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ICMS > Treatment of Large Animal Wounds > Flashcards

Treatment of Large Animal Wounds Flashcards

1
Q

Wound healing has 3 overlapping stages…. what are they?

A

Inflammatory phase
Proliferative phase
Remodeling phase

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2
Q

What occurs during the inflammatory phase of healing?

A

Vasoconstriction for hemostasis
Vasodilation
Formation of provisional wound matrix
Cellular response

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3
Q

how long does the inflammatory stage last for?

A

0-3 days

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4
Q

How long does the proliferative phase last for?

A

2-14 days, usually active by day 3

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5
Q

What is the main objective of the proliferative phase?

A

protection of the wound surface by formation of granulation tissue & new epithelium

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6
Q

What is the purpose of angiogenesis?

A

To restore oxygenation & supply nutrients to granulation tissue

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7
Q

What is important to remember about granulation tissue?

A

It does NOT have nervous innervation

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8
Q

When does the remodeling phase begin?

A

Around day 7+

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9
Q

What percentage of final wound strength is achieved in the first 3 weeks?

A
  • 20%
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10
Q

How long can scar formation take?

A

up to 2 years

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11
Q

Which heals better, ponies or horses? Why?

A

ponies - due to the differences in local inflammatory response & functional capacity of leukocytes

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12
Q

What are the 4 ways of classifying a wound based on contamination?

A
  • Clean
  • Clean-contaminated
  • contaminated
  • dirty or infected
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13
Q

What is a clean wound?

A
  • surgical incisions made under aseptic conditions
  • primary closures
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14
Q

What is a clean-contaminated wound?

A

Surgical incisions made to involve the respiratory, GI, or urogenital tracts entered under controlled conditions

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15
Q

What are contaminated wounds?

A

open wounds
Traumatic wounds
Sx incisions w/ major breaks in asepsis

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16
Q

What are dirty or infected wounds?

A

Exudative
Traumatic wound w/ delayed txt
Obvious contamination
Devitalized tissue present

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17
Q

What are examples of open wounds classified by type?

A

incisions, erosions, lacerations, burns, abrasions, punctures

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18
Q

What are examples of closed wounds classified by type?

A

bruises, hematomas, contusions

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19
Q

When classifying a wound based on bacteria, what are the options?

A

clean, clean-contaminated, contaminated
Dirty or infected

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20
Q

When classifying a wound based on time, what are the options?

A

Class 1 - < 6 hrs w/ minimal contamination
Class 2 - 6-12 hrs w/ significant contamination
Class 3 - >12 hrs w/ gross contamination

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21
Q

What sedative would you use when trying to assess wounds?

A

alpha-2 agonist & opioids

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22
Q

When do you take a swab for culture & sensitivity for wound management?

A

before you clean OR if its very contaminated, clean the outer aspect of the wound then lavage w/ sterile saline before swabbing deep

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23
Q

Determine the extent of wound by…

A
  • probing/sterile gloved finger
  • assess for damage to vital structures
  • assess for foreign bodies, sequestrate, etc
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24
Q

What are some general considerations during wound management?

A
  • Owner’s goals
  • treat or refer?
  • wound closure
  • antibiotics, anti-inflammatories, TAT, or toxoid
  • what type of dressing or bandage?
  • box rest?
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25
Q

What type of local anesthetic can be used?

A

distant perineural nerve blocks
ring or splash blocks

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26
Q

What is the duration of action of lidocaine?

A

90-180 mins

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27
Q

What is the duration of action of mepivacaine?

A

120-180 mins

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28
Q

What is the duration of action of bupivicaine?

A

180-500 mins

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29
Q

What are the aims of debridement?

A
  • reduce bacterial load & remove necrotic tissue
  • more rapid & cosmetic healing
  • minimise trauma to the wound bed
30
Q

What are the main types of debridement?

A

sharp, mechanical, chemical, biological, and autolytic

31
Q

What are the most common types of debridement in equines?

A

sharp and autolytic

32
Q

What are some benefits to sharp debridement?

A
  • one of the least traumatic
  • cost effective
  • allows assessment of tissue viability
  • minimal equipment required
33
Q

What are the 3 main forms of mechanical debridement?

A

woven gauze
Lavage
Versajet

34
Q

When doing mechanical debridement with lavage, what is the appropriate pressure & volume?

A

10-15 psi by using a 35 ml syringe & 19 g needle with non-cytotoxic solution like sterile saline

35
Q

What does versajet do?

A

uses water to debride mechanically

36
Q

What are the types of autolytic debridement?

A
  • hydrogels
  • manuka honey
  • chemical debridement
37
Q

What are the three types of wound closure?

A

primary closure
delayed primary closure
second-intention healing

38
Q

What are some considerations that have to be made when closing wounds?

A
  • vascularity & tissue health
  • debridement
  • management of dead space/debridement
  • facilities available
  • box rest or not
  • bandaging
39
Q

What are some indications for mechanical debridement?

A
  • surgical incisions
  • minimal tissue loss
  • minimal bacterial contamination
  • minimal tension on wound edges
  • exposed vital structures
40
Q

What are examples of appositional suture patterns?

A

simple interrupted
cruciate
interrupted vertical mattress

41
Q

What are examples of tension-relieving or everting suture patterns?

A

interrupted horizontal mattress
near-far-far-near
far-near-near-far
walking suture

42
Q

What is the aim of drains?

A

to channel unwanted fluids & air from tissues or body cavities

43
Q

What are some reasons to use a drain?

A
  • eliminate dead space
  • allow drainage of fluid/gas from the wound cavity
  • prevent anticipated build-up of fluid
44
Q

what makes an ideal drain?

A

inert, soft, non-reactive, radiopaque

45
Q

what are some complications with drains?

A

foreign body response
ascending infection
delayed healing

46
Q

What are some examples of passive drains?

A

gauze, penrose, sheet, tube

47
Q

What are some active drains that can be used (closed-suction systems)?

A

infected joints
under full thickness skin grafts
large deep wounds
evacuating pleural space

48
Q

When should a primary wound closure being used?

A

whenever possible

49
Q

Why is primary wound closure ideal?

A
  • reduced healing time
  • improved cosmesis
  • less aftercare & subsequently expense
  • earlier return to function
50
Q

What are some indications for delayed primary closure?

A
  • initial treatment to allow debridement & reduce contamination
  • mild/moderate bacterial contamination
  • minimal tissue loss
  • minimal tissue tension
51
Q

When is second intention healing used?

A
  • when neither primary or delayed primary closure is possible
52
Q

What are some indications for second intention healing?

A
  • primary/delayed primary closure not possible
  • unmanageable contamination
  • established infection
  • excessive tissue loss
53
Q

Granulation tissue is…

A
  • very vascular
  • devoid of nervous tissue
54
Q

What are some indications of skin grafting?

A
  • defects that exceed the ability of epithelialization or conventional closing techniques
  • where cosmesis is important in large, slow-healing wounds
  • where rapid healing is required
55
Q

What are some common topical treatments?

A
  • fucidic acid ‘Isaderm’
  • Silver sulphadiazine ‘Flamazine’
  • Manuka Honey
  • Vulketan Gel
  • Aloe Vera
  • Corticosteroids
56
Q

What is normal synovial fluid?

A
  • translucent, pale yellow
  • viscous
  • TP = <10-20 g/L
  • WBCs = 0.2 x 10^9 g/L
57
Q

What is abnormal synovial fluid?

A
  • increased volume
  • lowered viscosity
  • abnormal appearance
58
Q

Cloudy, turbid, amber synovial fluid is a sure sign of…

A

septic arthritis

59
Q

Haemorrhagic synovial fluid is a sure sign of…

A

traumatic arthritis

60
Q

When looking at synovial fluid, what are sure signs of definitive sepsis?

A

WBC >100 x 10^9 g/L
TP >40 g/L
Neutrophils >90%

61
Q

synovial contamination is an…

A

emergency

62
Q

if there is exposed bone, what should you do on Day 1

A

Take radiographs

63
Q

What is special about exuberant granulation tissue (EGT)?

A

it has no nerves but is increased blood supply
- unique to horses

64
Q

What is bandaging used for?

A
  • protection
  • pressure
  • support/immobilisation
  • absorption
  • optimal healing environment
65
Q

Contact/primary layer of bandaging is a … layer and is either… or …

A

Sterile layer
adherent or nonadherent

66
Q

What is the second layer of bandaging?

A

padding or conforming bandage

67
Q

What is the outer layer of bandaging?

A

cohesive bandage for compression and support

68
Q

What is adhesive tape for in bandaging?

A

to prevent slipping and debris tracking in or can be applied over length of bandage for extra compression & support

69
Q

Splinting of limb fractures depends on…

A

location and have been divided into 4 levels for fore & hindlimbs

70
Q

An effective splint must…

A

provide rigid support to neutralize the distracting forces acting at the fracture site

71
Q

An inappropriate splint can make…

A

a fracture worse

72
Q

Splints should extend one joint …

A

above and below a fracture splint

ICMS (22 decks)

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