Wound management

Question 1

How might closed (non-penetrating) wounds become surgical wounds?

Answer 1

If become problematic–> open up surgically to explore/remove damaged tissues

(Abscesses, bruising, hematomas, etc.)

Question 2

Why are traumatic wounds initially classified as contaminated at best?

Answer 2

Wound is open–no way to know what could’ve gotten into it or what the risk of infection is

Must consider ‘contaminated’ until proven otherwise

Question 3

What does the term “iceberg” lesion mean with regard to dog bite wounds?

Answer 3

Superficial lesions usually look less severe than they actually are–do not reflect the degree of internal trauma that is usually present

Question 4

What criteria are used to decide whether to treat a bite wound conservatively or surgically?

Answer 4

• Sizes/#’s of animals involved
• Locations of the wounds
  
  • Extremities more likely to be puncture wounds
  • Bites on the neck tend to slide and cause more trauma/are more severe
• Clinical assessment of severity of trauma

Question 5

What is a degloving injury?

Answer 5

• Result of shearing forces which sever cutaneous vessels supplying skin
• Often distal injuries

Question 6

What is the difference between physiologic and anatomic degloving injuries?

Answer 6

• Physiologic–skin devitalized but still in place
  
  • Remove skin as early as possible and close wounds
  • If multiple wounds that can’t all be done at once: leave skin on and allow it to function as a biological bandage (remove as soon as infection occurs)
• Anatomic–skin avulsed from underlying tissue
  
  • If skin is shiny and pale or dark black–>dead and needs to come off
    
    • Any color in between should be monitored
  • Managed as open wound

Question 7

What is a fistula?

Answer 7

Communication between two epithelial surfaces

Lined by epithelium

Ex: tracheoesophageal fistula

Question 8

What is a sinus tract?

Answer 8

• Communication between mesothelial surface and skin
• Often associated w/ FB migration
• Can be lined with granulation tissue
• Will “pseudo” heal with antibiotic administration but will reappear when discontinued

Question 9

T/F: Combined degloving and crush injuries are rare in small animals

Answer 9

FALSE

Common

Question 10

What diagnostic tests can be used to diagnose foreign bodies?

Answer 10

• Ultrasound
  
  • ​Most cost-effective
  • Non-radiopaque FBs (esp. plant-based)
• Radiographs–often won’t show up
• Contrast studies–ok, but still hard to interpret
• CT, MRI (CT if not seen on u/s)

Question 11

Which diagnostic test is most reliable for plant type FBs and could be used intraoperatively?

Answer 11

Ultrasound

(intraoperative u/s)

Question 12

What are the common etiologies of burn wounds?

Answer 12

• Thermal
  
  • House fires
  • Hot liquids (water/steam, grease, wax)
  • Direct contact (heating pads, heat lamps, exhaust pipes)
• Chemical
• Electrical

Question 13

What are the pathophysiologies of burn wounds?

Answer 13

• Burn wound
  
  • Injury progression (several zones)
  • Infection
• Smoke inhalation
  
  • Direct heat injury
  • Carbon monoxide
  • Inhaled toxins
• Systemic effects
  
  • Cardiovascular
  • Metabolic