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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
T/F: epithelialization occurs faster in a moist environment and will cover non-viable tissue
False Occurs faster in almost environment, but will NOT occur over non-viable tissue
26
What is wound contraction?
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
What things can inhibit wound contraction?
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
What occurs the maturation/remodeling phase of wound healing?
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
What is a class I wound?
Within 0-6hours of wounding Minimal contamination or tissue damage Within the “golden period”
30
What is the “golden period” for wounds?
Insufficient microbial replication to cause infection and usually can manage with primary closure
31
What is a class II wound?
Within 6-12 hours of wounding Microbial replication to critical level is possible but still within golden period
32
What is a class III wound?
>12hours of wounding Microbial replication is at critical level for infection
33
What are the types of wound management?
Primary closure (1st intention) Secondary closure Delayed primary Secondary intention healing
34
What types of local anesthetics can you use for wound management?
Injectable opioids NSAIDS (after blood work) Amantadine/gapapentin/tramadol/trazadone
35
T/F: bandaging is indicated for ALL wounds
True Prevent nosocomial contamination
36
How should you clip and scrub a wound?
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
T/F: alcohol is used to to scrub the area around a wound
False NEVER use
38
What is the preferred lavage solution?
Sterile isotonic saline or a balanced electrolyte solution (LRS) ***least cytotoxic ***
39
T/F: antibiotics or antiseptics can be used in lavage solution
True Can cause tissue damage - must be diluted properly
40
Solutions can be used in lavage?
``` LRS Normal saline 0.05% chlorohxidine solution (1:40) 0.1% povidone-iodine solution (1:100) Tap water ```
41
What lavage solution is effective and less detrimental than distilled/sterile water, but can cause some hypotonic tissue damage?
Tap water Has some cytotoxic trace elements
42
Why do you lavage?
Remove debris and bacteria via mechanical contact and dynamic fluid force Remove exudate Dilute and remove toxins associated with infection
43
What is the ideal pressure for wound lavage ? | What is the best way to achieve this pressure?
7-8psi 1L saline solution bag placed in an pressure cuff at 300mmHg Needle size does not matter
44
How much fluid should you use when flushing a wound?
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
When would you culture a wound?
Severely contaminated, crushed/infected wounds | Wounds > 6-8hours old
46
What type of samples would you collect to culture a wound?
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
What are the advantages of topical antimicrobial selection??
Selective bacterial toxicity | Efficacy in presence of organic material and combined efficacy with systemic antibiotics
48
What are the disadvantages to topical antimicrobal selection??
``` Expense Narrower antimicrobal spectrum Potential for bacterial resistance Creation of “super infections” Systemic or local toxicity Hypersensitivity and increased nosocomial infections ```
49
What topical antimicrobial is effective against most gram positives, gram negatives, fungi, and pseudomonas?
Silver sulfadizine
50
What is the drug of choice to treat burn wounds?
Silver sulfadiazine
51
What is in triple antibiotic ointment?
Bacitracin, neomycin, and Polymixin
52
What is the process of removing dead/damaged tissue, foreign material and microorganisms form a wound?
Debridement -healing is delayed if necrotic tissue is left in the wound
53
What are the methods of surgical debridement?
Layered -> devitalized tissue removed in layers En bloc- entire wound excised if there is sufficient healthy tissue surrounding and vital structures are preserved
54
T/F: contaminated SQ should be liberally excised
True - is easily devascularized and harbors bacteria
55
In what speices would you avoid extensive debridement of SQ ?
Cats
56
What is autolytic debridement?
Creation of a moist wound environment to allow endogenous enzymes to dissolve nonviable tissue
57
When would you opt for autolytic debridement over surgical debridement?
In wounds with questionable tissue viability | —> highly selective for devitalized tissue ONLY
58
What is biosurgical debridement?
Maggot therapy - best suited to necrotic, infectious or chronic non-healing wounds
59
What factors do you consider when deciding to close a wound?
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
If there is any level of contamination, potential for deep tissue injury, viability, or vascular compromise how should you proceed with closing the wound?
Delay closure

RUSVM Small Animal Surgery 1 (39 decks)

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