Wound Management

Question 1

what degree of contamination?
Nontraumatic
Do not involve respiratory, oropharyngeal, GI or urogenital organs
No visible contamination
Within 0-6 hours after surgery/wounding

Answer 1

category 1
clean wounds

Question 2

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

Answer 2

category 2
clean-contaminated

Question 3

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

Answer 3

category 3
contaminated

Question 4

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

Answer 4

category 4
infected

Question 5

what are the 4 healing stages

Answer 5

acute inflam phase
debridement phase
reparation or proliferation
remodeling or maturation phase

Question 6

what cells are part of the acute inflam phase

Answer 6

lymphocytes
PMNs
macrophages
chemotactic factors
platelets

Question 7

what inflammatory mediators are part of the acute inflammatory phase

Answer 7

cytokines (chemokines, lymphokines, monokines, interleukins, interferons)
Platelet-derived growth factor (PDGF)
Epidermal growth factor (EGF)
Fibroblast growth factor (FGF)
Vascular endothelial growth factor (VEGF)

Question 8

components of debridement phase

Answer 8

macrophages
cytokines
proteinases
proteolytic enzymes

Question 9

when does reparation or proliferation phase occur and what are the 3 processes

Answer 9

3-5 days post injury
1. granulation
2. contraction
3. epitheliazation

Question 10

cells prominent in granulation process

Answer 10

fibroblasts
+ fibrin, fibronectin, vitamin C

Question 11

cells prominent in contraction process

Answer 11

myofibroblasts

Question 12

cells prominent in epithelialization process

Answer 12

basal epithelial cells
+ increased TGF-beta

Question 13

in the remodeling or maturation phase collagen ___ is replaced by collagen ____

Answer 13

collagen III replaced by collagen I (stronger)

Question 14

what is defined by bacteria not replicating within the wound

Answer 14

contaminated

Question 15

what is defined by replicating bacteria without trauma to animals

Answer 15

colonization

Question 16

what is defined by bacteria replicating and causing trauma to animal

Answer 16

infection

Question 17

how does addition of foreign material affect the amount of bacteria in a tissue

Answer 17

reduces the volume of bacteria necessary for an infection from 10^5 to 10^4 (less is required)

Question 18

what are 4 wound cleaning techniques

Answer 18

scrubbing
lavage
antiseptic agents
topical antibiotics

Question 19

ideal lavage pressure in large animals? small animals?

Answer 19

15 psi LA
7-8 psi SA

Question 20

when to use isotonic vs hypertonic saline for a lavage

Answer 20

isotonic - relatively healthy wound, bone or synovial structures
hypertonic - heavily infected, exudative

Question 21

most selective method of debridement

Answer 21

autolytic debridement

Question 22

least selective method of debridement

Answer 22

sharp debridement (should be followed with enzymatic)

Question 23

types of debridement dressings

Answer 23

wet-wet
hypertonic saline dressing (curasalt)
honey > sugar
kerlix AMD polyhexamide

Question 24

what debridement dressing would be good for bone

Answer 24

kerlix AMD
NOT hypertonic saline

Question 25

type of antimicrobial dressing

Answer 25

Kerlix AMD - Polyhexamethylene biguanide (PHMB)

Question 26

type of moisturizing dressing

Answer 26

hydrogel wound dressings (curafil, amorphous hydrogel, curagel pad hydrogel)

Question 27

type of granulation and wound contraction dressing

Answer 27

calcium alginate (curasorb) - only use on healthy granulation tissue NOT necrotic

Question 28

can calcium alginate be used on bone

Answer 28

yes, moistened with isotonic saline

Question 29

when to use calcium alginate dressing

Answer 29

wounds where granulation tissue needs to be stimulated, dehisced surgical wound, abrasions, lacerations, skin tears, pressure ulcers, other external wounds with moderate-heavy exudate

Question 30

types of epithelialization dressings

Answer 30

semi-occlusive foam - COPA/hydrasorb
occlusive - silicone (scars in LA, only SA)

Question 31

mechanism of COPA dressing

Answer 31

increases temp by 1-2 degrees to stimulate epithelial cells and decrease fibroblasts

Question 32

canine and feline circulation vs human and pig

Answer 32

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.

Question 33

best way to lavage in small animals

Answer 33

pressure bag (1L isotonic saline) at 300 mmHg, any size needle, at 7 psi

Question 34

contract passive vs active drains

Answer 34

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

Question 35

dangers of banages

Answer 35

too tight
too loose
too short
too wet
too yummy

Question 36

where to start for debridement? proximal or distal?

Answer 36

distal as possible