Wound Management Flashcards
what degree of contamination?
Nontraumatic
Do not involve respiratory, oropharyngeal, GI or urogenital organs
No visible contamination
Within 0-6 hours after surgery/wounding
category 1
clean wounds
what degree of contamination?
Nontraumatic
Respiratory, oropharyngeal, GI or urogenital organs are opened without spillage of contents
Clean wounds in which drain is placed
Cases of small breaches in aseptic technique
Within 0-6hr after surgery
category 2
clean-contaminated
what degree of contamination?
Traumatic
Inflammatory processes with purulent exudate (> bacteria)
Procedures that are contaminated with contents of GI organs of infected urine
Serious breach in aseptic technique
Less than 4-6 hr
category 3
contaminated
what degree of contamination?
Traumatic
Obvious contamination or signs of infection or inflammatory processes with purulent exudate or necrotic tissue
Perforation of GI or infected urogenital organs, serious fecal contamination
contains > 10^5 bacteria/gram of tissue
More than 4-6 hrs old
category 4
infected
what are the 4 healing stages
acute inflam phase
debridement phase
reparation or proliferation
remodeling or maturation phase
what cells are part of the acute inflam phase
lymphocytes
PMNs
macrophages
chemotactic factors
platelets
what inflammatory mediators are part of the acute inflammatory phase
cytokines (chemokines, lymphokines, monokines, interleukins, interferons)
Platelet-derived growth factor (PDGF)
Epidermal growth factor (EGF)
Fibroblast growth factor (FGF)
Vascular endothelial growth factor (VEGF)
components of debridement phase
macrophages
cytokines
proteinases
proteolytic enzymes
when does reparation or proliferation phase occur and what are the 3 processes
3-5 days post injury
1. granulation
2. contraction
3. epitheliazation
cells prominent in granulation process
fibroblasts
+ fibrin, fibronectin, vitamin C
cells prominent in contraction process
myofibroblasts
cells prominent in epithelialization process
basal epithelial cells
+ increased TGF-beta
in the remodeling or maturation phase collagen ___ is replaced by collagen ____
collagen III replaced by collagen I (stronger)
what is defined by bacteria not replicating within the wound
contaminated
what is defined by replicating bacteria without trauma to animals
colonization
what is defined by bacteria replicating and causing trauma to animal
infection
how does addition of foreign material affect the amount of bacteria in a tissue
reduces the volume of bacteria necessary for an infection from 10^5 to 10^4 (less is required)
what are 4 wound cleaning techniques
scrubbing
lavage
antiseptic agents
topical antibiotics
ideal lavage pressure in large animals? small animals?
15 psi LA
7-8 psi SA
when to use isotonic vs hypertonic saline for a lavage
isotonic - relatively healthy wound, bone or synovial structures
hypertonic - heavily infected, exudative
most selective method of debridement
autolytic debridement
least selective method of debridement
sharp debridement (should be followed with enzymatic)
types of debridement dressings
wet-wet
hypertonic saline dressing (curasalt)
honey > sugar
kerlix AMD polyhexamide
what debridement dressing would be good for bone
kerlix AMD
NOT hypertonic saline
type of antimicrobial dressing
Kerlix AMD - Polyhexamethylene biguanide (PHMB)
type of moisturizing dressing
hydrogel wound dressings (curafil, amorphous hydrogel, curagel pad hydrogel)
type of granulation and wound contraction dressing
calcium alginate (curasorb) - only use on healthy granulation tissue NOT necrotic
can calcium alginate be used on bone
yes, moistened with isotonic saline
when to use calcium alginate dressing
wounds where granulation tissue needs to be stimulated, dehisced surgical wound, abrasions, lacerations, skin tears, pressure ulcers, other external wounds with moderate-heavy exudate
types of epithelialization dressings
semi-occlusive foam - COPA/hydrasorb
occlusive - silicone (scars in LA, only SA)
mechanism of COPA dressing
increases temp by 1-2 degrees to stimulate epithelial cells and decrease fibroblasts
canine and feline circulation vs human and pig
canine/feline - cutaneous artery & veins with branching in panniculus m. = allows skin to maintain blood supply
human/pig - musculocutaneous artery & veins with branching in skeletal m.
best way to lavage in small animals
pressure bag (1L isotonic saline) at 300 mmHg, any size needle, at 7 psi
contract passive vs active drains
passive
- conduit of fluid
- gravity dependent
- exit site separate from primary incision (ventral) and must be kept covered
- risk of ascending infection
- remove 3-5 days
active
- closed system, suction
- exit site anywhere
- fluid quantitation and analysis
- decreased risk of infection
dangers of banages
too tight
too loose
too short
too wet
too yummy
where to start for debridement? proximal or distal?
distal as possible
