Wound Management Flashcards
Othopedic and some soft tissue injuries will compromise this
Structural support
How do you restrain/analgesia a wounded horse for assessment?
a2 agonist + opioid
Good sedation, reversible, fast onset, potent analgesia
a2 agonists
Synergistic w/a2s
Opioids
How do you vaccinate for clostridium tetani?
Tetanus toxoid vaccine + booster 3wk later
How should you treat C. tetani if the vaccination status of the patient is unknown?
Booster w/tetanus toxoid
What is the most common reason that wound repairs fail?
Improper prep and assessment of the wound
Partial/full thickness wounds are classified as ______
Open
Crushing/contusion wounds are classified as ______
Closed
Period of time before there is more than 10^5 bacteria/g of tissue in the wound
Golden period
Is there a golden period for wounds in equine management?
No
Immediate closure for clean and clean-contaminated wounds
Primary (intention) closure (healing)
Closing a wound 2-5d after injury but before granulation tissue is produced
Delayed primary closure (healing)
Make sure wound bed is clean and as healthy as possible prior to closure
Delayed primary closure (healing)
Choice of closure for contaminated wounds or wounds w/questionable viability
Delayed primary closure (healing)
Closure >5d after injury
Secondary closure
Choice of closure for contaminated/infected wounds
Secondary closure
Granulation tissue, wound contracture, and epithelialization
Second intention healing
How do you decide when to close a wound?
Time, location, tissue availability, type of injury
What is the goal of wound closure?
Return damaged tissue to best fxn and appearance via manipulation of the healing process
What are the 3 phases of wound healing?
Inflammation/lag, proliferation, remodeling
Healing phase of hemostastis and acute inflammation
Inflammatory/lag phase
Healing phase of tissue formation
Proliferation
Healing phase of regaining strength
Remodeling
How is hemostasis initially affected by a wound?
Initial vasoconstrction, then vasodilation
How does platelet aggregation affect a wound?
Seals vessels, releases growth factors, fibrin deposition
What cells release wound repair mediators?
Platelets
What wound repair mediators do platelets release?
PDGF, TGF-B
What cells remove damaged tissue and release chemoattractants?
PMNs, macrophages, fibroplasts
What cells remain present for days to weeks and are imperative for wound healing?
Macrophages
What do macrophages release to initiate the proliferative phase of wound healing?
Tissue growth factors
When does angiogenesis, collagen deposition, and granulation tissue formation occur?
Proliferative phase
What initiates angiogenesis?
Decreased O2 tension, high lactate, low pH in wound
Release proteases to digest fibrin clot and arrange collagen into bundles parallel to the wound surface
Fibroblasts
What type of collagen is initially produced and why?
Initially type 3 d/t dense blood vessel population
What type does collagen production shift to as wound remodels?
Type 1
How soon after injury does epithelialization begin?
Immediately
How soon after injury does contraction begin?
2nd week after injury
How much does contraction reduce a wound?
40-80%
When does contraction stop?
When skin tension is greater than the ability to contrat
Why are scars weaker than original skin?
New epidermis lacks dermal layer
When does the remodeling phase begin and how long does it persist?
During 2nd week, lasts up to 2 years
How much weaker is the final scar compared to the original skin?
15-50% weaker
What is the single most important factor in successfully healing a wound?
Debridement
How do you minimze sequestrum formation?
Debride outer cortex of bone to max blood flow to area
Where do sequestrums most commonly occur?
Distal limbs
What are the 3 tyeps of debridement?
Sharp, irrigation, direct contact
What type of solution should you use to lavage a wound? What PSI/set-up?
Non-toxic (LRS, isotonic slaine, water) @ 7-8 PSI (1L bag set to 300mmHg)
Slows down wound healing
Steroids
Abx + steroid potion
Panalog
Abx ointment potion that is carcinogenic
Nitrofurazone
One of the ingredients in this potion is bleach
Vetricyn
What are the topical treatments of choice for wounds?
Silver sulfadiazine, polysporin ointment
Used for exudative or necrotic wounds
Hypertonic saline dressing
Curasalt
Hypertonic saline dressing
What is the best type of wound dressing?
AMD
What is the active agent in Kerlix AMD?
PHMB
How often do you need to change an AMD?
Q3-7d
How often do you need to change a hypertonic saline dressing?
Q24-48hr
How are wound vacuums beneficial?
Negative pressure = more rapid healing
What should you NEVER use for wound dressing?
Corticosteroids
Why is manuka honey the best honey to use for wound dressing?
UMF >15
Requires sx excision, few topical agents, and bandaging
Chronic wounds
