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RUSVM Small Animal Surgery 1 > Wound Managment > Flashcards

Wound Managment Flashcards

1
Q

What are the four stages of wound healing?

A

Inflammatory
Debridement
Repair
Maturation/remodeling

** significant degree of overlap, more than one stage can occur at a time

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2
Q

What is the lag phase os wound healing?

A

In the first 3-5days

There is not sufficient inflammation and debridement yet

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3
Q

What is a protective response initiated by tissue damage?

A

Inflammatory phase

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4
Q

What are characteristics of the inflammatory phase of wound healing?

A

Increased permeability of local blood vessels

Recruitment of circulatory cells

Release of growth factors and cytokines

Activation of neutrophils, lymphocytes, fibroblasts, and macrophages

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5
Q

What is the pathophysiology of the inflammatory phase of wound healing?

A

Hemorrhage

Vasoconstriction (5-10mins) - control hemorrhage with clot

Vasodilation -> increased vascular permeability and release of inflammatory mediators

Leukocyte response - macrophages (1st responders) and T lymphocytes

Platelets - coagulation plus production of cytokines and growth factors

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6
Q

When does the inflammatory phase occur?

A

0-5 days

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7
Q

What is the debridement phase of wound healing?

A

In wound bed, development of rich exudate rich in WBC

Arrival of neutrophils and monocytes

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8
Q

T/F: monocytes and neutrophils are essential for wound healing

A

False

Only Monocytes are essential

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9
Q

What is the function of macrophages in debridement?

A

Secrete collagenase- remove necrotic tissue, bacteria, and foreign material

Secrete chemotatic and growth factors

Recruit mesenchymal cells, stimulate angiogenesis and modulate matrix production in wounds

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10
Q

What factor promotes angiogenesis, granulation, and epithelialization via migration of epithelial cells, fibroblasts, and keratinocytes

A

Basic fibroblast growth factor

From macrophages/MC/Tlymphs

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11
Q

What factor simulates fibroblasts to secrete collagenase to degrade the matrix during the remodeling phase?

A

Epidermal growth factor

From platelets and macrophages

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12
Q

What factor stimulates keratinocytes migration, differentiation, and proliferation?

A

Keratinocyte growth factor

From fibroblasts

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13
Q

What factor attracts neutrophils/macrophages, and promotes collagen and proteoglycan synthesis?

A

Platelet derived growth factor

From platelets/macrophage/endothelial cells

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14
Q

What factor attracts neutrophils/macrophages, promotes angiogenesis, up regulates collagen production, and inhibits degradation.

A

Transforming growth facto r

From macrophages/platelet/lymphs/hepatocytes

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15
Q

What factor promotes angiogenesis during tissue hypoxia?

A

Vascular endothelial cell growth factor

From endothelial cells

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16
Q

When does the repair phase occur?

A

3-5days up to 2-4weeks

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17
Q

What are the main cells present in the repair phase?

A

Macrophages and fibroblasts

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18
Q

What is the role of fibroblasts in wound healing?

A

Originate from undifferentiated mesenchymal cells inn surrounding CT —> migrate into wound along fibrin strands

Synthesize and deposit collagen, elastin, and proteoglycans —> fibrous CT

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19
Q

During what phase does angiogenesis occur?

A

Repair phase

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20
Q

A combination of fibroblasts, new capillaries, and fibrous tissue development forms a bright red tissue called ??

A

Granulation tissue

-> filled defects and protects wounds

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21
Q

T/F: granulation tissue provides an barrier to infection

A

True

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22
Q

What type of cells come from granulation tissue and help in wound contraction?

A

Myofibroblasts

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23
Q

What is epithelization?

A

Mobilization, proliferation, and differentiation of epithelial cells

Migration guided by collagen fibers

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24
Q

In what time frame does epithelialization occur in sutured wounds vs open wound?

A

Sutured wounds: 24-48hours

Open wounds: 4-5days

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25
Q

T/F: epithelialization occurs faster in a moist environment and will cover non-viable tissue

A

False

Occurs faster in almost environment, but will NOT occur over non-viable tissue

26
Q

What is wound contraction?

A

Size of wound is reduced d/t fibroblasts, reorganizing collagen in granulation tissue and myofibroblasts contraction at the wound edge

-occur simultaneously with granulation and epithelialization

27
Q

What things can inhibit wound contraction?

A

If skin around wound is…

  • fixed
  • inelastic
  • under tension

OR

Myofibroblasts are inadequate (ie insufficient granulation tissue)

—> iatrogenic= anti-inflammatory steroids, anti-microtubular dugs, and local application of smooth muscle relaxants

28
Q

What occurs the maturation/remodeling phase of wound healing?

A

Strengthening of wound- scar formation

Collagen fibers remodel with alteration of orientation and increased cross-linking

Increase in type I collagen and decreased in type III

29
Q

What is a class I wound?

A

Within 0-6hours of wounding
Minimal contamination or tissue damage

Within the “golden period”

30
Q

What is the “golden period” for wounds?

A

Insufficient microbial replication to cause infection and usually can manage with primary closure

31
Q

What is a class II wound?

A

Within 6-12 hours of wounding

Microbial replication to critical level is possible but still within golden period

32
Q

What is a class III wound?

A

> 12hours of wounding

Microbial replication is at critical level for infection

33
Q

What are the types of wound management?

A

Primary closure (1st intention)

Secondary closure

Delayed primary

Secondary intention healing

34
Q

What types of local anesthetics can you use for wound management?

A

Injectable opioids

NSAIDS (after blood work)

Amantadine/gapapentin/tramadol/trazadone

35
Q

T/F: bandaging is indicated for ALL wounds

A

True

Prevent nosocomial contamination

36
Q

How should you clip and scrub a wound?

A

ASEPTICALLY

Protect wound with sterile lubricant or saline soaked sponges

WIDE clip
Scrub area around wound
- detergents in antiseptic scrubs can cause irritation , toxicity and pain in exposed tissue and may potentiated infection

37
Q

T/F: alcohol is used to to scrub the area around a wound

A

False

NEVER use

38
Q

What is the preferred lavage solution?

A

Sterile isotonic saline or a balanced electrolyte solution (LRS)

**least cytotoxic **

39
Q

T/F: antibiotics or antiseptics can be used in lavage solution

A

True

Can cause tissue damage - must be diluted properly

40
Q

Solutions can be used in lavage?

A 
LRS 
Normal saline 
0.05% chlorohxidine solution (1:40) 
0.1% povidone-iodine solution (1:100) 
Tap water
41
Q

What lavage solution is effective and less detrimental than distilled/sterile water, but can cause some hypotonic tissue damage?

A

Tap water

Has some cytotoxic trace elements

42
Q

Why do you lavage?

A

Remove debris and bacteria via mechanical contact and dynamic fluid force

Remove exudate

Dilute and remove toxins associated with infection

43
Q

What is the ideal pressure for wound lavage ?

What is the best way to achieve this pressure?

A

7-8psi

1L saline solution bag placed in an pressure cuff at 300mmHg
Needle size does not matter

44
Q

How much fluid should you use when flushing a wound?

A

500mL is usually adequate for an average wound

Wounds with high levels of debris, high bioburden, or in immunocompromised should be more aggressively irrigated

45
Q

When would you culture a wound?

A

Severely contaminated, crushed/infected wounds

Wounds > 6-8hours old

46
Q

What type of samples would you collect to culture a wound?

A

Samples from initial wound exploration or during initial debridement
-> remove superficial contaminants

Clip, clean, and lavage wound prior to procuring culture

Collect before antimicrobial flush solutions are used

47
Q

What are the advantages of topical antimicrobial selection??

A

Selective bacterial toxicity

Efficacy in presence of organic material and combined efficacy with systemic antibiotics

48
Q

What are the disadvantages to topical antimicrobal selection??

A 
Expense 
Narrower antimicrobal spectrum 
Potential for bacterial resistance 
Creation of “super infections” 
Systemic or local toxicity 
Hypersensitivity and increased nosocomial infections
49
Q

What topical antimicrobial is effective against most gram positives, gram negatives, fungi, and pseudomonas?

A

Silver sulfadizine

50
Q

What is the drug of choice to treat burn wounds?

A

Silver sulfadiazine

51
Q

What is in triple antibiotic ointment?

A

Bacitracin, neomycin, and Polymixin

52
Q

What is the process of removing dead/damaged tissue, foreign material and microorganisms form a wound?

A

Debridement

-healing is delayed if necrotic tissue is left in the wound

53
Q

What are the methods of surgical debridement?

A

Layered -> devitalized tissue removed in layers

En bloc- entire wound excised if there is sufficient healthy tissue surrounding and vital structures are preserved

54
Q

T/F: contaminated SQ should be liberally excised

A

True

  • is easily devascularized and harbors bacteria
55
Q

In what speices would you avoid extensive debridement of SQ ?

A

Cats

56
Q

What is autolytic debridement?

A

Creation of a moist wound environment to allow endogenous enzymes to dissolve nonviable tissue

57
Q

When would you opt for autolytic debridement over surgical debridement?

A

In wounds with questionable tissue viability

—> highly selective for devitalized tissue ONLY

58
Q

What is biosurgical debridement?

A

Maggot therapy - best suited to necrotic, infectious or chronic non-healing wounds

59
Q

What factors do you consider when deciding to close a wound?

A

Time lapse since injury? - golden period?

Degree of contamination - cause of wound?

Amount of tissue damage

Blood supply status

Ability to decontaminate
Systemic status
Tension/dead space/location
Client logistics

60
Q

If there is any level of contamination, potential for deep tissue injury, viability, or vascular compromise how should you proceed with closing the wound?

A

Delay closure

RUSVM Small Animal Surgery 1 (39 decks)

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