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Small Animal Surgery > Wound Management > Flashcards

Wound Management Flashcards

1
Q

Avulsion

A
  • Tearing away of body tissue due to shear
  • Degloving injury
  • Flaps of tissue
  • Avulsed part may be attached by flap of skin
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2
Q

What is the golden period in regards to timing of injury?

A
  • Within 6 hours of injury - this is when bacterial numbers are still low
  • Beyond 6 hours of injury, bacterial growth reach numbers that risk infection (105 per gram of tissue)
  • The earlier you can get to a wound, the better you can close it off without it becoming infected
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3
Q

Degree of Contamination: clean, clean contaminated, contaminated, dirty/infected

A
  • Clean: surgically created, no hollow viscous opened
  • Clean contaminated: minimal contamination; contamination can be effectively removed; includes surgery of hollow viscus (intestines, stomach, etc)
  • Contaminated: open traumatic wounds; break in aseptic technique
  • Dirty/infected: Old traumatic wounds; perforated viscus; clinical infection (open abdomen where there is already peritonitis)
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4
Q

Will the presence of bacteria alone cause an infection in a wound?

A

No, you need more than just some bacteria on a wound to cause an infection. Usually there is some compromised effect of local immunity, it depends on the blodo supply and the amoutn of traumatized tissue, and the amoutn/type of foreign debris present. Patient age also plays a role.

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5
Q

When to culture and what to culture

A
  • When to culture:
    • BEFORE anitbiotics if possible
    • When there is gross evidence of infection - not useful to culture a fresh wound
  • What to culture
    • Deep tissue layer, NOT the surface
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6
Q

Acute Wound Management Goals

A
  • Remove obvious devitalized tissue
  • Remove foreign bodies/debris
  • Reduce bacterial numbers to as close to zero as possible
  • Wound closure at earliest appropriate time
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7
Q

Acute Wound Treatment - Lavage

A
  • Can remove up to 90% of bacteria
  • Large quantities - moderate pressure
    • 35 mL syringe + 18 g needle = 7-8 psi
    • 1 L plastic bag within a 300 mmHg pressurized cuff
    • Main thing - deliver 7-8 psi
  • Contraindication in puncture wounds b/c fluid can’t get back out, and results in iatrogenic tissue edema!!
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8
Q

Most common lavage solution:

A

Normal saline

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9
Q

Two antiseptic lavage solutions:

A
  1. 0.05% Chlorhexidine
    1. any more will cause too much damage to fibroblasts in the wound
  2. 0.1% povidone-iodine
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10
Q

Pros and Cons of tap water with lavage:

A
  • Pros
    • GROSS contamination
    • Cheap
    • Available
    • Ease of application
  • Cons
    • Hypotonic
    • Cytotoxic trace elements
    • Not antimicrobial
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11
Q

Pros and cons of using electrolyte solutions with lavages

A
  • Pros:
    • Isotonic
    • Least cytotoxic
  • Cons
    • Not antimicrobial
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12
Q

pros and cons of using normal saline in lavage

A
  • Pros - isotonic
  • Cons
    • More acidic than LRS
    • Not antimicrobial
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13
Q

How to make 0.05% Chlorhexidine

A
  • Stock (2%) added to sterile water - 1:40 dilution
  • 25 mL per liter of sterile water
  • DO NOT USE SALINE to mix - liquid will become foamy!
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14
Q

Pros and cons of using 0.05% chlorhexidine in lavage

A
  • Pros
    • Wide antimicrobial spectrum
    • Residual activity - increases when repeated
    • Minimally inactivated by organic matter
  • Cons
    • Slows granulation and contraction in some rat models
    • Proteus, Pseudomonas, Candida resistance
    • Corneal toxicity
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15
Q

How to make 0.1% povidone-iodine

A
  • Stock (10%) added to sterile water, LRS, or saline … 1:100 dilution
  • 10 mL per liter of water/LRS/saline
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16
Q

Pros and Cons of 0.1% povidone-iodine in lavage

A
  • Pros
    • Wide antimicrobial spectrum
    • Short residual activity (4-6 hours)
    • More effective/active when more dilute - because the more free iodine is released!
  • Cons
    • Inactivated by organic matter
    • Cytotoxic >1%
    • Contact hypersensitivity
    • Thyroid disorder if absorbed
17
Q

Debridement

A

Removal of dead or damaged tissue, foreign material, microorganisms

18
Q

Surgical Debridement

A
  • Selective debridement
  • Layered (MC)
    • Devitalized
    • Black, green, white
    • if in doubt, leave it
    • Debris
  • En bloc - closing wound over gauze and excising it - risk removing a lot of healthy tissue, but gives you opporutinity to close wound immediately
19
Q

Autolytic Debridement

A
  • Selective debridement
  • Letting the wound do its thing
  • Moist wound environment
  • Protective bandage
  • Needs minimal/no surgical debridement
20
Q

Enzymatic Debridement

A
  • Semi-selective debridement
  • Needs minimal surgical debridement
  • good for poor anesthetic candidates
  • Good for “Debris” surrounding vital structures for reconstruction
  • Not effective on: burns, necrotic bone, connective tissue
  • Example - granulex V
21
Q

Three components of granulex V

A
  • Trypsin
    • Debridement
    • Liquiefies protein
  • Balsam of Peru
    • Stimulates circulation
    • Stimulates granulation
  • Castor oil
    • Prevents dessication
    • Improves epithelialization
22
Q

Bandage Debridement

A
  • Non-selective debridement
  • Bandage adheres to debris/tissue
  • Strips superficial wound layer every time
  • Wet-to-dry: put gauze in wet, exudates come up and the gazue dries with the exudate in it
  • Dry-to-dry: in luiqidy, non-viscous wounds, put gauze in dry and it will get wet right away once in the wound
  • Discontinue ASAP (proliferative stage) - when we see nice, healthy, granulation tissue
23
Q

Primar closure vs delayed primary closure vs seoncdary closure vs second intention

A
  • Primary closure
    • Immediate suturing to appose skin edges
  • Delayed primary closure
    • Delayed for up to 3 days to allow control of local infection or for damaged tissue to declare itself
  • Secondary closure
    • Closure is delayed until after a bed of granulation tissue has formed
  • Healing by second intention - nonclosure
    • Occurs by granulation tissue formation, wound contraction, and epitheliaization
    • natural
24
Q

Contact (primary) layer of bandage

A
  • Sterile
  • Conforms to wound/body contours
  • Allows fluid to pass to secondary layer
  • Non-toxic, non-irritating
  • Minimize pain
  • Adherent vs non-adherent
    • Use adherent for more traumatic wounds to remove debris - can take healthy tissue with it, painful, serves as bacterial media
    • Non-adeherent can promote healing by allowing enough fluid to circulate out, but still protect it in a moist enivonrment. We wnat to use non-adherent material when we have healthy granulation tissue
25
Q

Intermediate (secondary) laye of bandage

A
  • Absorb and hold drainage
  • Support/immobilization
    • Splint/cast incorporation
  • Pressure - to obliterate dead space
  • Control hemorrhage
  • Reduce edema
  • Can incorporate splints into second layer
26
Q

Outer (tertiary) layer of bandage

A
  • Secures first 2 layers
  • Stretch gauze
  • Prous tape
  • Vetwrap
  • Apply with even pressure
27
Q

When to use drains

A
  • Large dead space that can’t be closed
  • When fluid accumulation is likely
28
Q

Drain rules

A
  1. Only when necessary - avoid in oncological surgery
  2. Never exit through incision
  3. Do not place directly under skin suture line
  4. Always bandage passive drains - if stuff can come out, bugs can go in
  5. Don’t tack with burried sutures
  6. Remove ASAP - when there is decreased fluid production, and discharge becomes serous/serosanguinous
29
Q

Passive vs Active Drains

A
  • Passive - gravity dependent
    • Penrose
    • Exits via separate stab in dependent region
    • Greater risk for infection
    • Drains AROUND drain
  • Active/closed suction
    • Jackson-Pratt
    • May enhance healing
    • Less infection
    • Obstruction possible, but uncommon
    • Drains through drain
30
Q

Vacuum-Assisted Wound Closure

A
  • Open-cell foam*
  • Subatmospheric pressure
  • Pulls fluid through wound
  • Decreases swelling
  • Increased perfusion, granulation, infection resistance, flap survival
  • *wound is continually being bathed with it’s own tissue juices - good
31
Q

Bite wounds

A
  • Crushing, tearing, avulsion
  • Infection - worse with cat bite than dog bite
  • Worry about Pasteurella
  • Leave open or bandage - delayed primary or secondary closure
  • If thoracic/abdominal penetration - emergency surgery if abdominal
  • Extremity may be managed with surface lavage and sytemic antibiotics
32
Q

Do we use drains with abscesses?

A
  • NO! Treat abscess like an open wound - it itself is the drain
33
Q

Thermal Burn Medical Therapy

A
  • Topical cream
    • Aloe vera
    • Silver sulfadiazine
  • Systemic antibiotics
    • Fluoroquinolones

Small Animal Surgery (17 decks)

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