Surgical Wound Reconstruction Flashcards
what can secondary intention healing lead to?
contractures which require revision and can be painful
what are the advantages of simple suturing?
simple, quick and easy
what are simple sutures most appropriate for?
primary and delayed primary closure e.g fresh wound, clean or clean/contaminated, site and size of wound not too big or not too much skin loss
what are subdermal plexus flaps?
skin can be advanced in a straight line or can be rotated into place depdning where the wound is and where the skin tension is on the patient, used advantages of small veins and arteries due to elasticity
what are the two types of subdermal skin flaps?
- Flank fold flap for inguinal wounds
- Elbow fold flap for axillary wounds
what are the advantages of doing a subdermal plexus flap?
- Simple yet versatile
- Good for medium-sized wounds
- Reduces tension
what are the disadvantages of doing a subdermal plexus flap?
- Relies on accurate wound assessment
- Has size limitations
- Damage to plexus possible
what are subdermal plexus flaps most appropriate for
- fresh wounds
- clean is primary surgery
- contaminated/dirty if surgery delayed primary or secondary
- site and size of wound medium sized wounds
- surgical debridement
what does an axial pattern flap do?
Incorporate a direct cutaneous artery and vein capable of providing blood to large areas of skin that can then be ‘raised’ and moved to cover large defects with less
chance of breakdown due to vascular necrosis
what are the advantages of doing an axial pattern flap?
- Come with good blood supply
- Longer and wider flaps possible than subdermal
- Can offer rapid healing of chronic wound
what are the disadvantages of doing an axial pattern flap?
- Steep learning curve
- Flap necrosis could be catastrophic
- Good post-op care vital
+/- Cosmetic result
what are the disadvantages of doing a free skin graft?
- Needs a healthy bed of granulation tissue
- Needs some skin to ‘grow’ into that tissue
- Lower success rates
- Steep learning curve
- Requires a healthy granulation bed
- Requires a talented surgeon, committed nursing team, committed owner
what two types of free skin grafts can be done?
- Sheet => have to close the donor site as a primary wound (make involve
subdermal plexus flap) - Punch (biopsy punch)
what are the advantages of doing free skin graft?
- Punch grafts simple
- Sheet grafts good for large extremity defects
- Offer rapid healing of chronic wound
what are the 9 ypes of open wounds?
- Abrasion
- Avulsion
- Burn
- Degloving
- Incision
- Laceration
- Pressure sore
- Puncture
- Shearing
what is an abrasion wound?
- Superficial wound caused when skin moves parallel to a rough surface at speed
- Does not extend deep to dermis
- Common with RTA
- Pads abraded when excess exercise on rough surface
what is an avulsion wound?
- Tissue is torn from attachments
- Ligaments / Muscles / Skin
what is a burn wound?
- Thermal (dry / wet)
- Chemical / radiation / electrical
what is a degloving wound?
- A type of severe avulsion that affects legs, tails (extremities)
- Extensive skin loss like a ‘glove’ being removed
- Mechanical
- Skin pulled from subdermal attachments
- Physiological
- Skin necroses and sloughs due to damage to blood supply
what is an incisional wound?
- Surgical or traumatic
- Glass / wire / other sharp objects
- Typically skin deep only & clean cut
- Worth exploring to check for damage to deeper tissues
what is a laceration wound?
- Tearing injury
- Damages skin and deeper tissues
- Irregular edges
what is a pressure sore?
- Found on elbows/hocks of large breed dogs
- Can be graded for severity depending on depth of damage & if very severe > open
what is a puncture wound?
- An object creates a relatively small hole
- Bites
- Gun shots / stabbings
- Penetrating foreign bodies like grass seeds / stick injuries
- Snakes, insects, spider bites
what are shearing wounds?
- Similar aetiology to degloving
- Usually involve loss of deeper tissues
- When limbs affected may expose joints and/or bone
what are the 4 types of closed wounds?
- Contusion
- Crush injury
- Haematoma
- Hygroma
what is a contusion?
- An area of injury where capillaries have been damaged = a bruise
what is a crush injury?
- Caused by prolonged period of compression
- Direct tissue injury
- Secondary injury from damage to blood supply
what is a haematoma?
- Blood vessel damage underneath the skin
- Accumulation of blood in a pocket
what is a hygroma?
a kind of pressure sore
what types of bandaging wounds are there?
- Open/closed
- Over-tight
- Inadequate padding
- Excess exercise
- Wet/dirty
what contamination can be in a wound?
micro-organisation, debris
what might prevent a wound from healing?
- immuno-suppressive conditions
-poor ntrition - drug therapy
- stress
what surgical considerations are there for wound types?
➢ What (wound) have we got here?
➢ What (aetiology) have we got here?
➢ What (patient) have we got here?
➢ When are we likely to take this to surgery?
➢ Where is the wound?
what are the stages of skin healing?
inflammaition, proliferation, maturation
how woul you assess the patient?
- Pre-existing co-morbidities
- Current status
- Injuries
- Primary vs delayed wound management
what are client factors that you should consider?
- cost
- owner compliacne with revisits, bandage management and medications
- practicalities
what does the acronym TIME stand for?
Tissue, Infection/inflammation, Moisture, Epithelisation
what is the aim for TIME?
- Remove non-viable tissue
- Treat infection / factors pre-disposing to infection
- Ensure optimal moisture balance
- Identify delayed healing
what is viable tissue?
epithelial and granulation
what is non-viable tissue?
sloughing and necrosis
what are you considering with pre-existing infection wounds?
- the age of the wound
- is there discharge?
- is there a smell
what are you considering with the risk of infection of a wound?
- site of the wound
- wound aetiologu
- degree of contamination
- wound lavage
what are you considering with an inflammed wound?
unhealthy = infection
- healthy = granulation and healing
what can happen if a wound is too wet?
skin ca become macerated of excoriated
what can happen if a wound is too dry?
the wound can become desiccated and eschar may be present
what should you do if a wound is too wet?
try to absorb some of the moisutre
what should you do if a wound is too dry?
add moisture to the wound
how would you assess wounds?
- Wound edges= Pink, smooth = healing
-Darker red, uneven = not healing - Measurements (Width, Length, Depth
- Photos
- Drawings
- Tissue surrounding wound (Cellulitis, Oedema, Skin
what are you looking for with assessing of a wound?
progression and reasons for non-progression
how would you promote epithelisation?
use TIME
how would you protect new epithlial tissue?
bandaging
why would you lavage a wound?
- Rehydrate necrotic tissue
- Remove foreign material
- Reduce bacterial contamination
- Remove toxins & cytokines
what would you use to lavage a wound?
- Isotonic fluid; Hartmann’s may be marginally better than saline
- Tap water
- Additives?
when would you lavage a wound?
any traumatic wound
where would you lavage a wound?
- Aseptically
- Clip and sterile prep – aqueous gels for trapping fur
- Use a lot of liquid! Dilution is the solution
how would you lavage a wound?
- Should not require sedation
- Fluid bag with giving set
- 20ml syringe, 18g needle, 3-way tap
- Care not to apply too high pressure as can push the things we are trying to remove into deeper tissues > areolar tissue will show this by having a bubble-wrap
appearance
what is surgical debridement?
- Sharp dissection to remove all contaminated, necrotic tissue
- Avoid damage to normal tissue
what non-surgical debridement can be done?
- Physical = Using adherent dressings that remove tissue when the dressing is
removed - Chemical = using chemical substances to remove the dead tissue
why would you bandage an open wound?
Protect from
* Self-trauma
* Contamination / infection from environment
* Desiccation
what can bandaging an open wound provide?
- Pain relief
- Immobilisation of soft and any concurrent ortho injuries
- Pressure to reduce swelling / haemorrhage
- Deliver topical medications
what can you use for a chemical debridement of an open wound?
- Hydrogels
- Enzymatic / other agents
what can you use for physical debridement of an open wound?
- Wet to dry
- Dry to dry
- Larvae
what is the nurses role in wound management?
- Continuity
- Advocacy
- Nurse clinics
- Clinic audits
