdomen
US more useful
small- high output portable units
adult- stationary
abd width needs to be 70cm
Foals: LL and VD- because can be in recumbency
Adults: LL in standing: cranioventral, mid-ventral, mid-dorsal and dorsocaud
Diseases of the GIT
that show up on radiograph
SI or LI obstruction Atresia coli Rupture of hollow viscus Sand impaction Enterolithiasis
Radio of the bladder: pneumocystography
- where air is introduced to see if there is air getting into the abdomen
sedation, standing or dorsal recumbency
7mm diameter
5L in adult thoroughbred
Radio of bladder: positive contrast cystography
12ml/kgbw of contrast material
LL and VD’s
Asses the size and position of the bladder
Chemicals causing injuries
Acid- coagulation necrosis
Alkali- colliquation necrosis
also- chemicals
Thermal open injuries: burns
1st degree: erythmetosa
2nd degree: bullosa
3rd degree: escharctica
4th degree: carbonisatio
Thermal injuries: forstbite/congelation
1st degree: ischaemia
2nd degree: thrombus, stasis
3rd degree: cell degen, stopping of circulation, necrosis
Electricity caused injuries
Above 50mA- critical
Above 100mA- always death
Cell degen and coag
inlet and outelt
shock
Depth of wounds
Supf: graze, erosion, abrasion, 2nd healing intention
Deep
Healing stadium of wounds
Regular or irregular
Infected
with complication
Types of wounds
Incised Lacerated Contused Puncture Bite Gunshot
Incised wounds
Sharp objects Minimal tissue damage Edges are linear and smooth Damage to the underlying tissue is only in the incision line Good prognosis, easy to fix
Lacerated wounds
Irregular objects Extensive tissue damage, even loss Edges are irregular Underlying tissue is damaged Poor prognosis On eye- need to make sure that they eye can close--- myiasis
Contused wounds
Dull objects Extensive tissue damage Edges are irregular V painful Extensive damage to underlying tissue Poor prognosis (quite similar to lacerations)
Puncture wounds
Sharp object Supf- point like Deep- channel Can be penetrating or perforating Anaerobe infections!!! Be careful of shoe nails
Bite wounds
Car- puncture
Herb- contused
Gunshot wounds
Inlet- primary necrotisation Channel- necrobiotical zone Outlet- molecular commotional zone Direct effect-bullet wandering Indirect effect- bullet capsulation
Conc dependent antibiotics
aminoglycosides and fluoroquinolones
Ratio of peak plasma conc to MIC should be 10:1 or 12:1
Time dependent antibiotics
Beta-lactams and macrolides
Keep conc above the MIC for a longer period of time
When would we use antibiotics prophylactically
To improve surgical outcome
Should be:
- bactericidal
- produce effective tissue conc at the time of surgery
- should be able to maintain tissue levels
RLP= regional limb perfusion
Distal to tourniquet apply a high conc of AB
For distal limb 30ml, for more prox use a smaller volume
Amikacin often used
Wound healing: regeneration
Replacement with normal cells of the lost tissue
Cells need to then replicate (mitosis)
Epithelium, bone, liver
Wound healing: repair
must re-establish the continuity of the interrupted tissues
SCAR tissue
2nd best option to heal
Wound healing: partial thickness wounds
abrasion, erosion
underlying epithelium migrates and proliferates
Minimal input by inflamm or mesenchymal cells
Wound healing: full thickness wounds
acute inflamm
cellular prolif
matrix formation
remodelling with scar formation
What does the acute inflamm stage consist of
Inflamm stage Debridement stage Cellular prolif: -connective tissue -granulation tissue -wound contraction Matrix synth and remodelling
Acute inflamm: inflamm stage
Initial vasoC
Then vasoD and incr permeability- hist, bradykinin etc.– form inflamm exudate
Complement: fibrocellular clot
PMNS die- release enzymes- pus
Clot dehydrates- scab- protection
Heat, pain, swelling, redness, functio leasa- 6-12 hrs
Neutrophils: protease, phagocytosis, lysosoma, secretion into the EC matrix
Monocytes
Lymphocytes
Complement
Ig
Acute inflamm: Debridement stage
Starts 6hrs after injury
Removal of damaged and necrotic tissue and infection
Duration depends on amount of necrotic tissue and contamination
PMN leucocytes- breakdown
IgG’s and complement- opsonins
Monocytes and macrophages- phagocytosis and attract fibroblasts
If wound is uninfected- macrophages should be sufficient but if contaminated will need vet intervention
Acute inflamm: Cellular prolif
Fibroblasts
Epithelization
GrRANUlation tissue
Contraction of wound
Epithelization 12 hrs Fibroblasts- collagen synth- 3-5 days Granulation tissue- vascular loops Wound contraction- by myofibroblasts Tensile strength (tropocollagen)- 5-15 days
Cellular prolif: Connective tissue
Collagen fibres and ECM production
Cellular prolif: Granulation tissue
Hallmark
capillaries, macrophages, fibroblasts, mast cells
resistant to infection so no need for more AB’s
Cellular prolif: wound contraction
By myofibroblasts- the contractile properties of smooth muscle
Acute inflamm: matrix synth and remodelling
Maturation of collagen scar
Decr vasularity
Decr number of fibroblasts and macrophages
Tensile strength from collagen cross-linking
Factors affecting wound healing
- anaemia- hypoxia- 1st phases
- uremia
- protein deficit
- Zn deficit
- Cu deficit- collagen synth
- Vitamins- C, K, A
- NSAID’s
- SAID’s
- Trauma
- Infection
- Local cleaning
- Local anaesthetics- less leucocyte adhesion
- Suture materials and techniques
- Hematoma and serotoma- delay
- Local insulin- overall positive impact
- Bandages- can cause immobilization! Silicone dressing- nonadherent and fully occlusive. Amnion dressing is species specific
- Magnetic field therapy- positive
- Dehydration and edema- decreased perfusion-delayed
- Temp and pH- healing better at higher temp and low pH
Primary wound healing 10-14 days
Space fills up with blood and the clot Ne acc at 24 hrs Macrophages on 3rd day Angiogenesis 5th day Collagen and fibroblast on the 2nd week No inflamm after 1 mnth- there may be an avascularized scab
Disorders of primary wound healing
1.Hematoma
soft tissue swelling
lots of clots
needs to be opened and thrombotised
- Seroma
- Resorption fever
- Signs of sepsis
- Wound disjunction- colic surgery
Secondary wound healing
Loss of materials
Open lacerated edges (granulation tissue) or
Can be closed but infected
The cleaning of the wound (by the body) is regressive
Lots of granulation tissue
Constriction of granulation tissue- scar tissue
Epithelization
Disorders of Second intention wound healing
Longer regressive processes
Quantitative problems of gran tissue formation
Quality probs- breaking up, keloid formation
Problems with constriction phase
Problems during epithelization
Healing of bone fractures
Fractura= dislocation
Periosteal rupture often leads to callus formation
- Hematoma
- Acute inflamm- ne, monocytes, histiocytes
- Granulation tissue forms from the periosteum and endosteum–
- Temp callous: fibroblasts diff into osteoblasts
- Temporary osteoid, cartilage callous
- Temporary bone callous- irregular structure
- Regular lamellar bone callus
Lamellar bone callus
- Intermediate callus
lamellar bone
Haver’s ducts
compact substance - Endocallus
bone marrow area - Ectocallus
extra bone formation around the fractured area- disorganisation
Wound infections
Always delay the wound healing
reduce vasc supply
increase cellular response
collagenolysis
Clinical signs of wound infections
General: 3-6 days
high fever
depression
decreased appetite
Local: same as for inflamm! red, swelling etc
Bacteria causing wound infections
Aerobe: staph strep entrobact pseudomonas
Anaerobe:
clostridium
Fungal infections
Pythius sp
Other factors that may cause wound infections
High conc of disinfection- decr Ne migration
Bone sequester - no bs therefore necrosis- fistule channel
Suture material- esp non-absorbable
Talcum from gloves- septic peritonitis
Metal implants
Antiseptics
Povidone iodine
Chlorhexidine
H2O2
Acetic acid- but we don’t really use
Types of infection
Primary
Secondary
Exogenic- aerogenic, contact
Endogenic- by the blood
Clean
Non-traumatic surgical wounds
Hollow viscus not entered
The incision does not pass through the infected tissue
Clean-contaminated
Surgical wound that enters the alimentary, urogenital or resp tract
Minimal invasiveness
eg colic
Contaminated
Traumatic
inflamm
Surgical wounds that contain “spill” from other organs
Dirty and infected
Old traumatic wounds (3-5days)
Pus
Preoperative entry into viscera
e.g EINSCHUSS PHLEGMONE
Pyogenic infection: bacteria that can cause
PUS! strep rhodococcus corynebact pseudomonas E.coli
Pyogenic infection: 6-8hrs after wound
Endo and exotoxins:
Thrombotisation of vessels
Necrosis and neutrophils producing pus
Leucocytosis
Local and general signs the same as above
Pyogenic infection in a sutured wound
Swelling Tension of material and tissue Pus discharge Opening of edges 2nd intention healing
Tx: first US the size and content open some of the suturing ABx Open if its fluctuating Drain and bandage
Erysipelas
Pyogenic usually strep and staph
Fast!
Forms pustules, phlegmone and gangrene
Tx: ABx, sulphonamides
What is phlegmone
Septic or aseptic inflamm of the CT
3 main forms: subcutan, subfascial or intermuscular
Special form in Eq- Einschuss Phlegmone
Localized or diffuse
Clinical signs of phlegmone
Pain
Swelling sharply demarcated and doughy
Functional limitation
Fever
Subfascial and intermuscular phlegmone
Most painful when skin over the swelling is movable
Swelling is smooth and tight
Not weight bearing
Later pustula and gangrene
Strong functional limitation and gangrene
Tx: ABx, rest, hyperaemisation, warm bandage
Abscess
Cavity filled with pus
Empyema: pus in natural body cavity e.g colic after surgery
Sequester: abscess in bone
Causes of abscesses
Hematoma due to kicks Seroma Phlegmone FB infection Poor disinfection of skin Non-sterile instruments High conc of antiseptic fluids Necrotic tissue IM inj Vaccination
Signs of abscesses
Well-localized, fluctuating, painful swelling
Centhesis- 18 gauge needle
e.g teeth problems with fistula channels
Process of abscesses
Absorption
Abscesses
Fistula formation
What is pus
Serum and necrotic tissue
Dead leucocytes and bacteria
Is species specific
Where are abscesses very common
Cranial part of hoof solar surface
Warm
Arteries are pulsating
No weight bearing
Putrid bacteria
ROTTEN!
Clostridium
Proteus
Pseudomonas
Result of pyogenic infection
General:
Toxemia
Septicemia
Pyemia
Local:
Fistulation– use methylene blue as contrast
Anaerobic: gas phlegmone
Clostridium within 1-4 hrs due to toxins emphysematous gas production can be from gas IM injections
Tx: surgery, ABx, H2O2
Anaerobic tetanus
Clostridium tetani
Punctuated deep wound
Or after surgical procedures e.g castration after 10-14 days
Signs of anaerobic tetanus
Muscle rigidity
Open nostrils
Trismus- clenched jaw
Prolapse of membrane nicititans
Immediate therapy?: active vaccination or passive with tetanus serum
For clin signs: ABx, diazepam, tetanus serum IM/IV, infusion, ear plugs, darkness, clean wound if able to find it
Wound treatment- surgical wounds
Goal is primary intention healing
No suturing- secondary intention with contamination and lack of tissue??
Preventative ABx 15-30 mins before surgey IV
Postop ABx
Cleaning of site to remove microbes
Removal of suture after 10-14 days
Wound management of a fresh injury
Not universal- depends on injury
Start: patient exam or shock therapy
Prompt and thorough exam- determine exact site, depth and direction of wound
Which anatomical structures involved- tendons, joints, nerves, arteries
Local management of wounds
Local anesthesia- perineural Clip hair- do not shave!! could cause more damage Disinfection Excision Closing
Disinfection of wounds
Povidone iodine 0.1-0.2%
Chlorhexidine 0.05%
H2O2 3%
Acetic acid soln- dont really use this
Excision of wound
Depends on tissue, depth of wound and contamination within 24hrs removal of all dead tissue necrotomy - bone reduce haemorrhage with ligation
Closing of wounds
Primary closing or suturing
Open for draining
Open wound management- when not enough skin to cover
Anaerobe– v sensitive to clostridium tetani
Give vaccination but not booster vaccine
give serum at around 5-10 days
ABx
Suture material
Absorbable- jejunum and subcutan
Non-absorbable- skin, laryngoplasty
Monofil/ polyfil/ pseudomonofil
Natural/ synthetic- mostly synthetic
Types of sutures
Simple interrupted Simple continuous Forward overlooking (continuous) suture Horizontal mattress sutures Vertical mattress sutures Subcuticular sutures Supported quill sutures Walking sutures Staples
Simple interrupted sutures
Advantage: if one stitch disrupted- doesn’t affect the others- easy to remove
Can be used in combo with horizontal mattress
8-figure has better tension relief
Disadvantage: too slow to close, poor tension relief
Not good cosmetically
Simple continuous sutures
Advantage: simple and tension evenly distributed
Disadvantage: if one breaks the whole stitch loosened
Types:
Intracutaneous for abd colic surgeries with absorbable
Cushing
Forward overlooking (continuous) suture
Advantage: rapid closure, even tension along length
Disadvantage: not good cosmetically , can pucker. Slow removal
Horizontal mattress sutures
Advantage: high tension relief, strong, dont break down
Disadvantage: slow to insert, may cause necrosis of skin if too tight. Wound edges not brought into opposition
Vertical mattress sutures
Advantage: good tension relief and wound edges are brought into opposition
Disadvantage: Careful placement of stitches, double needle penetration
Subcuticular stitches
Advantages: Needs careful placement but excellent cosmetically
Disadvantage: Difficult on tight skin- tension not evenly distributed
Need to suture at least 2 levels- subcutis and skin
Supported quill sutures
Advantages: tension relief for wound margins
Disadvantages: slow to insert, excessive tension. Maybe necrosis
Walking sutures
Advantages: minimize fluid acc in subcutaneous, reduce tension, minimize contraction of the skin
Disadvantages: FB
Staples
Advantages: rapid, holds margins of the wound with no skin trauma
Disadvantages: skin needs to be positioned manually- removal needs a special tool
Drain indications and types
Indications: Foreign material Contamination Reduce acc of blood, serum Abscess cavity
Types:
Bandage
Tubular- semi-rigid, fenestrated
Penrose- soft and lumen is collapsible
Stents
Support the margins of the wound and coverage! useful when can't apply a bandage. For 2-5 days Advantages: reduces fluid acc prevent bacterial contam pressure Disadvantages: too much tension on wound wound site is difficult to examine- need to remove the stent to drain the fluid
e.g ulnar Fx used on the head and neck
How to treat an incised wound
Clean up
Excision
Primary suturing
How to treat a lacerated wound
Examine the circ of the flap and DO NOT REMOVE if the circ is good… but remember, it can necrotize after surgery
Cleaning
Excision- but not too much because the tissue is already tight
Take special care with tendons- try to suture also.. remember hindlimb when the fetlock is flexed the hock is also because of the apparatus
How to treat a contused wound
Radical excision
Necrotomy
Suturing over drain
Open management if it’s too big
How to treat a puncture wound
Needs a thorough exam
Look for foreign objects
Supf: excision and suturing over a drain
Body cavities: explore the opening and close afterwards
Nail tread is common: flush and clean, give ABx to prevent septic bursitis and infection of the tendon sheath etc
How treat bite wounds
NB!! Bacterial contam!
Deep: cleaning and open management
Supf: excision and suturing over drain
Body cavities: open, explore and close afterwards
Gun-shot wounds
Body cavities: open, explore and close afterwards
Removal of the bullet is not so important from a clinical point of view
Open joint injuries
Joint surface visible
Yellow discharge and foamy discharge during motion
Needs diagnostic intraarticular puncture
Use of probe not advised
Septic joint injuries
Effusion Swelling Warm Painful palpation Lameness
Therapy for joint wounds
emergency- needs to be within 6 hrs before bacteria propogate
Pre and postop ABx: gentamicin IM
Penicillin and amoxiclav
Joint lavage: the most NB!
Arthroscopic- debridement of fibrin clot (remove the bacteria)
Puncture away from the injured site
Lots of sterile fluid needed
Intraarticular ABx or regional limb perfusion with ABx (tourniquet)
Then local debridement and close the wound with a drain
DO NOT LEAVE THE WOUND OPEN
Wound management in standing position
Sedation Local and perineural anaesthesia Disinfection Debridement Wound lavage Suturing
Wound management in standing position: Sedation
Xylazine
Detomidine
Romifidine
Butimidor- combo! longer, 15-30 mins
Wound management in standing position: Local and perineural anaesthesia
Lidocain
Marcain
Mepivacaine
Mupivacaine
Wound management in standing position: Disinfection
Same as before
Wound management in standing position: Debridement
Removal of the injured and necrotic tissue
maybe also small pieces of bone
Wound management in standing position: Wound lavage
Removes debris and reduces bacterial numbers
Stim microcirc
Be careful not to push the contaminants deeper
Wound management during general anaethesia
Tendon suturing always requires!
IV or Inhalational (usually longer)
- premed: alpha2, combo with opioids:
- induction: ketamine and diazepam
- maint: myolaxin IV infusion– can combo with xylazine and ketamine
Lateral or dorsal recumbency
Reasons for bandaging
Reduce edema Prevent haemorrhage Protect the surgical sites from contam Immobilization Protection from dessication
Primary wound dressing
Applied in the surgical site or wound
Sterile, semiocclusive, non-adherent
Position with sterile conformational gauze
Secondary dressing
Applied over the primary
Sheet or roll cotton
1-2cm
Materials needed for bandages
Padding- cotton
Elastic bandage
Elastic adhesive bandage
