Wound healing

Question 1

descr the phases of wound healing

Answer 1

4 x inflm phases
3 x prolif phases
remodel and mature

Question 2

what happens in the inflammatory phases

Answer 2

1 - the insult occurs and vasocon–>dil. PLTs and fibrin seal/plug
2 - debrided by phagocytes 96hrs, erythema and oedema around edges
3 - PMNs go to high ppO2 (24-48hrs); monocytes + tissue factor-b –> mphages (48hrs)
4 - capillary sprouting

Question 3

desc the proliferative phases

Answer 3

1 - d4-12 = reduce tissue deficit by epithelial prolife
2 - granulation tissue forms over the top of f-vasc mesh - capillaries sprout through
3 - epithelial migration

Question 4

how is a scar remodelled

Answer 4

mechanical loading tells body where elastin and collagen is needed
wound strength 80% by 3mths

Question 5

list some impeding factors on wound healing

Answer 5

local =  perfusion, tissue viability, dead space --> haematoma/seroma, infection, movement
systemic = immune factors, oncology, DM, obesity, starvation, steroids, burns

Question 6

give the 6 main wound descriptors

Answer 6

1. laceration - damage beyond the epithelium
2. contusions - sub-epithelial damage
3. abrasions/erosions - loss of some surface epi, no dermis
4. ulcers - loss of surface epi + exposure of dermis
5. burns - thermal, electrical, radiation or chemical; 1st, 2nd, 3rd degree
6. punctures - damage into tendons/cavities..

Question 7

what do the descriptors
clean
clean contaminated
contaminated
dirty 
mean?

Answer 7

clean - aseptic
clean contaminated - involve a body tract (eg GI)
contaminated - been cleaned and debrided but still not aseptic
dirty - need to be left to drain (cat bit abscess)

Question 8

what are th 5 considerations needed about a wound when initially assessing

Answer 8

1. location
2. depth
3. direction
4. severity
5. any other structure involved

Question 9

what should all equine wounds receive

Answer 9

tetanus toxoid vaccine if not up to date

Question 10

when and what is the golden period

Answer 10

3-5hrs

time for bacteria to usually reach x10^5 (enough to stop 1st+2nd intention healing)

Question 11

how do you sx-ally deal with 2nd intention wounds

Answer 11

either following regular redressing and debridement –> delayed primary closure OR leave open to drain naturally/+lavage

Question 12

give basic aftercare for a O re the wound

Answer 12

• come back if any issues/worries
• sutures out at d10-14
• lead/box rest
• bustercollar
• NSAIDs - antiinflm and analgesia
• +-Abx

Question 13

what should be used to clean wounds (in the first instance and after that)

Answer 13

chlorhexadine initially - never sx-spirit

then saline - or all the f-cytes get killed and healing delayed

Question 14

why is the omentum useful in wounds

Answer 14

can be packed into notoriously difficult wounds (axilla etc)

Question 15

what are MMP and TIMP

Answer 15

MMP = build granulation; TIMP - degrades it

Question 16

why is amuka honey useful if suspect a foreign body

Answer 16

v effective at drawing it up and out. 87% sugar. anti-MO properties partic again pseudomona and other gram -!!!… remember to use a v absorbant dressing!

Question 17

after how long will a granulated wound not contract any further?

Answer 17

6wks+

Question 18

how long does epitheliasation take after thic 6wk period

Answer 18

1mm/10d - might be able to justify to owners a sx-intervention and graft