Wound Healing

Question 1

Wound – Injury that ____ the skin or other body ____

Answer 1

breaks, tissues

Question 2

◦ Surgical Wound – A ____ or ____ that is made during surgery
◦ _____ made
◦ Should cause ____ tissue damage

Answer 2

cut, incision, Purposefully, minimal

Question 3

◦ Traumatic Wound – _____ or ______ injury
◦ Many wounds seen in ___/___ are traumatic wound [ie: ?]

Answer 3

Sudden, unplanned, ER/GP, bites, burns, lacerations

Question 4

◦ Wound Healing – Biologic process that replaced ______ and missing _____
structures and tissue ____
◦ _____ tissue after injury

Answer 4

devitalized, cellular, layers, Restores

Question 5

◦ Open [Penetrating] Wound
◦ _____ skin and _____ tissue
◦ _____ wounds
◦ _____ wounds or incisions
◦ _____ wounds

Answer 5

Broken, exposed, Puncture, Surgical, Thermal

Question 6

◦ Closed [Non-Penetrating] Wound
◦ Damage to tissue ____ intact skin
◦ Usually secondary to ____ trauma
◦ Injured tissue is not ____, but there can be _____ +/- ____ to the underlying
muscle/internal organs/bones
◦ _______
◦ ________

Answer 6

under, blunt, exposed, bleeding, damage, Contusions, Hematomas

Question 7

◦ Abrasion
◦ Skin rubs or scrapes against a ____ or ______ surface [loss of ______ and maybe portion of the _____]
◦ Usually, no significant ______
◦ _____ and _____ wound to avoid infection

Answer 7

rough, hard, epidermis, dermis, bleeding, Scrub, clean

Question 8

◦ Laceration
◦ Cut or tear in skin that can vary in ___ and ____
◦ If the laceration is deep – bleeding can be _____ and ____

Answer 8

severity, depth, rapid, extensive

Question 9

Puncture
◦ Small ___ or wound caused by a ____, _____ object
◦ Examples – (4)
◦ _____ skin damage, but _____ tissue damage may be severe
◦ May not bleed much, but can be deep enough to damage ______ organ(s)
◦ Results in a ____ risk of subsequent infection by contamination introduced at ____ of puncture

Answer 9

hole, long, sharp, Nail, needle, teeth, knife, Minimal, underlying, internal, higher, time

Question 10

◦ Avulsion
◦ ____ or _____ tearing away of skin and tissue beneath
◦ Traumatic injury where ___ or ____ pieces of tissue are torn and ______ from the body
◦ Examples?
◦ Bleed ____ and _____

Answer 10

Partial, complete, one, more, detached, Crushing accidents, explosion, gunshots, head on collision, heavily, rapidly

Question 11

Contusion
◦ ____ force trauma that does ___ break skin, but causes _____ to the skin and _____ tissue
◦ Blood ____ from vessels within the skin or from _____ tissues
◦ Type of _____

Answer 11

Blunt, not, damage, underlying, leaks, deeper, hematoma

Question 12

◦ Hematoma
◦ _______ [_____] of blood ______ of a vessel
- ___ hematoma is common

Answer 12

Collection, pooling, outside, ear

Question 13

◦ Crushing Injury
◦ Force applied to an area of the body over a period of ____
◦ Commonly seen in ___ wounds

Answer 13

time, bite

Question 14

Additional Type of Wounds
◦ De-gloving Wound: most ______ type of wound in clinical practice; happens when the ___ layers of the skin are ripped in a traumatic fashion from underlying _____/_____/_____ itself
Examples?

Answer 14

severe, top, muscle/CT/bone

◦ Sinus Tract
◦ Burns
◦ Non-Healing Wounds
◦ Open Fracture
◦ Stings

Question 15

Wound Healing
◦ _____ processes continuously interacting to _____ tissue after injury
◦ Many factors affect how ___ or ____ a wound can heal including?

Answer 15

Multiple, restore, well, quickly

◦ Environment [temperature]
◦ Patient’s overall health
◦ Drug treatments
includes supplements and treatment plant?

Question 16

Wound Healing Phases
◦ Phase 1 – ______ Phase
◦ Occurs ______ after injury [within __-___ minutes]
◦ Mainly directed at ______ blood loss from the injured area by ______
◦ Vasoconstriction –> _____ aggregation -> ___ formation –> ______ –> ________

Answer 16

Inflammatory, immediately, 5 – 10 , minimizing, hemostasis, platelet, clot, vasodilation, phagocytosis

Question 17

Wound Healing Phases
◦ Phase 2 – Proliferative Phase
◦ Begins at 3 – 5 days and can last for several weeks [depends on the nature of the wound]
◦ Granulation contraction
◦ Epithelization of the injured tissue
◦ Phase 3 – Remodeling Phase
◦ Begins at approx. 3 weeks and can last weeks to months
◦ Formation of new collagen
◦ Wound tissue strengthening
◦ Scar formation

Question 18

Answer 18

1. GRanulation tissue in dog
2. ”” in cat
3. ”” in horses

Question 19

Principals of Wound Care
◦ There is no “golden rule” but there are 6
basic steps to stick with:
◦ 1. Prevention of further wound ________ [_____]
◦ 2. Debridement of dead and dying tissue
◦ 3. Removal of _____ debris and ______
◦ 4. Provision of adequate wound _____
◦ 5. Promotion of a viable ____ bed
◦ 6. Selection of appropriate method of ____

Answer 19

contamination, lavage, foreign, contaminants, drainage, vascular, closure

Question 20

How to Manage Wounds
◦ _____ assessment
◦ ____ assessment
◦ Wound ____ and _____
◦ Wound ______ plan

Answer 20

Patient, Wound, cleaning, debridement, management

Question 21

Patient Assessment
DO NOT TREAT WOUND WITHOUT _____
◦ Hemodynamic Stability
◦ Hypotension, murmurs, tachycardia or bradycardia, arrhythmias
◦ Hydration
◦ Start IVF vs. SQ fluid [if patient is dehydrated]
◦ Pain Sensation/Neuro Function
◦ Important in limb injuries
◦ Body Condition
◦ Poor body condition or muscle wasting noted?
◦ Organ Dysfunction
◦ Kidneys? Liver?
◦ Anemia -> is blood transfusion needed?
◦ Evidence of Sepsis
◦ Ie: left shift, toxic or degenerate neutrophils, hypo- or hyperglycemia, prolonged clotting times,
hemodynamic instability
◦ ** PROVIDE ANALGESIA**

Answer 21

ASSESSMENT

Question 22

Wound Assessment
◦ What type of wound is present?
◦ Clean
◦ Clean-Contaminated
◦ Contaminated
◦ Dirty and Infected

Question 23

Wound Contamination Classification
- Clean
◦ Involving non-______, non-______, and non- _______ surgical site. Most wounds are not ___ wounds unless ___-made.
◦ _______ tract, ____, or _____ tract is not entered
◦ _____ wound
◦ ____ technique is maintained during surgery
◦ Tissues are not predisposed to _____

Answer 23

contaminated, traumatic, inflamed, clean, self, Gastrointestinal, urinary, respiratory, Surgical, Aseptic, infection

Question 24

Wound Contamination Classification
– Clean-Contaminated
◦_______ tract, ____, and _____ tract is entered under _____ conditions without unusual contamination
◦ ____ surgical techniques with no ___ of organ contents
◦ Some ___ traumatic wound that have been cleaned
◦ Minor break in ____ [ie:?]
◦ Placement of a _____ in a “clean” wound

Answer 24

Gastrointestinal, urinary, respiratory, controlled, Aseptic, spillage, acute, sterility, perforated glove, drain

Question 25

Wound Contamination Classification
– Contaminated
◦ Surgery where ________ contents or infected ___ is spilled into an open cavity
◦ Examples:
◦ Major break in ____ technique
◦ Open ____
◦ ______ wound
◦ New ____ traumatic wounds/lacerations
◦ _____ and lavage +/- ______

Answer 25

gastrointestinal, urine, aseptic, fracture, Penetrating, open, Antibiotics, debridement

Question 26

Wound Contamination Classification
– Dirty/Infected
◦ Wound heavily ______/_____
◦ _____ discharge
◦ ______ material
◦ Examples?
◦ Treatment: ?

Answer 26

contaminated, infected, Purulent, Foreign ◦ Abscess
◦ Traumatic wound >12 hours after injury
◦ Surgery where a hollow organ/viscera is perforated, or fecal contamination occurs
◦ Gross spillage of contaminated body contents
◦ Intestines, gallbladder, pyometra

Antibiotics, lavage, debridement, drainage +/- bandage [wet to dry vs. other]

Question 27

Initial Approach
◦ Protect with _______ bandage, especially if wound care will be delayed
◦ Provide _____ ie: Lidocaine/Bupivacaine, NSAIDs, Opioids, Gabapentin, etc.
◦ Drug therapy
- _______ – topical = ointment vs. systemic
◦ Wear ____ = don’t want to introduce anything to patient; also do not want to get anything from patient
◦ Fill wound with a ______-soluble lubricant
◦ ____ and ____ with ___ margins
◦ Do not use ____ in the wound bed

Answer 27

occlusive, analgesia, Antibiotics, gloves, water, Clip, clean, wide, scrub

Question 28

Lavage
◦ Keep tissues ____
◦ Reduce _____ contamination
◦ Removed ____ contamination and ____ debris
◦ “ _____ IS THE SOLUTION TO POLLUTION”
◦ _____ wound with copious amounts of ____ fluids
◦ _____ vs. ____ vs. ______ solution
◦ _____ after lavage; going to get significant contamination, so lavage first.
◦ Do not lavage _____ wounds - depends on ____ and ___ of wound

Answer 28

hydrated, bacterial, gross, necrotic, DILUTION, Lavage, warm, Saline, LRS, chlorhexidine, Culture, puncture, area, depth

Question 29

Initial Debridement
◦ Surgical
◦ _______ edges -> ___ bleeding in that area.
◦ Sometimes only indicated in ____ for wound closure
–> _____ [Enzymatic]
◦ Use of enzymatic ointment to destroy _____ tissue.
◦ Patients that are ____ anesthetic candidates or need ____ debridement
–> Mechanical [Bandaging]
◦ Traps ______ tissue in the _____ layer of a bandage
◦ Wet to dry vs. dry to dry
◦ Biosurgical
◦ ____ therapy

Answer 29

Freshening, active, preparation, Chemical, necrotic, poor, minimal, devitalized, primary, Maggot

Question 30

Wound Debridement
–> What to debride:
◦ Contaminated SQ ___
◦ _____ fascia
◦ ______ muscle
◦ _____ skin
◦ Skin ____ [3-5mm]
–> What not to debride:
◦ Direct _____ vessels
◦ ______
◦ _____ muscles
◦ Bones with _____
◦ _____ attached to bone
◦ ____
◦ Other ___ structures

Answer 30

fat, Shredded, Macerated, Devitalized, edges, cutaneous, Hypodermis, Cutaneous, attachments, Ligament, Nerves, vital

Question 31

Closure Plan
◦ Management determined by wound classification and…
◦ ____ since injury
◦ ____ of wound
◦ Degree of _______
◦ Degree of tissue ____
◦ Extent of _____ or ___ space
◦ ____ supply of wound
◦ _____ condition of patient
◦ Results after ____ and ____

Answer 31

Time, Location, contamination, trauma, tension, dead, Blood, Clinical, debridement, lavage

Question 32

Wound Closure
–> First Intention
This is where we are using _____ and ____.
◦ Primary closure – within a few ____ [?]
–> Third Intention
◦ Delayed ____ closure [?]
◦ Prior to ______ formation
◦ ______ Closure
◦ After _____ tissue present
–> Second Intention
◦ ___-closure
◦ ______ and ______
◦ Epithelialization - Healing of ____ thickness wounds [includes ___-degree burns and ______]

Answer 32

sutures, staples, hours, 6 – 8 hours, primary, 18-24 hours, granulation, granulation, secondary, non, Contraction, epithelialization, partial, first, abrasions

Question 33

First Intention
◦ Describes ______ wound healing or closure
◦ Best choice for _____ wounds in well- ________ areas
◦ Wound is closed within ___ hours or injury with ___ or ____
◦ Minimal ____
◦ No ____ infection or _____ discharge
◦ Minimal scar formation
◦ Healing is ____
◦ Clean [____] or “___” traumatic wound after it’s been cleaned [clean-contaminated]
◦ Close a contaminated wound?
◦ Aggressively ___
◦ ____ blood supply
◦ No evidence of ______ infection
◦ <__ hours old

Answer 33

primary, healthy, vascularized, 24, sutures, staples, edema, local, serous, rapid, surgical, fresh, debride, Good, established, 6

Question 34

Third Intention
◦ Delayed _____ closure
◦ Wounds sutured ____ before _____ tissues forms
◦ Moderate to marked tissue ____
◦ ___ wounds
◦ Questionable ____
◦ _____
◦ Significant ____ and/or skin _____
◦ Best for _____ or ______ wounds that are too contaminated for primary closure
◦ Appear ___ and well ______ after approximately __-___ days
◦ Examples:
◦ Contaminated or infected wounds
◦ Extremity wounds
◦ Wounds from blunt trauma?

Answer 34

primary, closed, granulation, edema, Older, viability, Debride, swelling, tension, infected, unhealthy, clean, vascularized, 3 – 5, ◦ Contaminated or infected wounds
◦ Extremity wounds
◦ Wounds from blunt trauma

Question 35

Secondary Closure
◦ Wound closure __ ___ days after injury
◦ ______ ________ of wound initially, then _____ closed
◦ Ensure wound is clear of ____ before closing
◦ Excision of ________ edges and some ______ tissue may be required
◦ Recommended for ______ wounds or _____ wounds
Requires ____ tissue to be there ?

Answer 35

> 5, Medical management, surgically, infection, epithelialized, granulation, infected, large, granulation

Question 36

Second Intention
◦ _____ wound healing or _____ healing
◦ Wound is left ___
◦ Some may be closed _____ at some point [ _______ closure]
◦ Recommended when the patient is a poor _______/_____ candidate, _____ wounds, or ____ wound
◦ Risk of _______ formation
◦ Proud ____ in horses
◦ Examples:

Answer 36

Secondary, spontaneous, open, surgically, secondary, anesthetic, surgical, infected, large, contracture, flesh

◦ Moderate to small trunk wounds or burns
◦ Abscesses
◦ Distal extremity wounds
◦ Fistulae

Question 37

Answer 37

Second Intention Wound Healing
Know that it is going to take a long time, just do not know how long.
Expensive to manage

Question 38

Golden Period
Wound treated within ___-___ hours of injury are treated within the GOLDEN PERIOD
◦ Bacterial levels have not _____ to critical numbers yet
◦ Tissue has not become ____
◦ Wounds treated after the Golden Period should not be ____
◦ Infection is ___

Answer 38

6 – 8, multiplied, infected, closed, likely

Question 39

Tissue Viability is based on these factors…

Answer 39

◦ Attachment
◦ Color
◦ Texture
◦ Temperature

Question 40

Question 41

Bandaging
◦ Covers ____ and ____
◦ Reduces ____ space and ____
◦ _____ wounds [mechanically]
◦ Vehicle for _____
◦ _____
◦ _____
◦ ____ dressing in place

Answer 41

drains, wounds, dead, edema, Debrides, antiseptic, Immobilization, Cleanliness, Holds

Question 42

Bandaging Layers
–> Primary Layer – “______”
◦ ____ on the wound
◦ Made of ____ or ____ material that promotes early healing
◦ Allows ____ to pass through _____ layer and prevents tissue from ____ out
–> Secondary Layer
◦ Absorbs ___, ____ the wound, and decreases ____ space
◦ ______ or ______ the limb
◦ Frequently cast ______ or roll ____
–> Tertiary [Outer] Layer
◦ Provides some _____ on wound
◦ Holds ____ layers in place and protects from the environment
◦ Usually, ____ tap or ____ wraps

Answer 42

Dressing, Directly, gauze, mesh, fluid, secondary, drying, fluid, pads, dead, Supports, immobilizes, padding, cotton, pressure, inner, adhesive, elastic

Question 43

Hydrophilic Foam
◦ ______ dressing
◦ Maintains ____ wound environment
◦ ____ adherence to wound surface
◦ High ____-handling capacity
◦ Decreased ____ changes
◦ Decreased tissue _____

Answer 43

Hydrophilic, moist, Low, fluid, bandage, maceration

Question 44

Question 45

Sugar
◦ ______ wounds
◦ Decreased _______ proliferation
◦ Promotes _______ and ?
◦ Cost?
◦ ___ ___ thick layer
◦ SID – TID changes

Answer 45

Exudative, bacterial, debridement, granulation/epithelialization, Inexpensive, 1cm

Question 46

Honey
◦ Promotes?
◦ Reduces ____ and ____
◦ Easy to ____ and store
◦Cost?
◦ Clean or messy?

Answer 46

debridement, granulation, and epithelialization, edema, inflammation, acquire
Inexpensive
Messy

Question 47

Drain Placement
◦ When should a drain be placed?
◦ When dead space cannot be eliminated
◦ When fluid accumulation is likely
◦ When an infection is present
◦ Most drained remain in place for 3 – 7 days
◦ Passive Drains
◦ Relies on gravity, pressure differentials, or overflow to move fluid
or gas
◦ Fluid exits around the tube at the incision site
◦ Active Drains
◦ Apply an artificial pressure gradient to pull fluid or gas from a
wound
◦ Involves suction

Question 48

Management of Specific Wounds
◦ Cuts and Tears [Lacerations]
◦ Usually managed by complete closure
◦ Damage to muscles, tendons, or other tissue must be treated before wound can be closed
◦ Degloving Injuries
◦ Usually requires bandaging
◦ Puncture Wounds
◦ Leave open
◦ Explore? Underlying trauma?

Question 49

Management of Specific Wounds
◦ Abscess
◦ Establish draining
◦ Lavage copiously
◦ Warm compresses
◦ Antibiotics?
◦ Open Fracture
◦ Rapid wound care and culture
◦ Bandage/splint
◦ Antibiotics
◦ Analgesics
◦ Surgery consultation ASAP

Question 50

Complications
◦ Seroma
◦ Layered wound closure
◦ Drains
◦ Infection
◦ Debridement
◦ Antimicrobials
◦ +/- supportive care
◦ Dehiscence
◦ Tissue viability
◦ Closure technique
◦ Failure to heal
◦ Patient status
◦ Closure method