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RUSVM Large Animal Surgery > Wound Management/Granulation tissue > Flashcards

Wound Management/Granulation tissue Flashcards

1
Q

What should you do if a horse has sustained a penetrating wound at its vaccination status is unknown?

A

Booster with tetanus toxoid

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2
Q

What should you do if a horse sustains a penetrating wound and is unvaccinated?

A

Give tetanus toxoid AND tetanus antitoxin

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3
Q

T/F: the golden period is the time in which there is less than 10^5 in a wound of a horse

A

False

There is NO golden period in equine wound management

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4
Q

What is primary closure? What type of wounds can this be used on?

A

Immediate closure

Clean and clean-contaminated wounds

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5
Q

What is delayed primary closure? What type of wounds would you do this in?

A

2-5days after injury (before granulation tissue production)

Contaminated wounds / questionable viability
Edema/tension

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6
Q

What is secondary closure and in what type of wounds is it used?

A

Closure after more than 5days (granulation tissue has formed)

Contaminated/infected wound

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7
Q

What is second intention healing?

A

Wound edges are not apposed. Granulation tissue, wound contracture, and epithelialization

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8
Q

What are the three phases of wound healing?

A

Inflammation/ lag (hemostasis and acute inflammation)

Proliferative (tissue formation)

Remodeling (regaining of strength)

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9
Q

What occurs in the inflammation/lag phase of healing?

A

Hemostasis
—> platelet aggregation
—> vasoconstriction followed by vasodilation
—> fibrin formation

Inflammation
—> activated platelets release wound repair mediators
—> PDGF, TGF-B
—> PMNs, macrophages and fibroblasts (remove damaged tissue, release chemoattractatns, PMNs decrease after 2days, macrophages persist for days to weeks)

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10
Q

What occurs during the proliferative phase of healing?

A

Macrophages release tissue growth factors and initiates proliferation

Angiogenesis 
Fribroplasia and granulation tissue 
Collagen deposition 
Epithelialization 
Wound contraction
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11
Q

What initiates angiogenesis in wound healing?

A

Decreased O2 tension
High lactate
Low pH in wound

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12
Q

What is the purpose of fibroblasts in wound healing?

A

Release collagen, GAGs, HA, and glycoproteins

Release proteases to digest fibrin clot

Help arrange collagen molecules into fibers then bundles aligned parallel to wound surface

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13
Q

What type of collagen is present initially in a wound and what type is present as the wound remodels?

A

Collagen type III — initial wound healing with dense blood vessel population

Collagen type I — remodeling

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14
Q

When does epithelialization begin?

A

Immediately after wounding

Rapid in superficial injuries

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15
Q

New epidermis lacks __________ resulting in less strength and elasticity

A

Dermis

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16
Q

Contraction of wounds begins how long after injury?

A

2weeks

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17
Q

Fibroblasts differentiate into __________ allowing for wound contraction

A

Myofibroblasts

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18
Q

Remodeling phase begins when and can last how long?

A

2weeks post injury and can last 1-2years

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19
Q

What are the steps for optimal wound care?

A

Adequate restraint

Analgesia

DEBRIDEMENT

Lavage

Closure

Bandage

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20
Q

What A2 agonists can be used for restraint/analgesia and what is their duration of action?

A

Xylazine IV: 15-20mins

Detomidine IV: 30-45mins (can last longer if combined with butorphanol)

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21
Q

What steps do you do prior to debridement to prep a wound?

A

Wear gloves!

Clip
Can put a water soluble gel in would to prevent hair from going into the wound
Evaluate

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22
Q

What is the most important factor in success of wound healing

A

Debridement
—> remove necrotic tissue, decease bacterial load and remove microscopic foreign

Sharp
Irrigation (hydraulic)
Direct contact

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23
Q

What solutions can be used for wound lavage?

A

Non toxic solutions — LRS, Normosol, or saline

DO NOT used antiseptics —> cytotoxic

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24
Q

Preventing bacterial infection of wounds can be done with what methods?

A

Effective wound cleaning/debridement

Appropriate use of dressings and procedures for bandage changes

Appropriate use of topical antimicrobials

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25
Q

T/F: scarlet oil is a good topical product to increase healing of distal limb wounds

A

false

Scarlet oil is used to stimulate granulation tissue

Distal limbs a prone to over granulation

Scarlet oil is appropriate for large areas that need to be filled in. Eg over the shoulder or over the abdomen

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26
Q

What is the use of white lotion in wounds?

A

No use! Has lead in it, very bad

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27
Q

What is Panalog?

A

Steroidal antibiotic/antifungals

Steroids reduce the rate of healing (epithelialization)

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28
Q

Why should nitrofurazone never be used in wound managment?

A

Carcinogenic — can cause ovarian cancer

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29
Q

What are the only appropriate topical agents for wound healing?

A

Silver sulfadiazine

Polysporin (

30
Q

Wha type of wound dressing would you use on an exudative or necrotic wound?

A

Hypertonic saline dressing
— draws fluid out of wound

Change Q24-48hrs

31
Q

What is the best antimicrobial dressing?

A

Kerlix AMB

Active agent is polyhexamethylene biguanide
Should be changed q3-7days or sooner if soiled, wet, or slips

32
Q

T/F: corticosteroids can be used on wounds to reduce formation of granulation tissue

A

False

Never use

33
Q

T/F: all open joints are septic joints

A

True

34
Q

How can you determine is a found is penetrating into a synovial structure ?

A

Distend joint with sterile isotonic solution —> open if there is drainage from wound

35
Q

How would you treat a wound at the level of the fetlock with significant granulation tissue formation?

A

Debridement, cut out excessive amounts of granulation tissue

Bandage and cast (pressure /contact inhibiton prevents excessive granulation tissue formation)

36
Q

What synovial structures would you be concerned about is there is a laceration at the level of the pastern?

A

Deep digital flexor tendon sheath

Pastern joint

37
Q

What synovial structure would you be concerned about with heel bulb lacerations?

A

Coffin joint

38
Q

What synovial structures wound you be concerned about if you had a puncture wound to the sole/frog?

A

Navicular bursa

39
Q

What type of closure would you choose for a heel bulb laceration with excessive granulation tissue?

A

Chronic wound — debride out granulation tissue

Second intention healing — not enough tissue to close in this area

40
Q

What type of wound closure would you do for a wound at the level of the metacarpal? This would is acute and very edematous.

A

Delayed primary

— allows wound to declare itself and for edema to decrease

41
Q

How would you manage a degloving inury that has exposed bone?

A

Debride exposed bone back to refresh the capillaries

Second intention wound heleaind

Must truly immobilize the limb with cast/splint

42
Q

When are casts/splints indicated in wound management?

A

Extensive soft tissue loss

Loss/disruption of supportive soft tissue structures (look for changes in the angle of the limbs)

43
Q

What specific concerns to do you have for a wound in the axillary region?

A

Highly mobile area

Can become a sucking wound
—> in extension the wound is open allowing air to enter
—> in flexion the wound is closed and traps air

Can lead to crepitus, SQ emphysema, and pneumomediastinum

44
Q

Why must full thickness eyelid lacerations be repaired surgically?

A

To maintain functionality, comsemtics, and protection of the globe (abrasion, ulceration, and exposure keratitis)

45
Q

How can you repair an eyelid laceration if there is less than 1/3rd of the eyelid margin missing ?

A

Direct apposition

2-layer primary repair
Suture should never be exposed to the cornea —> ulceration

46
Q

How can you repair an eyelid laceration if there is greater than 1/3rd of the eyelid margin missing?

A

MUST use a grafting technique to achieve functional closure

47
Q

T/F: all full thickness lip lacerations must be repaired surgically

A

True

Debridement and a 2 layer closure
A lot of option in the lips

48
Q

Do wounds on the body or the limbs ave faster healing ?

A

Body : more efficient contraction (1mm/day)

Limb wounds: slow (0.2mm/day)

49
Q

What is another name for excessive formation of granulation tissue? Why are distal limb wounds more prone to development of this?

A

Proud flesh

Higher motion and lower vascularity
Inefficient a protracted inflammatory phase —> excessive proliferative phase

Fibroblasts maintain synthetic role

Chronic inflammation and pro-inflammatory mediators released by PMNs —> profibrotic state and exuberant granulation tissue

50
Q

What wound closure methods are best for preserving function and cosmetic appearance of distal limb wounds

A

Primary or delayed primary closure

However, second intention healing is often the only option

51
Q

How would you treat proud flesh?

A

Resection (back to level of skin) and bandage
—> very vascular, work distal to proximal,
—> no nerve endings

Delayed secondary closure

Skin grafts

52
Q

T/F: excessive granulation tissue can be inhibited by bandage

A

True

—contact inhibition

53
Q

Excessive granulation tissue is most likely to occur in which location?

A. Metacarpaus
B. Pectoral region
C. Thorax
D. Head and neck

A

A. Metacarpus

54
Q

What are indications for skin grafts?

A

Large wounds that wont heal otherwise

Any open wound that cant be sutured

55
Q

What are the two classifications of skin grafts?

A

Pedicle graft — remains attached to donor site

Free graft— completely separated from blood supply

56
Q

What type of skin graft provides the best cosmesis and hair growth?

A

Full thickness — epidermis and dermis

57
Q

T/F: the amount of dermis in a graft is indirectly proportional to the ability to survive

A

True
— amount of dermis directly proportional to grafts durability and cosmesis and inversely proportional to the ability to survive

58
Q

What is required for graft acceptance?

A

Adherence — adhered by fibrin

Serum imbibition — nourished by plasma like fluid via capillary action

Revascularization
—> 48hrs : inosculation, neovascularization
—> 4-5days: revascularization

Organization —epidermis thickens in the first 2 weeks

59
Q

What are the types of island grafts?

A

Punch
Pinch (seed)
Tunnel

60
Q

What are the advantages to punch and pinch grafts ?

A

General anesthesia is not required
Minimal equipment
Minimal expertise needed
Compete failure is rare

61
Q

What are the disadvantages of punch and pinch grafts?

A

Poor consensus

Little hair regrowth

62
Q

Where can you harvest punch grafts?

A

Under the mane or ventrolateral abdomen (excise SQ fascia and fat)

63
Q

T/F: recipient holes for a punch graft should be made with smaller punch than the graft

A

True

64
Q

How do you harvest a pinch graft?

A

Tent skin with burred needle (best) or forceps

Transection 3mm disc with blade

Store in saline moisten gauze

65
Q

What are the three main reasons for graft failure?

A

Hemorrhage (fluid accumulation ) —> hematoma/seroma prevents fibrin from attaching graft to the wound

Motion

  • Infection *
    —> 10^5 bacteria/g tissue, some can infect with lower amounts
    B-hemoltytic strep and pseudomonas
66
Q

What are the requirements for a recipient site to have good graft acceptance?

A

Clean, healthy granulation tissue

Granulation tissue flush with skin

Topical antibiotic 24-48hrs prior to grafting (Ticarcillin)

67
Q

What instruments are used to make split thickness sheet grafts?

A

Watson knife

Drum dermatome (Padgett )

Power dermatome (brown pneumatic or Stryker electric)

68
Q

Why would you use a mesh sheet graft

A

Allow graft to cover wound larger than itself

Prevent fluid from disrupting graft from fibrinous and vascular attachments

Conforms irregular surfaces

Allows drainage —> prevents fluid accumulation between graft and granulation tissue

69
Q

What do you do for aftercare for grafts?

A

Cover with sterile non-adherent dressing (telfa, release, adaptic)

Secure with elastic rolled gauze

Routine bandaging

Change bandage ever 4-5days (or daily, Dr. Little preference)

Heavily sedate horse for bandage changes

70
Q

What is the most common reason for skin graft failure in horses

A

Infection

RUSVM Large Animal Surgery (18 decks)

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