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RUSVM Large Animal Surgery 2017 > Wound Management > Flashcards

Wound Management Flashcards

1
Q

What is the first step in wound management?

A

Patient Stabilization

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2
Q

How would you stabilize active arterial hemorrhage?

A

Fluid therapy

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3
Q

Why would you use ultrasound for wound assessment?

A

Assess the depth of the wound

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4
Q

What instrument can be used for wound depth assessment?

A

Malleable probe

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5
Q

What should you administer for all wounds?

A

tetanus booster

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6
Q

What should you do if the vaccination status is unknown?

A

Booster with tetanus toxoid

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7
Q

What should you do if the vaccination status is unvaccinated?

A

Give tetanus toxoid and tetanus antitoxin

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8
Q

What is the reason that most repaired wounds fail?

A

improper preparation and assessment

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9
Q

Primary closure

A

immediate closure

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10
Q

When would you perform a primary closure?

A

clean

clean-contaminated wound

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11
Q

Delayed primary closure

A

2-5 days after injury - before granulation tissue production

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12
Q

When would you perform a delayed primary closure?

A

Contaminated wounds/ Questionable viability

Edema/tension

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13
Q

Secondary Closure

A

Closure 5 days after injury

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14
Q

When would you perform a secondary closure?

A

contaminated/infected wound

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15
Q

Second intention healing

A

granulation tissue, wound contracture and epithelialization

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16
Q

What are the factors that affect the decision of closure?

A 
Time 
Appearance of wound before and after debridement 
type of injury 
tissue availability 
location 
anticipated complications
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17
Q

What are the three phases of wound healing?

A

Inflammation/Lag
Proliferative
Remodeling

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18
Q

What occurs in the Inflammation/lag phase of wound healing?

A

Hemostasis and acute inflammation

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19
Q

What occurs in the Proliferative phase of wound healing?

A

Tissue formation

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20
Q

What occurs in the Remodeling phase of wound healing?

A

Regaining strength

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21
Q

List what occurs in the Proliferative Phase of wound healing?

A

Macrophage release of tissue growth factors initiating proliferative phase
Angiogenesis
Fibroplasia and granulation tissue formation
Collagen deposition
Epithelialization
Wound contraction

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22
Q

When is collagen produced in a wound?

A

2-3 days after wounding

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23
Q

When does epithelialization start?

A

Immediately

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24
Q

When does contracture begin?

A

2nd week after injury

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25
Q

When does contracture stop?

A

when skin tension is greater than the ability to contract

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26
Q

What is the single most important factor to wound success?

A

Debridement

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27
Q

What are the ways to debride?

A

Sharp
Irrigation
Direct contact

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28
Q

What are the characteristics of wound lavage?

A

Non-toxic solution

Appropriate pressure and volume

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29
Q

What is the best lavage fluid?

A

Saline LRS (Sterile isotonic)

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30
Q

Why would you ever use Scarlet Oil?

A

Used in an area for encouraging granulation tissue

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31
Q

What should you not use on a wound?

A

Steroids

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32
Q

What is the problem with using Nitrofurazone?

A

carcinogenic: causing ovarian cancer in rats

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33
Q

What is the problem with Vetricyn?

A

Hypochlorite

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34
Q

What is Polysporin?

A

Triple antibiotic without Neomycin

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35
Q

Why would you use Hydrogels?

A

Desiccates wounds that bring moisture into the wound bed

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36
Q

When would you use Hypertonic Saline Dressing?

A

Exudative or necrotic wounds

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37
Q

What is the reason for using Kerlix AMD?

A

Microbes unable to become resistant

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38
Q

What should you do if the wound is near a synovial structure?

A

After collecting a sample of synovial fluid distend the joint with sterile isotonic solution

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39
Q

What do you call an open joint?

A

Septic Joint

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40
Q

What is the purpose of the Slipper Cast?

A

Minimize movement of the coffin joint

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41
Q

What should you be aware of with Pastern lacerations?

A

Tendon sheath

Pastern joint

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42
Q

What should you be aware of with Heel bulb lacerations?

A

Coffin joint

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43
Q

What should you be aware of with a puncture wound to the sole/frog?

A

navicular bursa

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44
Q

When would you apply a cast/splint?

A

Extensive soft tissue loss

Loss/disruption of supportive soft tissue structures

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45
Q

What are the concerns for a wound in the axillary region?

A

Subcutaneous emphysema

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46
Q

What is the rule of full thickness eyelid repairs?

A

lacerations must be repaired surgically

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47
Q

What should you do if less than 1/3 of eyelid margin is missing?

A

direction apposition

48
Q

What should you do if greater than 1/3 of eyelid margin is missing?

A

must use grafting technique to achieve functional closure

49
Q

What are the objectives of eyelid repair?

A

Align the margin
Protect the eye from trauma during suturing
keep suture material from rubbing on eye when repair is complete

50
Q

What is the rule about lip lacerations?

A

Full thickness lip lacerations must be repaired surgically

51
Q

Why are lip lacerations high risk?

A

High amount of motion

52
Q

Why do you place stents in lip lacerations?

A

used to reduce stress and tension and avoid pressure necrosis and augment the repair

53
Q

What are the difference in healing based on wound locations?

A

Wounds on the body = more efficient contraction

Limb wounds = slow

54
Q

What is a characteristic of limb wounds?

A

excessive granulation tissue leading to proud flesh

Increased motion and decreased vascularity

55
Q

Why is the healing potential of distal limbs limited?

A

No muscle
no excessive tissue
close to contamination
constant movement

56
Q

What is the best closure for preserving function and cosmetic appearance?

A

Primary and delayed primary closure

57
Q

What is often the only option for closure of distal wounds?

A

Second intention

58
Q

Proud flesh

A

Excessive granulation tissue

59
Q

What are the causes of proud flesh?

A

topical agents or “potions” applied to the wound

60
Q

What is the treatment for proud flesh?

A

Resection and bandage
Delayed secondary closure
Skin grafts

61
Q

What kind of resection is usually used on proud flesh?

A

Sharp resection

62
Q

Why is proud flesh formed?

A

Inefficient and protracted inflammatory phase
Results in excessive proliferative phase
Fibroblasts don’t differentiate into myofibroblasts

63
Q

What is the problem with exuberant granulation tissue?

A

Delays healing by delaying epithelium from closing the wound

64
Q

How do you manage Exuberant Granulation tissue?

A

Surgical Resection
Bandaging
Delayed secondary wound closure

65
Q

What are the common bacterial invaders of wounds?

A

Staphylococcus

Pseudomonas

66
Q

What antibiotics would you use for Pseudomonas?

A

Potentiated penicillins

Beta lactams

67
Q

What are the indications for Skin Grafts?

A

Wounds so large they won’t otherwise heal

Any open wound that can’t be sutured

68
Q

Pedicle Graft

A

Remains connected to donor site

69
Q

Free graft

A

Completely separated from blood supply

70
Q

What type of graft is best for cosmesis and hair growth?

A

Full thickness

71
Q

Adherence

A

adhered by fibrin

72
Q

What are the steps of Graft Acceptance?

A

Adherence
Serum imbibition
Revascularization
Organization

73
Q

How long does it take for organization of a wound?

74
Q

Serum Imbibition

A

Nourished by plasma-like fluid via capillary action

75
Q

What are the types of Free Skin grafts?

A

Island grafts
Sheet grafts
Full thickness
Split thickness

76
Q

What are the types of Island grafts?

A

Punch
Pinch (seed)
Tunnel

77
Q

What are the advantages of Punch and Pinch grafts?

A

GA not required
Equipment minimal
Technical expertise minimal
Complete failure rare

78
Q

What are the disadvantages of Punch and Pinch Grafts?

A

Poor cosmesis

Little hair growth

79
Q

Where should you harvest punch grafts from on an equine?

A

Mane

Ventrolateral abdomen

80
Q

What are the main reasons for graft failure?

A

Hemorrhage
Motion
Infection

81
Q

Advantages of Full thickness sheet grafts

A

Resist trauma better than split thickness grafts

Best cosmetic appearance

82
Q

What is a disadvantage of Full thickness sheet grafts?

A

Not a readily accepted as split grafts

83
Q

Advantage of Meshing sheet grafts

A

Allow graft to cover wound larger than itself
Prevent fluid from disrupting graft from fibrinous and vascular attachments
Conforms to irregular surfaces

84
Q

What is required for grafting aftercare?

A

Cover site with sterile non-adherent dressing
Secure with sterile elastic confirming rolled gauze
follow with routine bandaging

85
Q

What are bandage functions?

A 
Wound/incision protection 
Support 
Secure dressing
Inhibit excessive granulation tissue
Reduce swelling, movement, edema
Assist in temporary stabilization of fractures
Decrease dead space
Reduce post-op hemorrhage/edema
Prevent contamination
86
Q

In which direction do you wrap the flexor tendons with a bandage?

87
Q

What will happen if the bandage is too tight?

A

Circulation
Soft tissue injury
Pressure sores

88
Q

Why do you extend the bandage distally to the coronary band?

A

to reduce the risk of swelling of the coronary band

89
Q

What are some examples of primary layers?

A 
Telfa
Curasalt
Kerlix AMD
Hydrogel 
Calcium Alginate
90
Q

What are the second layer functions of the bandage?

A

Provide support and padding
preventing excessive compression and protecting the limb
Absorbent for exudate

91
Q

What are the functions of the tertiary layer of the bandage?

A

Secures previous layers
Provides rigidity/support bandage
Helps protect bandage from contamination

92
Q

What is the purpose of the Elastikon in the tertiary layer?

A

seals the bandage and prevents dirt and debris from entering

93
Q

When would you use a full limb/ “stack” bandage?

A

Large wounds
Swelling/cellulitis
Assist with coaptation for temporary fracture stabilization

94
Q

Stent bandage

A

Bandage sutured over a wound or incision site

95
Q

When would you use an abdominal bandage?

A

after colic surgery r for thoracic/abdominal wounds

96
Q

When would you use a sweat bandage?

A

Decrease edema

97
Q

What are the uses of a splint?

A

Fracture stabilization for transportation

Reduce or eliminate flexion/extension of joints

98
Q

What is the rule for splint placement?

A

Must Immobilize a joint above and a joint below

99
Q

Olecranon fracture stabilization

A

Stack bandage with palmar splint

Extend splint from heels to top of elbow

100
Q

Radial Fracture Stabilization

A

Robert Jones Bandage
Palmar Splint from heels to elbow
Lateral splint from hoof to withers

101
Q

What is the signalment for Olecranon fracture stabilization?

A

young horses being broke to lead or tie when they flip over

102
Q

What is the treatment for Tibial fracture stabilization and why?

A

No treatment due to the anatomic placement and weight bearing

103
Q

What is the purpose of the Thomas Schroeder splint?

A

Radial and tibial fracture stabilization in FARM ANIMALS

104
Q

What animal can’t use the Thomas Schroeder splint?

105
Q

What are the principles of casting?

A

Smooth contour
No wrinkles
Never end a cast or a splint in the middle of a long bone
A joint above and a joint below

106
Q

Cast uses

A

Immobilization for lacerations, fracture stabilization, transfixation pin casting, support for fracture repair, Soft tissue injuries (flexor tendon injuries)

107
Q

What are the best characteristics for casting material?

A 
Lightweight 
Rapid set
Inexpensive 
Easy to apply 
Durable
108
Q

What is the disadvantage of using Plaster Paris?

A

Takes too long to set
Messy
Poor strength to weight ratio
too heavy

109
Q

What are the complications of immobilization?

A

Articular cartilage degeneration
Loss of bone density
Decreased muscle strength

110
Q

How long should the stockinette be cut to?

A

2.5 times the length of the cast

111
Q

What is important for cast application?

A

Foot must be incorporated into the cast

Extra padding at proximal aspect of cast as well as around coronary band/heel bulbs and fetlock region

112
Q

Why is it important to imcorporate the hoof into the cast for large animals?

A

to ensure maximum diversion of weight from the limb and ground forces away from the limb to the cast

113
Q

For how long after cast removal should you continue stall rest?

114
Q

What are cast complications/failure?

A 
Swelling 
Foul Odor
Moisture
Cracks 
Increased temp at the cast
115
Q

What are the reasons for cast complications/failure?

A 
Poor placement 
Poor owner compliance 
Poor animal behavior 
Subsolar abscess
Post op complications 
Septic processes under cast
116
Q

When should you change a cast?

A

at the first sign of lameness
6 weeks in adults
7-14 days in neonates
If significant swelling at time of placement - 3-5 days

RUSVM Large Animal Surgery 2017 (14 decks)

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