Wound Management

Question 1

What diagnostics do you want to perform on a wound?

Answer 1

• PE, radiographs, US, probing

Question 2

What bacteria do you want to make sure horses are vaccinated against? How should you treat if vaccine status unknown? if unvaccinated?

Answer 2

• Vaccinate for Clostridium tetani
• If status unknown —> give tetanus toxoid
• If unvaccinated –> give tetanus toxoid AND tetanus antitoxin

Question 3

What is an example of an open wound? Closed wound?

Answer 3

• Open –> partial/ full thickness

- Closed –> crushing/ contusion

Question 4

What are the different wound classification?

Answer 4

Clean
Clean-contaminated
Contaminated
Infected/ dirty

Question 5

What is the “golden period” of wounds?

Answer 5

Period of time when there is less than 10^5 bacteria/ g of tissue

NOT IN HORSES

Question 6

What is primary closure?

Answer 6

Immediate closure only with clean/ clean-contaminated wounds

Question 7

What is delayed primary closure?

Answer 7

Waiting 2-5 days after injury but before granulation tissue forms –> used on contaminated wounds

Question 8

What is secondary closure?

Answer 8

Closing >5 d after injury –> used in contaminated/ infected wounds

Question 9

What is second intention healing?

Answer 9

Granulation tissue forms, wound contracts, epithelialization occurs

Question 10

What is the goal of wound closure?

Answer 10

Return damaged tissue to best possible function and appearance via manipulation of the healing process

Question 11

What are the 3 phases of wound healing? Describe each of them

Answer 11

• Inflammation/ Lag phase – includes hemostasis and acute inflammation
• Proliferation – includes tissue formation
• Remodeling – tissue regains strength

Question 12

Describe inflammation/ lag phase in more detail

Answer 12

• Hemostasis includes platelet aggregation, vasoconstriction to vasodilation, then fibrin deposition
• Inflammation include wound repair mediators released from platelets, as well as PMNs, macrophages, and fibroblasts (remove damaged tissues)

Question 13

Describe the proliferative phase in more detail

Answer 13

• Macrophages release growth factors –> induces angiogenesis, fibroplasia, collagen deposition, epithelialization, wound contraction

Question 14

What initiates angiogenesis?

Answer 14

Decreased O2 tension, high lactate, low wound pH

Question 15

When does epitheliazation start? when does the wound being to contract?

Answer 15

• Epithelialization occurs immediately after damage

Contraction begins 2 weeks after injury, stops when skin tension is greater than the ability to contract

Question 16

When does the remodeling phase start?

Answer 16

• starts 2 weeks after injury can last for years

- Following scar is weaker than original skin

Question 17

Where do you cut for sheep skin incision? What are your landmarks? How deep do you cut?

Answer 17

• Cut on L flank with 6” incision
• Caudal to 13th rib, ventral to tranverse processes of lumbar vertebra, cranial to tuber coxae
• Cut through skin, SQ, cutaneous trunci only
• Close in 2 layers

Question 18

What closure patterns do you want to use on the skin incision?

Answer 18

• Close cutaneous trunci m and SQ together with simple continuous and bury knots with 3-0 polydiaxanone
• Close skin with 2-0 non-absorbable with free choice of patterns

Question 19

What drugs do you want to give peri op for skin incision?

Answer 19

• Give meloxicam 1mg/kg once the night before
• Give thiamine 5mg/kg immediately post op when patient standing
• Remove sutures 11-14 days post op

Question 20

What should be included in your initial wound prep?

Answer 20

Glove, clip, water soluble gel

Question 21

What is the purpose of debridement?

Answer 21

• Most important factor in success
• Removes necrotic tissue, bacteria, foreign materal
• Can be sharp, irrigation, direct contact

Question 22

What should be included in your wound lavage?

Answer 22

• non- toxic solution with appropriate pressure/ volume
• Don’t use dilute antiseptics
• Don’t put something in the wound that you wouldn’t eat or put in your eye

Question 23

What are some examples of hypertonic saline dressing and when would you want to use them?

Answer 23

• Curasalt/ 20% hypertonic saline

- Exudative or necrotic wounds –> switch tissue once resolved

Question 24

What is negative pressure wound healing beneficial?

Answer 24

Allow for more rapid healing

Question 25

T/F

Corticosteroids are useful for wound healing

Answer 25

FALSE

Don’t use steroids, not even for granulation tissue reduction

Question 26

What causes chronic wounds and how do you treat them?

Answer 26

• Caused by patients/ owners delaying treatment
• Requires surgical excision, topical agents, bandaging
• Granulation tissue killing agents may also kill epithelium