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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

Give tetanus toxoid AND tetanus antitoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

Immediate closure

Clean and clean-contaminated wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is second intention healing?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three phases of wound healing?

A

Inflammation/ lag (hemostasis and acute inflammation)

Proliferative (tissue formation)

Remodeling (regaining of strength)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What initiates angiogenesis in wound healing?

A

Decreased O2 tension
High lactate
Low pH in wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does epithelialization begin?

A

Immediately after wounding

Rapid in superficial injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

New epidermis lacks __________ resulting in less strength and elasticity

A

Dermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraction of wounds begins how long after injury?

A

2weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fibroblasts differentiate into __________ allowing for wound contraction

A

Myofibroblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Remodeling phase begins when and can last how long?

A

2weeks post injury and can last 1-2years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the steps for optimal wound care?

A

Adequate restraint

Analgesia

DEBRIDEMENT

Lavage

Closure

Bandage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What solutions can be used for wound lavage?

A

Non toxic solutions — LRS, Normosol, or saline

DO NOT used antiseptics —> cytotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
T/F: scarlet oil is a good topical product to increase healing of distal limb wounds
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
26
What is the use of white lotion in wounds?
No use! Has lead in it, very bad
27
What is Panalog?
Steroidal antibiotic/antifungals Steroids reduce the rate of healing (epithelialization)
28
Why should nitrofurazone never be used in wound managment?
Carcinogenic — can cause ovarian cancer
29
What are the only appropriate topical agents for wound healing?
Silver sulfadiazine | Polysporin (
30
Wha type of wound dressing would you use on an exudative or necrotic wound?
Hypertonic saline dressing — draws fluid out of wound Change Q24-48hrs
31
What is the best antimicrobial dressing?
Kerlix AMB Active agent is polyhexamethylene biguanide Should be changed q3-7days or sooner if soiled, wet, or slips
32
T/F: corticosteroids can be used on wounds to reduce formation of granulation tissue
False Never use
33
T/F: all open joints are septic joints
True
34
How can you determine is a found is penetrating into a synovial structure ?
Distend joint with sterile isotonic solution —> open if there is drainage from wound
35
How would you treat a wound at the level of the fetlock with significant granulation tissue formation?
Debridement, cut out excessive amounts of granulation tissue Bandage and cast (pressure /contact inhibiton prevents excessive granulation tissue formation)
36
What synovial structures would you be concerned about is there is a laceration at the level of the pastern?
Deep digital flexor tendon sheath | Pastern joint
37
What synovial structure would you be concerned about with heel bulb lacerations?
Coffin joint
38
What synovial structures wound you be concerned about if you had a puncture wound to the sole/frog?
Navicular bursa
39
What type of closure would you choose for a heel bulb laceration with excessive granulation tissue?
Chronic wound — debride out granulation tissue Second intention healing — not enough tissue to close in this area
40
What type of wound closure would you do for a wound at the level of the metacarpal? This would is acute and very edematous.
Delayed primary | — allows wound to declare itself and for edema to decrease
41
How would you manage a degloving inury that has exposed bone?
Debride exposed bone back to refresh the capillaries Second intention wound heleaind Must truly immobilize the limb with cast/splint
42
When are casts/splints indicated in wound management?
Extensive soft tissue loss | Loss/disruption of supportive soft tissue structures (look for changes in the angle of the limbs)
43
What specific concerns to do you have for a wound in the axillary region?
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
Why must full thickness eyelid lacerations be repaired surgically?
To maintain functionality, comsemtics, and protection of the globe (abrasion, ulceration, and exposure keratitis)
45
How can you repair an eyelid laceration if there is less than 1/3rd of the eyelid margin missing ?
Direct apposition 2-layer primary repair Suture should never be exposed to the cornea —> ulceration
46
How can you repair an eyelid laceration if there is greater than 1/3rd of the eyelid margin missing?
MUST use a grafting technique to achieve functional closure
47
T/F: all full thickness lip lacerations must be repaired surgically
True Debridement and a 2 layer closure A lot of option in the lips
48
Do wounds on the body or the limbs ave faster healing ?
Body : more efficient contraction (1mm/day) Limb wounds: slow (0.2mm/day)
49
What is another name for excessive formation of granulation tissue? Why are distal limb wounds more prone to development of this?
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
What wound closure methods are best for preserving function and cosmetic appearance of distal limb wounds
Primary or delayed primary closure However, second intention healing is often the only option
51
How would you treat proud flesh?
Resection (back to level of skin) and bandage —> very vascular, work distal to proximal, —> no nerve endings Delayed secondary closure Skin grafts
52
T/F: excessive granulation tissue can be inhibited by bandage
True | —contact inhibition
53
Excessive granulation tissue is most likely to occur in which location? A. Metacarpaus B. Pectoral region C. Thorax D. Head and neck
A. Metacarpus
54
What are indications for skin grafts?
Large wounds that wont heal otherwise | Any open wound that cant be sutured
55
What are the two classifications of skin grafts?
Pedicle graft — remains attached to donor site Free graft— completely separated from blood supply
56
What type of skin graft provides the best cosmesis and hair growth?
Full thickness — epidermis and dermis
57
T/F: the amount of dermis in a graft is indirectly proportional to the ability to survive
True — amount of dermis directly proportional to grafts durability and cosmesis and inversely proportional to the ability to survive
58
What is required for graft acceptance?
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
What are the types of island grafts?
Punch Pinch (seed) Tunnel
60
What are the advantages to punch and pinch grafts ?
General anesthesia is not required Minimal equipment Minimal expertise needed Compete failure is rare
61
What are the disadvantages of punch and pinch grafts?
Poor consensus | Little hair regrowth
62
Where can you harvest punch grafts?
Under the mane or ventrolateral abdomen (excise SQ fascia and fat)
63
T/F: recipient holes for a punch graft should be made with smaller punch than the graft
True
64
How do you harvest a pinch graft?
Tent skin with burred needle (best) or forceps Transection 3mm disc with blade Store in saline moisten gauze
65
What are the three main reasons for graft failure?
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
What are the requirements for a recipient site to have good graft acceptance?
Clean, healthy granulation tissue Granulation tissue flush with skin Topical antibiotic 24-48hrs prior to grafting (Ticarcillin)
67
What instruments are used to make split thickness sheet grafts?
Watson knife Drum dermatome (Padgett ) Power dermatome (brown pneumatic or Stryker electric)
68
Why would you use a mesh sheet graft
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
What do you do for aftercare for grafts?
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
What is the most common reason for skin graft failure in horses
Infection