Wound Healing

Question 1

What are three major decisions that must be made about wound management?

Answer 1

(What structures are involved, are you going to tx in field or refer, and are you going to do a primary closure or manage by second intention healing (other important principles are using abx and NSAIDs, what/how to lavage the wound, and +/- a bandage))

Question 2

What answers to the question “when did your horse last receive a tetanus toxoid booster” would lead you to booster a wounded horse’s tetanus vaccine?

Answer 2

(Never, no idea, or > 6 months ago)

Question 3

Why might you ask ‘did you notice anywhere where this injury may have occurred’?

Answer 3

(The answer may or may not impact what you do for the wound (was it a shit covered nail or something idk) but also, this can help the owner to fix that issue and prevent another injury from occurring)

Question 4

(T/F) You need a wounded horse to trot to assess the extent of the damage.

Answer 4

(F, trotting a horse is not relevant to how you will proceed with a wound and if there was enough damage to cause a fracture, you could make it worse)

Question 5

If a wound has granulation tissue, it is at least how old?

Answer 5

(~5 days old)

Question 6

What are the two explanations for distraction of wound margins?

Answer 6

(Either tissue was removed (this means a primary closure is unlikely to be successful) or there is tension pulling the wound margins apart (primary closure still possible if you use mechanical creep to your advantage))

Question 7

Of the following, which would be appropriate for thorough cleansing of a wound?

• Hydrogen peroxide
• Saline or filtered water
• Dilute betadine or chlorhexidine scrub
• Full strength betadine or chlorhexidine solution
• Dilute betadine or chlorhexidine solution

Answer 7

• Hydrogen peroxide (No)
• Saline or filtered water (Yes)
• Dilute betadine or chlorhexidine scrub (No)
• Full strength betadine or chlorhexidine solution (No)
• Dilute betadine or chlorhexidine solution (Yes)

Question 8

What is the purpose of giving antibiotics to a horse with a fresh wound with no granulation tissue?

Answer 8

(To prevent cellulitis until granulation tissue grows → usually do 5-7 days of TMS)

Question 9

What are some of the purposes of a bandage for wound management?

Answer 9

(Control hemorrhage, protect tissue, control swelling, reduce wound motion, maintain topical meds/txs, absorb exudate, and wound debridement)

Question 10

What is the main disadvantage of using bandages in wound management?

Answer 10

(Potential to increase granulation tissue formation)

Question 11

What are the benefits of regional antibiotic delivery?

Answer 11

(You can get very high concentrations of drug at the site of suspected infection, you are avoiding systemic toxicity, and you have a wider antibiotic selection if you choose this route of adm; it’s also cheaper)

Question 12

What are the different types of wound debridement?

Answer 12

(Mechanical (most common, sterile saline, gauze, dressings, sharp), chemical, and autolytic)

Question 13

The inflammatory phase is shortened/prolonged (choose) when dense fibrous tissue such as tendon or bone is exposed due to a wound.

Answer 13

(Prolonged, those tissues take longer to debride and sprout granulation tissue)

Question 14

What diagnostic imaging is great for looking at foreign bodies in wounds?

Answer 14

(Ultrasound, can also use it to check for abdominal penetration with a foreign body)

Question 15

The use of free/pedicle (choose) grafts is more common in equine wound cases.

Answer 15

(Free, their skin is not compatible with pedicle grafting)

Question 16

How is a graft held in place and how does it receive nutrition during the adherence phase?

Answer 16

(It is held in place by fibrin and it receives nutrition from the wound bed via diffusion)

Question 17

What are some reasons for graft failure?

Answer 17

(Poor recipient bed preparation, poor graft harvesting technique, infection, movement (shear forces), hematoma/seroma formation, wound exudate, poor blood supply to graft bed, and tumor transformation (specifically sarcoids, uncommon))

Question 18

What are some of the things that selection of a graft type depends on?

Answer 18

(Wound location, desired cosmetics, nature of granulation bed, expertise, personal preference, and owner finances)

Question 19

(T/F) Island grafts (such as tunnel, punch, or pinch) can be done on a standing (but sedated) horse.

Answer 19

(T)

Question 20

What are the disadvantages of island grafts?

Answer 20

(Not the best cosmetics and it is tedious for large wounds; advantages are easy, inexpensive, standing horse, functional, and rewarding)

Question 21

Describe the optimal recipient bed for a graft.

Answer 21

(Smooth, no infection, no necrotic tissue, bleeds readily, trimmed as needed)

Question 22

What are the primary goals of your donor site choice for grafts?

Answer 22

(You’re looking for a spot with enough tissue to donate that will not affect the cosmetics of the horse)

Question 23

Donor sites for grafts should be clipped/shaved (choose).

Answer 23

(Clipped, shaving causes micro cuts and irritation; should be surgically prepped, anesthetized, and then rinsed with sterile saline)

Question 24

What layers are taken from the donor site when performing a punch graft harvest and do you want to trim anything from it prior to placing it in the recipient bed?

Answer 24

(Epidermis, dermis, and subq are taken with a punch, you need to trim the subq tissue off prior to grafting)

Question 25

Pinch graft harvesting goes partial thickness into the epidermis/dermis/subq tissue (choose).

Answer 25

(Dermis)

Question 26

Grafts are not firmly attached with fibrous adhesions and vessels until what day post grafting?

Answer 26

(9-10 days, so be careful with bandage changes, minimize them and use bandage material that will not adhere to the grafts (or when you pull it off, it might look like a pore strip))