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Small Animal Surgery 1 > wound management > Flashcards

wound management Flashcards

1
Q

what are the stages of wound healing ?

A

Inflammatory phase
Debridement phase
Repair
Maturation/remodeling phase

  • I Demand Rossies Memorize*
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2
Q

Can more than one phase of wound healing occur at a time ?

A

yes

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3
Q

what is the lag phase of wound healing?

A

the first 3-5 days because inflammation and debridement predominate

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4
Q

what phase of wound healing is characterized by the release of cytokines and growth factors ?

A

inflammatory phase

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5
Q

what are the characteristics of the inflammatory phase ?

A
  • release of growth factors and cytokines
  • increased permeability of local blood vessels
  • recruitment of circulatory cells
  • activation of neutrophils, lymphocytes, fibroblasts and macrophages
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6
Q

what is the first response to any injury ?

A

hemorrhage

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7
Q

what initiates the debridement phase?

A

WBCs leaking from blood vessels into wounds

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8
Q

what happens after hemorrhage occurs?

A
  • vasoconstriction
  • fibrin clot
  • vasodilation
  • leukocyte response
  • platelets for coagulation
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9
Q

what helps control hemorrhage?

A

the fibrin clot

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10
Q

how long does vasodilation last?

A

~ 5 days

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11
Q

what is the order of leukocyte response?

A
  1. neutrophils
  2. macrophages
  3. T-lymphocytes
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12
Q

how long is the debridement phase?

A

2-5 days

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13
Q

what is the job of neutrophils in the debridement phase?

A

prevent infection and phagocytize organisms & debris

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14
Q

how are monocytes stimulated in the debridement phase?

A

the degeneration of neutrophils releases enzymes that facilitate breakdown of bacteria and extracellular debris and that stimulates monocytes

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15
Q

what leukocyte is essential for wound healing ?

A

monocytes

- neutrophils and lymphocytes are not essential

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16
Q

what do macrophages do in the debridement phase?

A
  • secrete collagenases
  • remove necrotic tissue, bacteria and foreign material
  • secrete chemotactic and growth factors
  • recruit mesenchymal cells, stimulate angiogenesis & modulate matrix production in wounds
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17
Q

how long does the repair phase last?

A

5 days to 2-4 weeks

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18
Q

what happens in the repair phase?

A
  • macrophages stimulate fibroblast and DNA proliferation - capillaries infiltrate the wound behind fibroblasts which leads to angiogenesis
  • the combo of fibroblasts, new capillaries and fibrous tissue lead to the development of granulation tissue
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19
Q

what does the granulation tissue do?

A

fills defects and protects wounds

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20
Q

true or false.

granulation tissue is a good barrier to infection.

A

true

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21
Q

how fast is granulation tissue formed at each wound edge daily?

A

0.4 to 1 mm/day

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22
Q

what are the special fibroblasts used in wound contraction ?

A

myofibroblasts

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23
Q

do sutured wounds need granulation tissue to epithelialize?

A

no, can begin in 24-48 hours because of this

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24
Q

what guides the migration of epithelial cells?

A

collagen fibers

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25
Q

what is contact inhibition?

A

contact on all sides with other epithelial cells inhibits further cell migration

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26
Q

does epithelialization occur faster in a dry or moist environment ?

A

moist environment

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27
Q

true or false.

epithelialization will occur slower in nonviable tissue than in more viable tissue

A

FALSE, will NOT occur in nonviable tissue

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28
Q

wet to dry bandages debride newly formed epithelium which causes what?

A

delayed re-epithelialization

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29
Q

true or false.

wound contraction, granulation and epithelialization all occur simultaneously.

A

true

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30
Q

what is the rate of wound contraction ?

A

0.6 - 0.8 mm/day

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31
Q

how many days until wounds appear smaller post injury?

A

5-9 days

32
Q

when does wound maturation begin?

A

once adequate levels of collagen are reached

33
Q

true or false.

scars eventually become as strong as normal tissue.

A

false, normal tissue strength is never regained

34
Q

what is the golden period?

A

within 0-6 hours of wounding, minimal contamination so insufficient microbial replication to cause an infection

35
Q

what is a class 1 wound?

A

within 0-6 hours old wound, minimal contamination or tissue damage

36
Q

what is a class 2 wound?

A

within 6-12 hours old wound

37
Q

what is a class 3 wound?

A

over 12 hours old wound, microbial replication at a critical level allowing infection

38
Q

what is a primary closure?

A
  • 1st intention healing
  • wound is clipped, cleaned and suture closed IMMEDIATELY
  • mostly used for class 1 wounds and sometimes class 2
39
Q

what is a delayed primary closure ?

A

appositional closure BEFORE granulation tissue develops, done within 3-5 days of wounding

40
Q

what is secondary closure?

A

appositional closure AFTER granulation tissue has developed, more than 3-5 days after wounding

41
Q

what is second intention healing?

A

healing by contraction/epithelialization

42
Q

true or false.

second intention healing involves surgery once tissue granulates in.

A

FALSE, no surgery involved

43
Q

true or false.

second intention healing is common and uses open wound management.

A

true

44
Q

should we complete a PE and stabilize before we close wounds?

A

yes! treat life threatening problems first

45
Q

is it okay to use local anesthesia and pain meds for wound evaluation ?

A

yes, they are painful even if stable

46
Q

true of false.

placing a protective bandage on all wounds that enter the hospital can help prevent nosocomial infections.

A

true, truncal wounds may be harder to cover but can secure with tape

47
Q

when clipping wounds , why is it important to clip a wide area?

A

there can be extensive bite wounds we may not be able to see under the fur

48
Q

where should we scrub for wound repair?

A

around the wound

49
Q

true or false.

scrub the area around the wound with alcohol before repairing it.

A

FALSE, NEVER use alcohol on open tissue, it can damage it

50
Q

true or false.

we can use any kind of chlorohex scrub for the wound

A

false! there is a cytotoxic and a non-cytotoxic version of chlorohex. The 2% solution is cytotoxic so don’t use that

51
Q

what is the preferred lavage solution?

A

sterile isotonic saline or a balanced electrolyte solution (LRS)

52
Q

what is important to remember if we use antibiotics or antiseptics in the lavage solution ?

A

we have to dilute them properly, they may damage tissue

53
Q

why do we lavage wounds instead of using sponges to clean the wounds?

A

using a sponge to scrub the wound leads to tissue damage and that can effect the ability of the wound to resist infection

54
Q

what are some examples of lavage solutions?

A
  • LRS
  • normal saline - 0.9% NaCl
  • 0.05% chlorhexidine solution
  • 0.1% povidone-iodine solution
55
Q

can we use tap water to clean wounds?

A

its not ideal because it can be cytotoxic, can use in the initial stages of severely contaminated wounds, it is less detrimental than using sterile or distilled water

56
Q

which should be used around the eye, chlorhexidine or iodine ?

A

iodine! chlorhex is toxic to cornea

57
Q

what is the ideal pressure for wound irrigation?

A

7-8 psi

58
Q

what equipment should we use to lavage a wound ?

A
  • standard recommendation is a 35 ml syringe with an 18g needle
  • 1 L bag with pressure cuff
59
Q

how can we achieve the gold standard of 7-8 psi while lavaging a wound?

A

Using a 1 L bag with a pressure cuff at 300 mmHg, using a syringe and needle generates too much pressure

60
Q

true or false.

minimally contaminated wounds less than 6-8 hours old can be clean and closed without culture or antibiotics.

A

true

61
Q

when should we get samples from for a wound culture ?

A

during initial wound exploration or during initial debridement
- initial debridement is more preferred

62
Q

what antibiotic can you use to treat wounds empirically ?

A

amoxi-clav

63
Q

when should you use fluoroquinolones and aminoglycosides for antibiotics with wounds ?

A

only if a culture is performed

64
Q

should we debride wounds we use topical antimicrobials on ?

A

yes, debridement allows antimicrobial access to the bacteria

65
Q

what topical antimicrobial is effective against psuedomonas?

A

silver sulfadiazine

66
Q

what is a disadvantage of using zinc bacitracin ?

A

it can retard wound contraction

67
Q

what are methods of debridement?

A
  • surgical excision
  • autolytic mechanisms
  • enzymes
  • wet to dry bandages
  • biosurgical methods
68
Q

what is a danger of using surgical debridement?

A

removing an excessive amount of viable tissue

69
Q

what is layered surgical debridement ?

A

removing tissue in layers beginning at surface and progressing deeper, can be done with sharp dissection, cautery or laser

70
Q

what is en bloc surgical debridement?

A
  • entire wound is excised at same time
71
Q

when can en bloc debridement be used?

A

when there is sufficient healthy tissue surrounding the wound

72
Q

what form of debridement is highly selective for devitalized tissue ?

A

autolytic

73
Q

what is autolytic debridement?

A

creation of moist environment to allow endogenous enzymes to dissolve non-viable tissue

74
Q

what is an example of biosurgical debridement?

A

using maggots to debride wounds

75
Q

what is the most common form of debridement ?

A

layered debridement

76
Q

when should we delay the closure of a wound?

A

when there is any question to the level of contamination, potential for deep tissue injury, tissue viability or vascular compromise

you are NEVER wrong to delay the closure of an open wound

77
Q

what growth factors are produced from macrophages?

A
  • basic fibroblast growth factor (BFGF)
  • epidermal growth factor (EGF)
  • platelet derived growth factor (PDGF)
  • transforming growth factor (TGF)

Small Animal Surgery 1 (13 decks)

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