wound care

Question 1

abrasions

Answer 1

scraping away of the outer layer of epidermis: mild road rash

Question 2

lacerations

Answer 2

skin is sliced open (cut on wire, piece of metal)

Question 3

surgical incisions

Answer 3

scalpel

Question 4

puncture wounds

Answer 4

sticks, wire, nail, tree branch

Question 5

penetrating wounds

Answer 5

these connect to a body
cavity (example: thorax)

Question 6

avulsion injuries

Answer 6

Tearing of tissue from its
attachments. HBC

Question 7

contusions

Answer 7

bruises; stays in body (closed wound)

Question 8

crushing injuries

Answer 8

doesn’t expose body’s inner tissue to outside world (closed wound)

Question 9

clean

Answer 9

Surgically created under aseptic conditions. Minimal trauma. These wounds are sutured

Question 10

clean contaminated

Answer 10

• Surgical wound with minor break in sterile technique.
• Surgery in which the intestinal, urinary or respiratory tracts
  are entered

Question 11

contaminated

Answer 11

• Open traumatic wound or a surgical wound with a major break in sterile technique
• Colon surgery
• Needs aggressive cleansing and treatment.
• Dogfight wounds, gunshot wounds, degloving injuries

Question 12

infected

Answer 12

• Old traumatic wound or high bacterial count ( > 105 /gram tissue)
• Perforated viscera. Purulent discharge.
• Intensive treatment

Question 13

how to treat small animal wounds

Answer 13

• stablize patient
• remove debris
• debride
• manage wound drainage
• protect wound through healing
• clip around wound
• cleanse around wound
• lavage
• pain management and closure

Question 14

3 stages of wound healing

Answer 14

1. Inflammatory phase
2. Proliferative phase
3. Remodeling phase(maturation phase)

Question 15

inflammatory phase

Answer 15

(immediate, lasts 3-5 days)
- Blood is released, platelets aggregate, fibrin clot forms (hemostasis)
- Growth factors released - Macrophages & neutrophils are recruited
- Remove bacteria & cellular debris
- Erythema, swelling, heat and pain develop

Question 16

proliferative phase

Answer 16

(starts at 2-3 days; lasts several weeks)
- Granulation, Contraction & Epithelialization occurs
- Fibroblasts migrate to wound
- More growth factors releases, stimulate proliferation & recruitment of these cells
- Extracellular matrix is produced

Question 17

remodeling/maturation phase

Answer 17

(begins 3 weeks after injury; lasts months to years)
- Remodeling and realignment of collagen fibers
- Wound gains strength – most likely never be as strong as normal

Question 18

extracellular matrix

Answer 18

• Meshwork-like substance attached to outer cell surface
• Support and anchorage of healing compounds/cells

Question 19

granulation tissue and characteristics

Answer 19

• Consists of fibroblasts & myofibroblasts, endothelial cells,
  inflammatory cells & new blood vessels & extracellular matrix
• Pink to red in color, shiny and bleeds easily
• Not painful
• Infection is unlikely to occur
• Fibroblasts deposit collagen in wound for strength
• provides oxygen, moisture, and a surface for epithelial cells to proliferate and cross

Question 20

epithelialization

Answer 20

coverage of wound by epithelial cells

Question 21

wound contraction (beginning and end)

Answer 21

myofibroblasts contract within the granulation tissue (begins 1 week after injury; lasts several weeks)

Question 22

healing as it relates to tensile strength

Answer 22

load capacity - how much weight, pressure, movement it can handle

Question 23

proud flesh (can it be controlled)

Answer 23

Body creates too much granulation tissue

Can control by:
Immobilizing limb (cast)
Wound bandaging
Caustic agents
Surgical excision

Question 24

factors affecting wound healing

Answer 24

• health and age of patient
• type of injury
• tissue affected
• contamination level
• increased wound exudate
• tension on wound or movement of surrounding tissue
• time and method of treatment
• re-injury during healing process

Question 25

time it takes for an uncomplicated wound to heal

Answer 25

couple weeks (?)

Question 26

first intention

Answer 26

- primary closure - Healing of a wound when the skin edges reattach to each other - for clean or clean contaminated wounds

Question 27

delayed primary closure

Answer 27

- Closure or suturing is delayed for a couple of days before granulation - for wounds older than 8 hours

Question 28

secondary closure

Answer 28

- Surgical closure of a wound after granulation tissue is established - for heavily contaminated wounds, necrotic wounds, failed primary closure wounds - may require drains

Question 29

second intention

Answer 29

- Wound is allowed to heal without closure (open) - for heavily contaminated or infected wounds - more scar tissues and heals slower

Question 30

fast healing tissues

Answer 30

- GI tract, especially the mouth - Skin-Usually heals in 7 days if properly apposed and not infected

Question 31

slow healing tissues

Answer 31

- Bone- if well stabilized and well apposed; Takes 4-6 weeks to heal - Tendon, ligaments, fascia-heal VERY slowly

Question 32

variable healing tissues

Answer 32

Muscle-heals by fibrous (scar) tissue replacement

Question 33

dehiscence

Answer 33

Amount of devitalized tissue present

Question 34

factors leading to dehiscence

Answer 34

- Long surgical procedure - Poor blood supply- lack of nutrients, WBC’s - Foreign material present - Infectious organisms-type and quantity: eg: MRSA

Question 35

when is a wound considered infected

Answer 35

when the bacterial count is >100,000 organisms/gram of tissue

Question 36

factors leading to infection

Answer 36

wound is not kept dry, clean, or protected allowing bacteria to grow

Question 37

usage of antimicrobials

Answer 37

oral - stable IV - severe infections or compromised patient

Question 38

wound treatment goals

Answer 38

prevent further contamination - allow healing phases to complete successfully

Question 39

indicate when a wound is not healing normally (?)

Answer 39

- longer to heal than expected - tissue not healing like expected - keeps breaking open

Question 40

topical agents for wound care

Answer 40

- antibiotic ointment - SSD - honey and sugar

Question 41

home care for owners regarding wound care

Answer 41

- Have owner monitor closely - Give written instructions - Have owner sign discharge sheet acknowledging receipt of the instructions - When in doubt, apply e-collar - Protects wound, focus owner attention to situation - call with questions or concerns - lots of rechecks and visits

Question 42

special considerations regarding equine wounds

Answer 42

- bandage change every 2-3 days - lower legs heal slower and more complications - can be career ending or fatal