Wound Managmenet In LA

Question 1

Prolonged inflammation

Answer 1

Leads to delayed proliferation & remodeling phases
Causes delayed healing
Infection
Motion
Cell transformation
Foreign body
Necrotic tissue

Question 2

Cell transformation - DWH

Answer 2

With non-healing wounds, be suspicious of cell transformation to sarcoid or squamous cell carcinoma & collect tissue samples for Histopathology

Question 3

Common materials for foreign bodies

Answer 3

Wood 59%
Metal 24%
Hair 8%
Bone 5%
Plant material 3%

Question 4

Features of a sequestrum

Answer 4

Involcrum
Sequestrum
Cloaca
Inflammatory debris /granulation tissue

Question 5

Wound assessment

Answer 5

Deeper structures that could be exposed
Joint
Tendon sheath
Bursae
Tendons
Collateral cartilages
Bone
Ligaments

Question 6

Features of wound assessment

Answer 6

History
Physical exam
Synoviocentesis - cytology/c/s
Radiographs with contrast
Ultrasound

Question 7

Treatment decisions

Answer 7

Physical exam findings - severity, type of injury. Structures involved, duration of injury
Owner expectations/finance
Medical expertise & temperament of animal

Question 8

Initial management

Answer 8

Appropriate environment - allow full assessment
Restraint/pain manage

Question 9

Wound debridement

Answer 9

Mechanical debridement - sterile saline, gauze, dressings
Chemical
Automatic
NEVER remove ANY tissue unless youre 100% sure its dead

Question 10

Wound lavage

Answer 10

Noncytotoxic solution
- saline, tap water, NOT hydrogen peroxide (toxic to fibroblasts) delays healing
Appropriate pressure and volume
-35ml syringe +19 gauge needle or Spray bottle

Question 11

Lavage solutions

Answer 11

Chlorhexidine - 0.05%, 1:40 dilution
Povidone-iodine: 0.1-0.2%, 10-20 ml/L
NEVER use scrub on/in a wound (contains detergent, toxic to fibroblasts)

Question 12

Primary closure

Answer 12

Ideal approach BUT distal limbs (common injury in LA) and are susceptible to dehiscence
Best closure for facial lacerations, limb wounds + immobilization

Question 13

Second intention healing

Answer 13

Commonly used in horses when there’s extensive tissue trauma, contamination or high motion areas
Most have good cosmetic outcome possibilities

Question 14

Lower limb wounds - second intention healing

Answer 14

Allow granulation tissue to form
Contraction + epithelialization, healing is prolonged
Increased chance of scar formation
More after care, less cosmetic scar

Question 15

Exuberant granulation tissue

Answer 15

“Proud flesh” - raised above wound margins, protrudes over epithelial margin
Caused by dysregulated Fibroplasia & chronic inflame
Occurs in lower limb
Horses»>ponies
** bandages often stimulate granulation formation**

Question 16

Management of granulation tissue

Answer 16

Trim exuberant tissue - use to your advantage
Judicious use of Triamcinolone ointment - use to advantage

Question 17

Triamcinolone ointment

Answer 17

Inhibits epithelialization by reducing water content/swell
Allows wound contraction & epithelization by removing physical barrier
Use BEFORE exuberant

Question 18

Skin grafting

Answer 18

Punch grafts - island graft, full thickness functional/easy
Expect 80-90% acceptance of graft
Axial pattern graft -

Question 19

Septic synovial structures

Answer 19

EMERGENCY TREAT AGGRESSIVELY

Question 20

Etiology of SSS

Answer 20

Puncture wound, hematogenous spread, iatrogenic
severe lameness, effusion, soft tissue swelling, heat

Question 21

DX SSS

Answer 21

Clinical signs
Ultrasound +/- radiographs
Synovial fluid analysis -
Dark yellow, turbid, foamy (^TP), ^cell#, ^ neutrophils
- nucleated cell count
- cell differential
- prescience of bacteria
- culture & sensitivity

Question 22

TX of SSS

Answer 22

Supportive care
- pain management, anti inflame, antimicrobials, surgical

Question 23

Regional antibiotic delivery for SSS

Answer 23

Very high concentrations
Avoid systemic toxicity
Wider antibiotic selection
- intra-articular, intravenous

Question 24

IV regional antibiotic delivery

Answer 24

Sedation ± local block, tourniquet
Butterfly cath, aminoglycosides, ceftiofur
Can repeat every 24-72 hours