Wound healing and reconstruction Flashcards by Leah Stevenart

What is an abrasion?

loss of epidermis and some dermis

How well did you know this?

Not at all

Perfectly

What is an avulsion?

tearing of tissues from attachments

How well did you know this?

Not at all

Perfectly

What is a laceration?

Tearing of wound creating irregular defect

How well did you know this?

Not at all

Perfectly

Describe the initial/inflammatory phase of wound healing

Transient vasoconstriction initially to control blood loss
Vasodilation follows:
- increases capillary permeability
- intrinsic and extrinsic clotting cascade
- chemotaxis of inflammatory cells
- neurtophils -> macrophages

How well did you know this?

Not at all

Perfectly

Describe the repair phase of wound healing

Fibroplasia
Cessation of inflammatory phase
Fibroblast migration:
- contact inhibition
- produce and secrete proteoglycans, collagen and elastin
Granulation tissue forms
Wound contraction
Epithelialisation

How well did you know this?

Not at all

Perfectly

Describe the remodelling/maturation phase of wound healing

Matrix synthesis and degradation
Cross linking collagen
Increase in tensile strength
Takes weeks-months

How well did you know this?

Not at all

Perfectly

How is cat wound healing different to dogs?

Granulation tissue forms slower

How well did you know this?

Not at all

Perfectly

What systemic/general factors negatively affect wound healing?

Old age
Meds (Steroids)
Radiation
Co-morbidities (e.g., Cushing’s)
Nutrition (e.g., hypoproteinaemia)

How well did you know this?

Not at all

Perfectly

What local factors negatively affect wound healing?

Contamination/infection
Seroma
Neoplasia
Foreign material
Self trauma
Necrotic tissue

How well did you know this?

Not at all

Perfectly

Describe the factors contributing to bacterial contamination of a wound

Golden period (6-12 hrs = infection)
Factors that influence:
- vascular supply (reduced ability to fight infection)
- devitalised tissue
- Type of contamination
- Cause of wound e.g., glass vs bite
- type of bacteria
- foreign bodies

How well did you know this?

Not at all

Perfectly

What are the principles of wound management?

Clip hair to protect wound
Debride wound
Antimicrobial therapy
Open vs closed healing

How well did you know this?

Not at all

Perfectly

What is the function of a wound lavage

Dilute bacteria
Mechanically remove foreign bodies
Encourage healing
Isotonic is best (Hartmann’s)

How well did you know this?

Not at all

Perfectly

Describe debridement of a wound

Removal of foreign material
Surgical vs non-surgical

How well did you know this?

Not at all

Perfectly

Describe surgical debridement of a wound

aseptic
sharp incision
remove necrotic material
repeat as often as necessary

How well did you know this?

Not at all

Perfectly

Describe the process and function of non-surgical debridement

Acts to draw away purulent and necrotic material
Wet-to-dry dressing:
Sterile swabs are moistened with sterile isotonic and excess fluid squeezed out/removed
Placed directly onto wound and layered with dry sterile swabs
Debridement occurs by osmosis
Swabs changed daily until repair phase

How well did you know this?

Not at all

Perfectly

What wound closure techniques are there?

Primary closure
Delayed primary closure
Secondary intention healing
Walking sutures
Local flaps
Skin grafts
Axial pattern flaps

How well did you know this?

Not at all

Perfectly

Describe primary closure of a wound

Immediate suture
For clean or clean-contaminated

How well did you know this?

Not at all

Perfectly

Describe delayed primary closure of a wound

For clean-contaminated or contaminated wounds
Reduces incidence of infection
Closure after 3-5 days of wound management (debridement, lavage, wet-to-dry dressings)

How well did you know this?

Not at all

Perfectly

What is secondary intention healing?

Allowing the wound to heal on its own by formation of granulation tissue, wound contraction and epithelialisation

How well did you know this?

Not at all

Perfectly

What are the advantages and disadvantages of secondary intention healing?

How well did you know this?

Not at all

Perfectly

What is the function of surgical drains?

Remove fluid accumulation
Eliminate dead space

How well did you know this?

Not at all

Perfectly

What are the advantages and disadvantages of surgical drains

How well did you know this?

Not at all

Perfectly

What is a seroma?

build up of fluid in an area where tissue has been removed

What types of drains are there?

Active and passive

Describe how passive drains/penrose drains work?

Latex rubber tube Gravity and capillary action Needs large SA Always cover (risk of ascending infection) Do not cut (reduces surface area)

Describe how active suction drains work

Closed system Needs reactivating when -ve pressure reduced -ve pressure applied to allow wound to remain dry and reduce infection rate Can easily monitor production More expensive

Describe removal of surgical drains

ASAP all drains cause FB reaction so fluid is produced Daily assessment for fluid reduction Removed in 1-5 days

Describe the potential benefits of vacuum assisted closure

increased wound perfusion Increased granulation tissue decreased bacterial count Decreased oedema

Describe the ideal wound healing environment

Moist Free of infection and excessive debris Free of toxic chemicals Warm New tissue undisturbed (minimise dressing changes) Allow for adequate gas exchange/oxygenation Dressing painless to apply and remove Dressing minimises contamination

What moisture absorbing wound dressings are there?

Wet to dry Alginates (made from seaweed) Foam dressings Hydrocolloid dressing

What types of dressings retain moisture?

Hydrogels

What types of dressing maintain moisture

Contact layer - woven or perforated material Requires secondary layer

What is the effect of honey as a wound dressing?

Osmotic action draws fluid out (Debridement) Antibacterial

How do live maggots function as a wound dressing?

Stage 1 larvae of green fly Debride necrotic material and absorb bacteria

what the issues associated with wound tension?

Circulatory compromise Reduced wound healing Infection Dehiscence (splitting) Skin necrosis

What methods can be used to provide minimal to moderate wound tension

Patient positioning Undermining Suture patterns Relaxing incisions Advancement flaps

How can patient positioning be used to minimise wound tension?

Maximises skin availability: - skin trapped by animals weight - elevation of area in front or behind - release leg ties for inguinal region - chain mastectomies

How does skin undermining minimise wound tension?

makes use of natural elasticity Increases dead space and seroma Undermine below panniculus or in deep fascia

How can walking sutures be used to minimise wound tension?

Used after skin undermining Distributes skin tension Advances skin - skin pulled forward in increments - cumulative effect of multiple walking sutures

How can relaxing incisions be used to minimise wound tension?

Single or multiple incisions on either or one side of wound to reduce tension Allows primary wound to be closed Relaxing incisions heal by secondary intention

On what kind of wounds would relaxing incisions be used?

closing chronic non healing wounds wounds exposing essential tendons, ligaments and nerves protecting surgical implants areas susceptible to trauma

What is a skin flap?

a section of skin elevated and moved into wound for coverage Skin flap retains its own blood supply

What are the main types of skin flap?

Subdermal plexus flap (may not include direct cutaneous artery) Axial pattern flap (will always include a direct cutaneous artery)

What types of subdermal plexus flaps are there?

advancement rotational transposition

What complications can arise from subdermal plexus flaps

partial thickness necrosis full thickness necrosis desensitisation and self trauma

Why can axial pattern flaps be larger?

Supplied by a names diect cutaneous artery/vein so larger area can be elevated due to more consistent blood supply

How do free skin grafts work?

Elevating and removing a section of skin from one area and placing it on another Relies on revascularisation of graft Which in turn relies on immobilisation, bandaging and placement on a well vascularised bed

What is a pocketing wound and how is it managed?

Space between skin and underlying granulation tissue prevents closure Tissue under skin is debrided and dead space closed Continue with secondary intention healing until pockets reduce

What are the benefits of a tie-over bolus dressing?

Local Can change easily by releasing tie over Avoids bandage trauma over joints skin stretching achieved

Describe the common anatomy of arachnida (ticks and mites)

1 part/non-segmented body 4 pairs of legs one pair of chelicera mouth parts one pair of pedipalps mouth parts

What are the 2 main differences between soft ticks (argasidae) and hard ticks (ixodidae)?

Describe the lifecycle of ixodidae ticks

How many hosts can hard ticks have?

May need 1,2 or 3 hosts to complete its lifecycle

What is questing in hard ticks?

ticks crawl up stems of grass with front legs extended ready to climb onto passing host

Describe the mite lifecycle

Eggs 6-legged larvae Moults to become 8-legged nymph 3 nymphal stages: - protonymph - deutonymph - tritonymph Moults to become 8-legged adult

What are the main clinical sympotoms of babesiosis?

fever pale mucous membranes coloured urine enlarged spleen swollen lymph nodesw

What are the clinical signs of louping ill?

muscular tremors nervous nibbling ataxia weakness collapse