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Jorge ENI > Wound healing and reconstruction > Flashcards

Wound healing and reconstruction Flashcards

1
Q

What is an abrasion?

A

loss of epidermis and some dermis

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2
Q

What is an avulsion?

A

tearing of tissues from attachments

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3
Q

What is a laceration?

A

Tearing of wound creating irregular defect

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4
Q

Describe the initial/inflammatory phase of wound healing

A

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

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5
Q

Describe the repair phase of wound healing

A

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

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6
Q

Describe the remodelling/maturation phase of wound healing

A

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

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7
Q

How is cat wound healing different to dogs?

A

Granulation tissue forms slower

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8
Q

What systemic/general factors negatively affect wound healing?

A

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

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9
Q

What local factors negatively affect wound healing?

A

Contamination/infection
Seroma
Neoplasia
Foreign material
Self trauma
Necrotic tissue

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10
Q

Describe the factors contributing to bacterial contamination of a wound

A

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

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11
Q

What are the principles of wound management?

A

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

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12
Q

What is the function of a wound lavage

A

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

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13
Q

Describe debridement of a wound

A

Removal of foreign material
Surgical vs non-surgical

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14
Q

Describe surgical debridement of a wound

A

aseptic
sharp incision
remove necrotic material
repeat as often as necessary

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15
Q

Describe the process and function of non-surgical debridement

A

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

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16
Q

What wound closure techniques are there?

A

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

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17
Q

Describe primary closure of a wound

A

Immediate suture
For clean or clean-contaminated

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18
Q

Describe delayed primary closure of a wound

A

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

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19
Q

What is secondary intention healing?

A

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

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20
Q

What are the advantages and disadvantages of secondary intention healing?

A
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21
Q

What is the function of surgical drains?

A

Remove fluid accumulation
Eliminate dead space

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22
Q

What are the advantages and disadvantages of surgical drains

A
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23
Q

What is a seroma?

A

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

24
Q

What types of drains are there?

A

Active and passive

25
Q

Describe how passive drains/penrose drains work?

A

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

26
Q

Describe how active suction drains work

A

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

27
Q

Describe removal of surgical drains

A

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

28
Q

Describe the potential benefits of vacuum assisted closure

A

increased wound perfusion
Increased granulation tissue
decreased bacterial count
Decreased oedema

29
Q

Describe the ideal wound healing environment

A

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

30
Q

What moisture absorbing wound dressings are there?

A

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

31
Q

What types of dressings retain moisture?

A

Hydrogels

32
Q

What types of dressing maintain moisture

A

Contact layer - woven or perforated material
Requires secondary layer

33
Q

What is the effect of honey as a wound dressing?

A

Osmotic action draws fluid out (Debridement)
Antibacterial

34
Q

How do live maggots function as a wound dressing?

A

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

35
Q

what the issues associated with wound tension?

A

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

36
Q

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

A

Patient positioning
Undermining
Suture patterns
Relaxing incisions
Advancement flaps

37
Q

How can patient positioning be used to minimise wound tension?

A

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

38
Q

How does skin undermining minimise wound tension?

A

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

39
Q

How can walking sutures be used to minimise wound tension?

A

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

40
Q

How can relaxing incisions be used to minimise wound tension?

A

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

41
Q

On what kind of wounds would relaxing incisions be used?

A

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

42
Q

What is a skin flap?

A

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

43
Q

What are the main types of skin flap?

A

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

44
Q

What types of subdermal plexus flaps are there?

A

advancement
rotational
transposition

45
Q

What complications can arise from subdermal plexus flaps

A

partial thickness necrosis
full thickness necrosis
desensitisation and self trauma

46
Q

Why can axial pattern flaps be larger?

A

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

47
Q

How do free skin grafts work?

A

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

48
Q

What is a pocketing wound and how is it managed?

A

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

49
Q

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

A

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

50
Q

Describe the common anatomy of arachnida (ticks and mites)

A

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

51
Q

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

A
52
Q

Describe the lifecycle of ixodidae ticks

A
53
Q

How many hosts can hard ticks have?

A

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

54
Q

What is questing in hard ticks?

A

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

55
Q

Describe the mite lifecycle

A

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

56
Q

What are the main clinical sympotoms of babesiosis?

A

fever
pale mucous membranes
coloured urine
enlarged spleen
swollen lymph nodesw

57
Q

What are the clinical signs of louping ill?

A

muscular tremors
nervous nibbling
ataxia
weakness
collapse

Jorge ENI (81 decks)

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