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Equine Surgery and Medicine > Surgery > Flashcards

Surgery Flashcards

1
Q

X-ray production

A

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

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2
Q

Most radiopaque to most radioluscent

A

Metal
Bone
Soft tissue, fat, water
gas

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3
Q

KV

A

Energy of electrons

penetrating ability

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4
Q

mAs

A

amount of radiation produced over a set time i.e the number of electrons
Contrast

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5
Q

Types of x-rays

A

Conventional
Computed- phosphor plate
Digital/direct

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6
Q

Indications for taking x-rays

A

orthopedic:
Lameness
Obvious lesions e.g when there is swelling
Pre-purchase

Non-orthopedic:
Head- teeth and sinuses
Thorax
Abdomen

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7
Q

Basic principles of interpretation- orientate the radiographs in a standard fashion

A

Dorsal/cranial to the left on laterals
Medial to the left on DP’s (dorsoproximalis)
Left side to the right for head DP’s

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8
Q

What are pyhses?

A

usually in young horses, separate centres of ossification

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9
Q

Describing lesions

A

Active: smooth, regular and well-defined

benign, long-standing lesions usually

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10
Q

Estimating how long the lesion has been present

A

Osteophyte formation- 3 weeks

Incomplete fissure fractures- may take weeks to appear

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11
Q

Bone growth

A

Wolff’s law- bone models due to the stress applied to it

X-rays detect changes in mineralization- but not the early stages

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12
Q

Increased bone production-

A

more radiopaque

cortical thickening- e.g bucked shin in race

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13
Q

New bone

A

Periosteum- on the outside of the bone
Endosteum- on the inside of the bone
From infection, inflamm, neoplasia etc

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14
Q

Sclerosis

A

Densification– more radiopaque
Often within trabecular pattern
stress- osteomyelitis
protect a weakened area- OCLL

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15
Q

Focal new bone formation

A

Osteophyte- at edges of articular cartilage and periarticular new bone
Entheseophyte- where tendons, ligaments and joint capsules attach

Sometimes hard to differentiate the 2

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16
Q

Demineralization– general

A

Thinning of cortices and more obvious trabecular pattern
Radiographic overexposure
Disuse osteopenia- healing of fractured

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17
Q

Demineralization- focal

A

Chronic prolif synovitis

cysts: subchondral bone cyst, osseous cyst like lesion

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18
Q

Fractures

A

Location
Complete/incomplete
Displaced/non-displaced
Articular/non-articular

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19
Q

Physitis

A

growing horses
irregularity between the epiphyseal and metaphyseal margins of growth plate
Soft tissue swelling
(separate centres of ossification)

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20
Q

OCD= osteochondrosis dessecans

A

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

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21
Q

Osteoarhtritis

A

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

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22
Q

Contrast radiography

A

Radiodense material

To check if a wound has travelled to synovia or to check communication between synovial cavities

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23
Q

Standard views for lameness diagnosis

A

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

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24
Q

Standard view for laminitis

A

LM

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25
Q

Problems associated withe the navicular bone

A

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

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26
Q

What structures does navicular disease involve

A 
Navicular bursa
DDF
Distal sesamoidean impar ligament
Collateral ligaments of the navicular bone 
Chondrosesamoidean ligaments
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27
Q

Abnormalities of the distal phalanx

A 
Sagital fracture 
Parasagital fracture
OCLL
Keratoma 
Infectious osteitis
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28
Q

Laminitis

A

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

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29
Q

Fractures of the fetlock

A
  1. Traumatic/stress: proximal phalanx- short incomplete or sagittal
  2. Condylar: race and endurance, usually medially
  3. Prox sesamoid bones: race
  4. Sesamoiditis- abnormal thickening of vascuclar channels
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30
Q

Problems occurring at the carpus

A

Sclerosis/ fractures: third carpal bone usually
Osteoarthritis
Osteochondroma

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31
Q

Elbow

A

Olecranon fracture

Osseous cyst like lesions of the radius

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32
Q

Shoulder

A

Fracture of greater tubercle of humerus
Fracture of supraglenoid tubercle
Osteoarthritis

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33
Q

Technique for radiographing the neck

A

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

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34
Q

Common findings of the neck

A

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

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35
Q

Myelography of the neck

A

Contrast medium into the vertebral canal at the atlantooccipial fissure
Latero-latero and dorso-ventral images

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36
Q

Abnormalities of the fetlock (hindlimb)

A 
OCD
Osteoarthritis 
Deformed sesamoid bone 
Superchondylar lysis 
Very low position of the proximal sesamoid bones
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37
Q

Abnormalities of the metatarsal region

normal- almost uniform opacity

A

Patchy opacity
Marked entheseous reaction
Splint bones are very susceptible- especially IV- kicks!
Sequestrum (piece of bone separated due to necrosis)

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38
Q

Abnormalities of the hock

A

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

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39
Q

Abnormalities of the stifle

A

OCD- lateral trochlear ridge of the femur
Osteoarthritis- osteophytes
Calcinosis circumseptica

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40
Q

Radiography of the back

A

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

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41
Q

What is the most common cause of backpain in the horse?

A

Impinging “kissing” dorsal spinous processes

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42
Q

Open magnet for the adult horse (MRI)

A 
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

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43
Q

Computer tomography (CT)

A

“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

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44
Q

Contrast enhanced CT-

A

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

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45
Q

Scintigraphy

A

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

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46
Q

Orthopedic US

A

Lameness
Stronger returning echo- brighter
Weaker returning echo- darker
Linear abdominal macroconvex probes

Clip horse- air

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47
Q

PRP-Platelet rich plasma

A

Autograft
Centrifuge 2 fractions
Over: thrombocyte and WBC rich
Under: RBC rich

Centrifuge to activate the alphagranules in the thrombocytes- release of growth factors

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48
Q

US of the shoulder

A

Cranial to caudal scanning
Weightbearing position
5-10MHz

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49
Q

Radiology of the head- techniques

A 
Use tranquilizers 
Large size cassettes and imaging plates 
Right and left laterolateral 
Dorsoventral and ventrodorsal (similar to neck and back)
Obliques 
Collimation, cassetteholder 
Ropehalter
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50
Q

Radio of cranium

A

LL: 5cm caud to the orbit
VD: beam centred at the larynx
Obliques: TMJ

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51
Q

Cranium of mature vs young horses

A

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

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52
Q

Radio of paranasal sinuses and maxilla

A

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

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53
Q

Significant pathologies of the head

A

Sinusitis
PEH- proliferative ethmoid hematoma
Cyst
Trauma- fractures

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54
Q

Radio of thorax

A 
High output x-ray unit 
Leave gap between patient and casette 
Short exposure 
Full INspiration
LL views: fields- dorsocaud, ventrocaud, dorsocran, ventrocran
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55
Q

Patterns of lung disease

A 
Interstitial
Vascular
Bronchial
Alveolar 
Cavitary pulmonary lesions 
Pulmonary masses 
Pleuropneumonia 
Pneumothorax
Pneumomediastinum
Tracheal collapse/ stenosis 
RAO
Pneumonia- eosinophilic, bacterial and aspiration
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56
Q

Vascular lung disease

A

vessels within the interstitium
changes the shape of pulmonary arteries and veins
congenital heart disease or inflamm lung disease

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57
Q

Radio of the abdomen

A

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

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58
Q

Diseases of the GIT

that show up on radiograph

A 
SI or LI obstruction
Atresia coli
Rupture of hollow viscus 
Sand impaction
Enterolithiasis
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59
Q

Radio of the bladder: pneumocystography

A
  • 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
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60
Q

Radio of bladder: positive contrast cystography

A

12ml/kgbw of contrast material
LL and VD’s
Asses the size and position of the bladder

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61
Q

Chemicals causing injuries

A

Acid- coagulation necrosis
Alkali- colliquation necrosis
also- chemicals

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62
Q

Thermal open injuries: burns

A

1st degree: erythmetosa
2nd degree: bullosa
3rd degree: escharctica
4th degree: carbonisatio

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63
Q

Thermal injuries: forstbite/congelation

A

1st degree: ischaemia
2nd degree: thrombus, stasis
3rd degree: cell degen, stopping of circulation, necrosis

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64
Q

Electricity caused injuries

A

Above 50mA- critical
Above 100mA- always death

Cell degen and coag
inlet and outelt
shock

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65
Q

Depth of wounds

A

Supf: graze, erosion, abrasion, 2nd healing intention

Deep

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66
Q

Healing stadium of wounds

A

Regular or irregular
Infected
with complication

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67
Q

Types of wounds

A 
Incised 
Lacerated 
Contused 
Puncture 
Bite 
Gunshot
68
Q

Incised wounds

A 
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
69
Q

Lacerated wounds

A 
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
70
Q

Contused wounds

A 
Dull objects 
Extensive tissue damage 
Edges are irregular 
V painful
Extensive damage to underlying tissue 
Poor prognosis 
(quite similar to lacerations)
71
Q

Puncture wounds

A 
Sharp object 
Supf- point like 
Deep- channel
Can be penetrating or perforating 
Anaerobe infections!!!
Be careful of shoe nails
72
Q

Bite wounds

A

Car- puncture

Herb- contused

73
Q

Gunshot wounds

A 
Inlet- primary necrotisation
Channel- necrobiotical zone 
Outlet- molecular commotional zone 
Direct effect-bullet wandering 
Indirect effect- bullet capsulation
74
Q

Conc dependent antibiotics

A

aminoglycosides and fluoroquinolones

Ratio of peak plasma conc to MIC should be 10:1 or 12:1

75
Q

Time dependent antibiotics

A

Beta-lactams and macrolides

Keep conc above the MIC for a longer period of time

76
Q

When would we use antibiotics prophylactically

A

To improve surgical outcome

Should be:

  • bactericidal
  • produce effective tissue conc at the time of surgery
  • should be able to maintain tissue levels
77
Q

RLP= regional limb perfusion

A

Distal to tourniquet apply a high conc of AB
For distal limb 30ml, for more prox use a smaller volume
Amikacin often used

78
Q

Wound healing: regeneration

A

Replacement with normal cells of the lost tissue
Cells need to then replicate (mitosis)
Epithelium, bone, liver

79
Q

Wound healing: repair

A

must re-establish the continuity of the interrupted tissues
SCAR tissue
2nd best option to heal

80
Q

Wound healing: partial thickness wounds

A

abrasion, erosion
underlying epithelium migrates and proliferates
Minimal input by inflamm or mesenchymal cells

81
Q

Wound healing: full thickness wounds

A

acute inflamm
cellular prolif
matrix formation
remodelling with scar formation

82
Q

What does the acute inflamm stage consist of

A 
Inflamm stage 
Debridement stage 
Cellular prolif: 
-connective tissue 
-granulation tissue 
-wound contraction
Matrix synth and remodelling
83
Q

Acute inflamm: inflamm stage

A

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

84
Q

Acute inflamm: Debridement stage

A

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

85
Q

Acute inflamm: Cellular prolif

A

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
86
Q

Cellular prolif: Connective tissue

A

Collagen fibres and ECM production

87
Q

Cellular prolif: Granulation tissue

A

Hallmark
capillaries, macrophages, fibroblasts, mast cells
resistant to infection so no need for more AB’s

88
Q

Cellular prolif: wound contraction

A

By myofibroblasts- the contractile properties of smooth muscle

89
Q

Acute inflamm: matrix synth and remodelling

A

Maturation of collagen scar
Decr vasularity
Decr number of fibroblasts and macrophages
Tensile strength from collagen cross-linking

90
Q

Factors affecting wound healing

A
  1. anaemia- hypoxia- 1st phases
  2. uremia
  3. protein deficit
  4. Zn deficit
  5. Cu deficit- collagen synth
  6. Vitamins- C, K, A
  7. NSAID’s
  8. SAID’s
  9. Trauma
  10. Infection
  11. Local cleaning
  12. Local anaesthetics- less leucocyte adhesion
  13. Suture materials and techniques
  14. Hematoma and serotoma- delay
  15. Local insulin- overall positive impact
  16. Bandages- can cause immobilization! Silicone dressing- nonadherent and fully occlusive. Amnion dressing is species specific
  17. Magnetic field therapy- positive
  18. Dehydration and edema- decreased perfusion-delayed
  19. Temp and pH- healing better at higher temp and low pH
91
Q

Primary wound healing 10-14 days

A 
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
92
Q

Disorders of primary wound healing

A

1.Hematoma
soft tissue swelling
lots of clots
needs to be opened and thrombotised

  1. Seroma
  2. Resorption fever
  3. Signs of sepsis
  4. Wound disjunction- colic surgery
93
Q

Secondary wound healing

A

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

94
Q

Disorders of Second intention wound healing

A

Longer regressive processes
Quantitative problems of gran tissue formation
Quality probs- breaking up, keloid formation
Problems with constriction phase
Problems during epithelization

95
Q

Healing of bone fractures

A

Fractura= dislocation

96
Q

Periosteal rupture often leads to callus formation

A
  1. Hematoma
  2. Acute inflamm- ne, monocytes, histiocytes
  3. Granulation tissue forms from the periosteum and endosteum–
  4. Temp callous: fibroblasts diff into osteoblasts
  5. Temporary osteoid, cartilage callous
  6. Temporary bone callous- irregular structure
  7. Regular lamellar bone callus
97
Q

Lamellar bone callus

A
  1. Intermediate callus
    lamellar bone
    Haver’s ducts
    compact substance
  2. Endocallus
    bone marrow area
  3. Ectocallus
    extra bone formation around the fractured area- disorganisation
98
Q

Wound infections

A

Always delay the wound healing
reduce vasc supply
increase cellular response
collagenolysis

99
Q

Clinical signs of wound infections

A

General: 3-6 days
high fever
depression
decreased appetite

Local: same as for inflamm! red, swelling etc

100
Q

Bacteria causing wound infections

A 
Aerobe: 
staph
strep
entrobact
pseudomonas

Anaerobe:
clostridium

101
Q

Fungal infections

A

Pythius sp

102
Q

Other factors that may cause wound infections

A

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

103
Q

Antiseptics

A

Povidone iodine
Chlorhexidine
H2O2
Acetic acid- but we don’t really use

104
Q

Types of infection

A

Primary
Secondary
Exogenic- aerogenic, contact
Endogenic- by the blood

105
Q

Clean

A

Non-traumatic surgical wounds
Hollow viscus not entered
The incision does not pass through the infected tissue

106
Q

Clean-contaminated

A

Surgical wound that enters the alimentary, urogenital or resp tract
Minimal invasiveness
eg colic

107
Q

Contaminated

A

Traumatic
inflamm
Surgical wounds that contain “spill” from other organs

108
Q

Dirty and infected

A

Old traumatic wounds (3-5days)
Pus
Preoperative entry into viscera
e.g EINSCHUSS PHLEGMONE

109
Q

Pyogenic infection: bacteria that can cause

A 
PUS!
strep
rhodococcus 
corynebact
pseudomonas 
E.coli
110
Q

Pyogenic infection: 6-8hrs after wound

A

Endo and exotoxins:
Thrombotisation of vessels
Necrosis and neutrophils producing pus
Leucocytosis

Local and general signs the same as above

111
Q

Pyogenic infection in a sutured wound

A 
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
112
Q

Erysipelas

A

Pyogenic usually strep and staph
Fast!
Forms pustules, phlegmone and gangrene

Tx: ABx, sulphonamides

113
Q

What is phlegmone

A

Septic or aseptic inflamm of the CT
3 main forms: subcutan, subfascial or intermuscular
Special form in Eq- Einschuss Phlegmone
Localized or diffuse

114
Q

Clinical signs of phlegmone

A

Pain
Swelling sharply demarcated and doughy
Functional limitation
Fever

115
Q

Subfascial and intermuscular phlegmone

A

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

116
Q

Abscess

A

Cavity filled with pus
Empyema: pus in natural body cavity e.g colic after surgery
Sequester: abscess in bone

117
Q

Causes of abscesses

A 
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
118
Q

Signs of abscesses

A

Well-localized, fluctuating, painful swelling
Centhesis- 18 gauge needle
e.g teeth problems with fistula channels

119
Q

Process of abscesses

A

Absorption
Abscesses
Fistula formation

120
Q

What is pus

A

Serum and necrotic tissue
Dead leucocytes and bacteria
Is species specific

121
Q

Where are abscesses very common

A

Cranial part of hoof solar surface
Warm
Arteries are pulsating
No weight bearing

122
Q

Putrid bacteria

A

ROTTEN!
Clostridium
Proteus
Pseudomonas

123
Q

Result of pyogenic infection

A

General:
Toxemia
Septicemia
Pyemia

Local:
Fistulation– use methylene blue as contrast

124
Q

Anaerobic: gas phlegmone

A 
Clostridium 
within 1-4 hrs 
due to toxins 
emphysematous gas production
can be from gas IM injections

Tx: surgery, ABx, H2O2

125
Q

Anaerobic tetanus

A

Clostridium tetani
Punctuated deep wound
Or after surgical procedures e.g castration after 10-14 days

126
Q

Signs of anaerobic tetanus

A

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

127
Q

Wound treatment- surgical wounds

A

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

128
Q

Wound management of a fresh injury

A

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

129
Q

Local management of wounds

A 
Local anesthesia- perineural
Clip hair- do not shave!! could cause more damage 
Disinfection
Excision
Closing
130
Q

Disinfection of wounds

A

Povidone iodine 0.1-0.2%
Chlorhexidine 0.05%
H2O2 3%
Acetic acid soln- dont really use this

131
Q

Excision of wound

A 
Depends on tissue, depth of wound and contamination
within 24hrs 
removal of all dead tissue
necrotomy - bone 
reduce haemorrhage with ligation
132
Q

Closing of wounds

A

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

133
Q

Suture material

A

Absorbable- jejunum and subcutan
Non-absorbable- skin, laryngoplasty
Monofil/ polyfil/ pseudomonofil
Natural/ synthetic- mostly synthetic

134
Q

Types of sutures

A 
Simple interrupted 
Simple continuous 
Forward overlooking (continuous) suture 
Horizontal mattress sutures 
Vertical mattress sutures 
Subcuticular sutures 
Supported quill sutures
Walking sutures 
Staples
135
Q

Simple interrupted sutures

A

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

136
Q

Simple continuous sutures

A

Advantage: simple and tension evenly distributed
Disadvantage: if one breaks the whole stitch loosened

Types:
Intracutaneous for abd colic surgeries with absorbable
Cushing

137
Q

Forward overlooking (continuous) suture

A

Advantage: rapid closure, even tension along length
Disadvantage: not good cosmetically , can pucker. Slow removal

138
Q

Horizontal mattress sutures

A

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

139
Q

Vertical mattress sutures

A

Advantage: good tension relief and wound edges are brought into opposition
Disadvantage: Careful placement of stitches, double needle penetration

140
Q

Subcuticular stitches

A

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

141
Q

Supported quill sutures

A

Advantages: tension relief for wound margins
Disadvantages: slow to insert, excessive tension. Maybe necrosis

142
Q

Walking sutures

A

Advantages: minimize fluid acc in subcutaneous, reduce tension, minimize contraction of the skin
Disadvantages: FB

143
Q

Staples

A

Advantages: rapid, holds margins of the wound with no skin trauma
Disadvantages: skin needs to be positioned manually- removal needs a special tool

144
Q

Drain indications and types

A 
Indications:
Foreign material
Contamination
Reduce acc of blood, serum
Abscess cavity

Types:
Bandage
Tubular- semi-rigid, fenestrated
Penrose- soft and lumen is collapsible

145
Q

Stents

A 
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

146
Q

How to treat an incised wound

A

Clean up
Excision
Primary suturing

147
Q

How to treat a lacerated wound

A

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

148
Q

How to treat a contused wound

A

Radical excision
Necrotomy
Suturing over drain
Open management if it’s too big

149
Q

How to treat a puncture wound

A

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

150
Q

How treat bite wounds

A

NB!! Bacterial contam!
Deep: cleaning and open management
Supf: excision and suturing over drain
Body cavities: open, explore and close afterwards

151
Q

Gun-shot wounds

A

Body cavities: open, explore and close afterwards

Removal of the bullet is not so important from a clinical point of view

152
Q

Open joint injuries

A

Joint surface visible
Yellow discharge and foamy discharge during motion
Needs diagnostic intraarticular puncture
Use of probe not advised

153
Q

Septic joint injuries

A 
Effusion
Swelling
Warm
Painful palpation
Lameness
154
Q

Therapy for joint wounds

A

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

155
Q

Wound management in standing position

A 
Sedation
Local and perineural anaesthesia 
Disinfection
Debridement 
Wound lavage
Suturing
156
Q

Wound management in standing position: Sedation

A

Xylazine
Detomidine
Romifidine
Butimidor- combo! longer, 15-30 mins

157
Q

Wound management in standing position: Local and perineural anaesthesia

A

Lidocain
Marcain
Mepivacaine
Mupivacaine

158
Q

Wound management in standing position: Disinfection

A

Same as before

159
Q

Wound management in standing position: Debridement

A

Removal of the injured and necrotic tissue

maybe also small pieces of bone

160
Q

Wound management in standing position: Wound lavage

A

Removes debris and reduces bacterial numbers
Stim microcirc
Be careful not to push the contaminants deeper

161
Q

Wound management during general anaethesia

A

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

162
Q

Reasons for bandaging

A 
Reduce edema 
Prevent haemorrhage 
Protect the surgical sites from contam
Immobilization
Protection from dessication
163
Q

Primary wound dressing

A

Applied in the surgical site or wound
Sterile, semiocclusive, non-adherent
Position with sterile conformational gauze

164
Q

Secondary dressing

A

Applied over the primary
Sheet or roll cotton
1-2cm

165
Q

Materials needed for bandages

A

Padding- cotton
Elastic bandage
Elastic adhesive bandage

Equine Surgery and Medicine (10 decks)

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