Wound Management Flashcards
quittor
infection of lateral cartilage of pastern
a wound is near a synovial joint. what should you do?
collect synovial fluid sample
then distend joint with STERILE ISOTONIC SALINE
look for drainage from wound to determine if joint involved
epithelization starts….
immediately
polysporin
gentler antibiotic ointment than neomycin
secondary closure is used on what wounds
> 5 days old; after granulation tissue has set in
diagnostics for LA wounds (4)
- PE
- rads
- US
- always probe!!
true or false: lavaging with dilute antiseptics is NOT effective
true
nitrofurazone
yellow topical antibiotic agent used in horses
carcinogenic
scarlet oil
horse wound potion; stimulates granulation tissue so contraindicated on limbs
hydrogels are good for…
desiccated/dry wounds; leave in place for 4-7 days
what type of wound can damage navicular bone/bursa
punctures to sole/frog
you should always ______ when dealing with wounds (3)
- debride well (#1 factor for successful healing)
- wear gloves
- bandage
how to prevent infections
- debride/clean (may need to debride multiple times)
- bandage
- appropriate use of topical antimicrobials
vetricyn
contains bleach; should never be used on horse wound
_____ types of closures are used AFTER granulation tissue appears
secondary closure or second intention healing
what’s a concern with wounds near coronary band?
can affect future hoof growth
true or false: you should avoid putting anything on a wound that you don’t want in eyes or consumed
true
what’s a concern with punctures to the sole/frog
concern for navicular bone/bursa damage
a horse gets a wound; he’s already vaccinated for tetanus
booster him
hydrogen peroxide
cytotoxic; do NOT use on wounds
true or false: there isn’t really a golden period of wound healing in horses
true
always evaluate _____ before giving a horse analgesia
heart
phases of wound healing (3)
- inflammatory: hemostasis + acute inflammation + fibrin deposit
- proliferative: tissue formation + angiogenesis
- remodeling: regains some strength via cross linking of collagen fibers + alignment along lines of tension
can use _____ syringe when lavaging LA wounds
35 cc
cause of proud flesh
horse limbs have:
- increased motion
- decreased vascularity
- poor wound contraction
- little muscular support
- inefficient inflammatory phase in horses (neutrophils stay longer) -> profibrotic/chronic inflammatory state
- some topical agents can contribute (scarlet oil)
true or false: full thickness lip lacerations MUST be repaired surgically
true
steroids on wounds?
NO
ointment can _______ when applied to wounds
inhibit epithelialization
contraction of wounds begins when?
week 2
occurs centripetally
fibroblasts -> myofibroblasts
tissue formation and angiogenesis occurs during which phase of wound healing?
proliferative
______ indicates infection
> 10^5 bacteria/gram of tissue
PRP
growth factors used on wounds
what’s a concern with heel bulb lacerations?
concern for coffin joint involvement
what’s a concern with lacerations to the pastern (2)
concern for:
- pastern joint involvement
- DDF tendon sheath involvement
- collateral cartilage damage/quittor if on lateral aspect
panalog
antibiotic + steroid ointment; should NOT be used on horse wounds
semiocclusive foam is good for what type of wounds?
healthy/not infected
_____ types of closures are used BEFORE granulation tissue appears
primary or delayed primary closure
how to deal with chronic wounds
no potions!!
remove excess granulation tissue SURGICALLY (don’t use chemical agents because kills epithelium)
remodeling phase of wound healing: begins when and involves what
begins after 2 weeks and continues for years sometimes
wound regains some strength via alignment of collagen along lines of tension + crosslinking of collagen fibers
white lotion
contains lead; should never be used on horse wound
why are healed wounds weaker?
new epidermis lacks dermis
primary closure is used for ______ wounds
clean and clean contaminated BEFORE granulation tissue
UMF > ____ needed when using honey for wounds
UMF >10 for dogs
UMF > 15 for horses
most repaired wounds fail due to…
improper preparation and assessment
type of biological dressing used in horses
equine amnion
hypertonic saline/wet-dry dressing is good for…
highly exudative/necrotic wounds;
change q 24-48 hours
antiseptics on wounds?
no; cytotoxic
analgesia options for horses
- alpha 2 agonists (reversible; sedation + analgesia; xylazine is good short acting option)
- NSAIDS
- opioids: butorphanol can improve effect of alpha 2 agonists
a tetanus naïve horse gets a wound
give BOTH toxoid and antitoxin
1 factor for successful wound healing
debridement
what’s a concern with axillary wounds?
SQ emphysema/pneumomediastinum
**strict stall rest
calcium alginate is good for what type of wounds?
wounds in granulation phase or wounds over broken bones
treatment options for excess granulation tissue (3)
- resection + bandage (contact inhibition; no nerve block needed because no nerves in granulation tissue)
- delayed secondary closure (often needs multiple debridements)
- skin grafts
why don’t you need local blocks when debriding granulation tissue?
no nerves in granulation tissue
healthy granulation tissue appears…
pink; flat/even with skin; no fissures; no hematomas; no inflammation
if granulation tissue isn’t healthy enough yet for a skin graft, what should you do?
debride; use TAO for a few days
types of skin grafts
- pedicle vs. free graft
- full thickness (requires GA) vs. partial thickness (epidermis + part of dermis; uses watson know or dermatome)
- auto vs. allograft vs. xenograft
what tools are used to harvest partial thickness
- watson knife or
- dermatome
pros of full thickness skin graft
- more cosmetic
- resists trauma better
con of full thickness skin graft
not as readily accepted
skin grafts adhere to recipient bed via…
fibrin
how are skin grafts fed?
nourished by plasma like fluid via capillaries (serum imbibition)
general steps for applying a skin graft
- create recipient holes FIRST to allow for hemostasis (6 mm apart; start distally because bleeds a lot; recipient holes must be SMALLER than graft)
- harvest graft from under mane or ventrlateral abdomen (excise SQ + fat to ensure adherance)
reasons for graft failure
- ** site prep most important for survival
- hemorrhage
- infection
- motion -> stall rest
graft survival is most dependent upon….
site prep
______ ( a complication of skin grafting) prevents fibrin adherence and vessel growth
hemorrhage/fluid accumulation
graft must ______ to prevent fluid accumulation
contact wound
what must you pay attention to when applying sheet graphs?
direction of hair growth
some bacteria can infect wounds with <10^5 bacteria/gram of tissu. which bacteria can do this? (2)
- pseudomonas
- B hemolytic strep
types of free skin grafts
- island free grafts:
- pinch/seed
- punch
- tunnel (rare)
- sheet free grafts
- split vs. full thickness
- solid vs. meshed
types of island free grafts (3)
- pinch/seed
- punch
- tunnel
types of sheet free grafts
- split vs. full thickness
- solid vs. mesh
pros of mesh grafts (3)
- allows graft to cover larger area
- prevents fluid accumulation
- conforms to irregular surfaces
survival rate of punch grafts
60-75%
recovery following skin graft
- bandage: sterile, non-adherent, use elastic gauze roll because don’t want tension
- STALL REST
____ scalpel blade is used for recipient bed prep for pinch grafts
15
_____ scalpel blade is used for harvesting pinch graft
11
size of pinch graft
3 mm
how far apart should island skin grafts be?
6 mm
how do you secure sheet graphs?
at margins
pros of pinch and punch skin graphs (3)
- no GA needed!!
- minimal equipment/skill
- complete failure rare (60-75% survival rate)
cons of pinch and punch skin graphs (2)
- poor cosmesis
- little hair growth
