Wound Management Flashcards
Why is US used for wound diagnostics?
To ensure that there are no foreign bodies
What diagnostic tool measures depth of a wound?
Probe
What percentage of a horses body weight is blood?
8%
What should you do if a horse has unknown vaccination status vs. if a horse is unvaccinated?
Vaccination status unknown: booster w/ tetanus toxoid
Unvaccinated: give tetanus toxoid + tetanus antitoxin
What is the Golden Period?
Period of time before which there is less than 10^5 bacteria/g of tissue
This does NOT exist in equine wound management- environment is always dirty so there is never a “clean cut”
What is primary intention closure?
Debride at time of presentation then appose w/ sutures
Immediate closure
Clean and clean-contaminated wounds w/ minimal tissue loss
What is delayed primary closure?
Close wound 2-5 days after injury, before granulation tissue production
Typically wounds that have questionable viability
What is secondary closure?
Closure > 5 days after injury
Contaminated/infected wounds
What is second intention healing?
Body heals on its own, leaves bigger scar this way
Granulation tissue present, wound contracture and epithelialization
What is the goal for wound closure?
Return damaged tissue to best possible function and appearance via manipulation of healing process
What are the three phases of wound healing?
Inflammation/Lag
Proliferative
Remodeling
What occurs in the inflammation/lag phase?
Hemostasis and acute inflammation
What occurs during hemostasis of the inflammatory stage of wound healing?
Platelet aggregation- seals vessels, release growth factors, fibrin deposition
Responsive vasoconstriction then vasodilation
Fibrin deposition
What is the first cell on site of wounds?
Neutrophils
What cells come to wounds to clean up the area?
Monocytes –> macrophages
How long are macrophages present for in wounds?
Days to weeks
What processes makes up the proliferative phase of wound healing?
Angiogenesis Fibroplasia and granulation tissue formation Collagen deposition Epithelialization Wound contraction
What is angiogenesis initiated by?
Decreased O2 tension, increase lactate, decrease pH in wound
When does collagen deposition occur post wound formation?
2-3 days after wounding
Initially type III collagen deposited –> shifts to type I as wound remodels
When does epithelialization occur post-wound?
Immediately after wounding
What component of wound healing most commonly results in a disaster with distal limb wounds?
Wound contraction (begins 2nd week after injury)
What percentage of the original wound is reduced by contraction?
40-80%
What phase is when the wound is regaining strength?
Remodeling
When does the remodeling phase start and how long does it last?
Begins 2nd week and lasts 1-2 years
The final scar is ____ weaker than original skin
15-50%
What pain management is used for wound care?
Alpha-2 agonists, NSAIDs, +/- opioids
What is the most common drug used for analgesia in wounds?
Phenylbutazone- IV only
Can lead to severe sloughing of skin if extravasation
What are three common antibiotics that are used for wounds?
Penicillin
Gentamicin
Amikacin
What is the single most important factor in success of wound healing?
Debridement
What type of debridement is best in equine patients?
Sharp and autolytic debridement
What is the best choice of material for irrigation of wounds in equine?
35 cc syringe + 19g needle
What is the solution that is most commonly used for wound lavage?
Non-toxic solution- Saline
What solutions are not effective and cytotoxic to the flesh?
Dilute antiseptics- Betadine & Chlorhex
What are some “potions” that are bad for wounds?
Scarlet oil (increase granulation tissue formation)
White lotion (used to have lead)
Panalog (steroid and Ab in this which can reduce the rate of healing)
Nitrofurazone (carcinogen)
What are two safe wound agents that can be applied topically?
Silver sulfadiazine
Triple antibiotic ointment
What are some different wound dressings that can be used?
Hypertonic saline Honey Antimicrobial dressing Hydrogels Calcium alginate Growth factors Semi-occlusive foam Negative pressure therapy Steroids Antiseptics
What is the most common wound dressing used?
Hypertonic saline dressing: curasalt/20% hypertonic saline on Kerlix
Used for exudative or necrotic wounds
What is the best antimicrobial dressing used?
Kerlix AMD
What active antimicrobial agent is good for post-op wounds to prevent infections?
Polyhexamethylene biguanide
T/F: Corticosteroids can be used to help increase the rate of wound healing.
FALSE- this will decrease the rate of wound healing
What is the most common anatomical location for wounds?
Distal limb
