Wound Managmenet In LA Flashcards
Prolonged inflammation
Leads to delayed proliferation & remodeling phases
Causes delayed healing
Infection
Motion
Cell transformation
Foreign body
Necrotic tissue
Cell transformation - DWH
With non-healing wounds, be suspicious of cell transformation to sarcoid or squamous cell carcinoma & collect tissue samples for Histopathology
Common materials for foreign bodies
Wood 59%
Metal 24%
Hair 8%
Bone 5%
Plant material 3%
Features of a sequestrum
Involcrum
Sequestrum
Cloaca
Inflammatory debris /granulation tissue
Wound assessment
Deeper structures that could be exposed
Joint
Tendon sheath
Bursae
Tendons
Collateral cartilages
Bone
Ligaments
Features of wound assessment
History
Physical exam
Synoviocentesis - cytology/c/s
Radiographs with contrast
Ultrasound
Treatment decisions
Physical exam findings - severity, type of injury. Structures involved, duration of injury
Owner expectations/finance
Medical expertise & temperament of animal
Initial management
Appropriate environment - allow full assessment
Restraint/pain manage
Wound debridement
Mechanical debridement - sterile saline, gauze, dressings
Chemical
Automatic
NEVER remove ANY tissue unless youre 100% sure its dead
Wound lavage
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
Lavage solutions
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)
Primary closure
Ideal approach BUT distal limbs (common injury in LA) and are susceptible to dehiscence
Best closure for facial lacerations, limb wounds + immobilization
Second intention healing
Commonly used in horses when there’s extensive tissue trauma, contamination or high motion areas
Most have good cosmetic outcome possibilities
Lower limb wounds - second intention healing
Allow granulation tissue to form
Contraction + epithelialization, healing is prolonged
Increased chance of scar formation
More after care, less cosmetic scar
Exuberant granulation tissue
“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**
Management of granulation tissue
Trim exuberant tissue - use to your advantage
Judicious use of Triamcinolone ointment - use to advantage
Triamcinolone ointment
Inhibits epithelialization by reducing water content/swell
Allows wound contraction & epithelization by removing physical barrier
Use BEFORE exuberant
Skin grafting
Punch grafts - island graft, full thickness functional/easy
Expect 80-90% acceptance of graft
Axial pattern graft -
Septic synovial structures
EMERGENCY TREAT AGGRESSIVELY
Etiology of SSS
Puncture wound, hematogenous spread, iatrogenic
severe lameness, effusion, soft tissue swelling, heat
DX SSS
Clinical signs
Ultrasound +/- radiographs
Synovial fluid analysis -
Dark yellow, turbid, foamy (^TP), ^cell#, ^ neutrophils
- nucleated cell count
- cell differential
- prescience of bacteria
- culture & sensitivity
TX of SSS
Supportive care
- pain management, anti inflame, antimicrobials, surgical
Regional antibiotic delivery for SSS
Very high concentrations
Avoid systemic toxicity
Wider antibiotic selection
- intra-articular, intravenous
IV regional antibiotic delivery
Sedation ± local block, tourniquet
Butterfly cath, aminoglycosides, ceftiofur
Can repeat every 24-72 hours
