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ENI 2 > wound healing and reconstruction > Flashcards

wound healing and reconstruction Flashcards

1
Q

what is an abrasion

A
  • loss of epidermis and maybe some dermis
  • not full tickness
  • due to blunt trauma/shearing
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2
Q

what is an avulsion

A
  • tearing of tissues from attachments but usually left as flap
  • on limbs: degloving
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3
Q

what is an incision

A
  • Created by a sharp object
  • minimal trauma
  • all surgical wounds
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4
Q

what is a laceration

A
  • similar to incision but not controlled
  • tearing of wound creating irregular defect
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5
Q

what is a puncture

A
  • penetrating wound
  • superficial damage may be minimal
  • deep damage may be substantial (organs etc.)
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6
Q

what type of wound is this

A

abrasion

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7
Q

what type of wound is this

A

avulsion/laceration

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8
Q

what type of wounds are these

A

incisions

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9
Q

what type of wound is this

A

puncture

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10
Q

discuss vascular supply of the skin

A
  • 3 layers of supply to all 3 layers of skin (deep, middle and superficial
  • subdermal plexus is major netwrok supplying blood from direct cutaneous artery
  • direct cutaneous artery branches off to supply skin
  • if cut, patch of skin it was feeding will die
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11
Q

what are the 3 phases of wound healing

A
  • inflammation/hemostasis
  • fibroplasia
  • maturation
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12
Q

what occurs during the inflammatory phase of wound healing and how can you tell you are looking at a wound in this phase

A
  • transient vasoconstriction (prevet bleeding out) then vasodilation (to get as many clotting factors and inflam cells as possible to site)
  • increased capillary permeability
  • activation of intrinsic and extrinsic clotting cascade
  • chemotaxis of inflammatory cells
  • neutrophils called to site followed by macrophages (macros send signals for more cells to accumulate)

can tell: fresh blood, fresh edges, no granulation tissue

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13
Q

what occurs during the repair phase and how can you identify that you are looking at a wound in this stage

A
  • fibroplasia
  • cessation of inflammatory phase
  • fibroblast migration (contact inhibition = cells meet eachother and signal to stop spreading and production of proteoglycans, collagen and elastin)
  • wound contractions
  • epithelialisation

Can tell: granulation tissue and pink epithelisation around edges

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14
Q

what occurs in the maturation/remodelling phase and how can you tell you are looking at a wound in this phase

A
  • matrix synthesis and matrix degradation
  • cross linking of collagen type 1 and 3
  • inrease in tensile strength
  • scar formation
  • takes weeks to months

can tell: dry scab, no visible granulation tissue (or very little), scar

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15
Q

what species has slower wound healing

A

cats: granulation tissue forms slower and wound strength therefore less at same healing timeperiods

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16
Q

list systemic factors that negatively impact wound healing

A
  • old age
  • medications (steroids)
  • radiation
  • co-morbidities (cushings and diabetes)
  • nutrition
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17
Q

list local factors that negatively affect wound healing

A
  • seroma
  • neoplasia
  • foreign material
  • self trauma
  • necrostic tissue
  • contamination infection
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18
Q

you are presented with a patient with a wound. what will you do first

A

assess the patient for other injuries
- always stabilise patient first, dont miss something more traumatic inside that can kill the patient by being distracted by the wound!!!
- TPR, imaging, bloodwork, history,

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19
Q

what things will you look for when assessing a wound

A
  • level of contamination (soil/organic material within?)
  • type of tissue affected (just skin? muscle? bone? tendon?)
  • vascular compromise (are the tissues viable)
  • foreign material (hair and sutures)
20
Q

most animal wounds are contaminated. how do you distinguish contaminationf from infection

A

for a wound to be infected, the bacterial must be present in large amounts for period of time. contamination is considered as bacteria where it doesnt belong. it takes 6-12 hours for bacteria to divide and more than 12 hours for bacteria to invade the tissue

21
Q

what factors influence bacterial contamination of a wound

A
  • vascular supply (reduced ability to fight infection)
  • devitalised tissue (increased bacteria growth)
  • foreign body (reduced ability to fight infection)
  • type of contamination (bite vs cut from glass?)
  • type of bacteria
22
Q

what are the goals of wound management

A
  • promote healing
  • convert contaminated into “clean”
  • control infection
23
Q

what are the principles of wound management

A
  • clip hair to protect wound
  • debride wound
  • antimicrobial therapy
  • open vs closed healing
24
Q

discuss wound levage

A
  • purpose to dilute bacteria and flush out FB
  • encourages healing
  • isotonic solutions are best (can use water but could kill good cells)
  • always culture AFTER levage
25
Q

what concentrations of chlorohexidine and iodine are appropriate for flushing wounds

A
  • chlorohexidine 0.05%
  • iondine 0.1-0.01%
26
Q

how do you prepare a wet to dry dressing and what is its purpose

A
  1. moisten sterile swabs with sterile isotonic solution
  2. remove excess fluids
  3. place directly onto wound
  4. layer with dry sterile swabs
  5. debridement occurs by osmosis and the contaminated material will be drawn up toward dry gauze
  6. change daily until reach repair stage
27
Q

what is a tie over bolus

A
  • useful for hard to dress areas
  • loop stay sutures around wound (nylon)
  • umbilical tape criss crosses over gauze
28
Q

what is primary closure

A
  • immediate suture
  • clean or clean-contaminated only
29
Q

what is delayed primary closure

A
  • clean-contaminated to contaminated wounds
  • reduces incidence of infection
  • closure after 3-5 days of wound management
30
Q

what is secondary intention healing and what are the advantages/disadvantages

A
  • no skin closure, leave wound and manage with bandages to heal on its own
  • advantages: optimum wound drainage, local infection control and cheap
  • disadvantages: poor cosmetic results, poor functional results if in a functional area, timely, results in thinner, fragile skin
31
Q

what is proud flesh

A

exuberant (overgrowth) of granulation tissue
- particularly issue in horses
- must be cut off as will prevent epithelium from making contact

32
Q

what are the advantages of a surgical drain

A
  • remove fluid accumulation
  • eliminate dead space
  • increase healing capacity
  • reduce tension from seroma formation
33
Q

what are the disadvantages of surgical drains

A
  • introduction of FB
  • introduction of infection
  • seroma always better than abscess!
34
Q

list types of drains

A
  • passive: penrose
  • active:
35
Q

what is the ideal healing envionment for advanced wound care

A
  • a moist environment that isnt macerated
  • free of infection and excessive debris
  • free of toxic chemicals, particles or fibres
  • warm - at the optimum temperature for healing
  • leave new tissue undistrubed (minimise frequency of dressing changes)
  • allow for adequate gas exchange
  • dressing should be painless to apply and remove
  • dressings should minimise contamination both to and from the wound
36
Q

give examples of dressing that absorb moisture

A
  • wet to dry
  • alginates (made from seaweed)
  • foam dressings (can also be used for dry wounds)
  • hydrocolloid dressings (can also use on dry wounds)
37
Q

what dressings maintain moisture

A
  • hydrogels
  • blister plaster
38
Q

what are the principles of wound closure

A
  • know your anatomy
  • have a plan A, B and C
  • always have good client communication
  • clip and prepare larger area than anticipated
39
Q

what are the issues with wound tension

A
  • circulatory compromise
  • reduced wound healing
  • infection
  • dehiscence
  • skin necrosis
40
Q

how do you minimise wound tension

A
  • patient positioning
  • undermining
  • suture patterns
  • relaxing incision
  • advancement flaps
  • techniques that provide additional skin
41
Q

what is skin undermining and its benefits? how is it performed

A
  • using blunt tipped metzenbaum scissors (or scalpel if scar tissue), blunt dissect under skin
  • preserve direct cutaneous artery if possible
  • gives you extra space to work with
42
Q

what are walking sutures

A
  • used after skin is undermined
  • method of distributing skin tension
  • method of advancing skins
  • in areas where undermining and suture closure is sufficient for closure
  • skin pulled forward in increments (great cumulative effect of multiple)
43
Q

what are relaxing incisions

A
  • either single or multiple incisions on either or one side of the wound to reduce tension
  • enables the primary wound to be closed
  • heal by secondary intention
44
Q

what is a skin flap

A
  • a section of skin elevated (usually local to the wound) and moved into the wound for coverage
  • a skin flap retains its own blood supply
  • as long as there is availible skin, a skin flap can be used anywhere
  • 2 types: subdermal (random) plexus flap (may or may not include direct cutaneous artery) and axial pattern flap (will always include a direct cutaneous artery)
45
Q

list complications of skin flaps

A
  • partial thickness necrosis
  • full thickness necrosis
  • desensitisation and self trauma

ENI 2 (81 decks)

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