Wound Healing Complications

Question 1

What are the key types of traumatic/open wound?

Answer 1

Abrasion
Shear/degloving
Laceration
Puncture
Crushing 
Burns

Question 2

What is an abrasion?

Answer 2

Partial thickness skin wound

Through epidermis and part of dermis

Question 3

What is a laceration?

Answer 3

A tear resulting in a full thickness irregular skin wound

Variable amount of damage to underlying tissue

Question 4

What are puncture and crushing wounds?

Answer 4

Small surface wound can have deeper effects e.g. crushing muscle, FBs etc

Question 5

What are the stages of wound healing?

Answer 5

Coagulation
Inflammation
Migration/proliferation
Remodelling

Question 6

What is the progression of cell types in wound healing?

Answer 6

Platelets 
Neutrophils 
Macrophages 
Fibroblasts 
Lymphocytes

Question 7

What is healing by secondary intension?

Answer 7

A clean wound that will heal by itself

Question 8

What is healing by primary intention?

Answer 8

A clean wound that can be closed surgically

Question 9

What are the principles of open wound management?

Answer 9

1) Assess and stabilise the whole patient
2) Initial in depth wound assessment - wound cleansing and debridement
3) Wound closure/reconstruction

Question 10

What should you do to assess and stabilise the patient?

Answer 10

1) cover wound with sterile dressing to parent nosocomial (hospital acquired) infection (get nurse to - focus of vet is what is life threatening)
2) Stabilise the patient - deal with any potentially life threatening conditions
3) Sedate or ideally anaesthetise the patient for in depth wound assessment

Question 11

How do you perform an initial in depth wound assessment ?

Answer 11

Cover the wound surface

Clip and clean around the wound as for aseptic surgery

Lavage wound

Debride wound

Close wound or continued wound debridement and care

Question 12

Why should you cover the wound surface before cleaning the surrounding skin?

Answer 12

Protect the open wound from hair etc being clipped and other surface debris

Question 13

What is the best solution to use for lavage?

Answer 13

0.9% ringer - lactated solution

Question 14

What should you use to debride a wound?

Answer 14

Scalpel

Question 15

How should you debride a wound if it is more than 6 hours old and significant ?

Answer 15

Consider staged debridement

Question 16

When should you close the wound?

Answer 16

Less than 6h old
No remaining necrotic tissue 
No remaining gross swelling/bruising 
All contaminated tissues debride 
Healthy wound

Question 17

When should you consider continued debridement?

Answer 17

More than 6h old 
Concern of ongoing necrosis 
Appears infected 
Significant skin/tissue loss 
Simple closure over a penrose drain not possible

Question 18

What is the goal of continued wound debridement?

Answer 18

Healthy granulation tissue

Question 19

What are the features of healthy granulation tissue?

Answer 19

Macrophages - naturally antibacterial
Fibroblasts - Lay down collagen to strengthen the wound and act as a scaffold for angiogenesis
Endothelial cells - creating capillary loops to bring nutrition to the wound
Epithelial cells migrating from wound edges into the wound

Question 20

What are the types of debriding dressings?

Answer 20

Wet-to-dry dressing
Hydrogel
Honey/sugar
Negative pressure wound therapy

Question 21

How does a wet-to-dry dressing work?

Answer 21

Moist sterile gauze applied to wound
Dry sterile gauze applied on top and held securely onto wound

Draws exudate out of wound into the moist then dry
Gauze adjacent to wound dries
Bacteria and necrotic tissue dry out and adhere to gauze

Mechanical wound debridement as dressing is removed

Question 22

What are the benefits of wet-to-dry dressings?

Answer 22

Inexpensive
Available
Easy to apply
Effective

Question 23

What are the disadvantages of wet-to-dry dressings?

Answer 23

Must be changed every 12-24h or as soon as moisture penetrates the outer layer (strike through)

Pain on removal - requires sedation and/or anaesthesia

Question 24

How do hydrogels work?

Answer 24

Gives up water to the wound and maintains moist wound
Wound exudate remains in contact with the wound
-endogenous GFs and cytokines promote healing
- Endogenous enzymes break up necrotic tissue
- Attracts white blood cells - phagocytosis of tissue debris and bacteria

Question 25

What are the benefits of hydrogels?

Answer 25

Inexpensive 
Easy to apply 
Effective 
Comfortable 
Useful in deep pocketed wounds

Question 26

What are the disadvantages of using hydrogels?

Answer 26

Change every24-48h

Gel, necrotic debris and dead bacteria must be flushed off the wound at each dressing change

Question 27

What are the benefits of negative pressure wound therapy?

Answer 27

Only need to change every 3 days
Animal can eat and recover from trauma
Expense is equal to daily dressing changes

Question 28

What are the disadvantages of negative pressure wound therapy?

Answer 28

Not for infected wounds
Not to be placed over large exposed blood vessels
Failure/loss of vacuum
Gauze incorporated into healing wound

Question 29

When should you stop antibiotics?

Answer 29

Once a healthy bed of granulation tissue is achieved