Wound Managment and Bandaging 2 Flashcards
what are the 3 phases of wound healing?
inflammatory, proliferative, maturation
when does the inflammatory phase occur in wound healing?
immediate-3/5 days
what happens during the inflammatory phase of wound healing?
blood clot formation, macrophages and neutrophils go to the site to prevent infection, growth factors are released, and angiogenesis occurs
angiogenesis
formation of new blood cells
when does the proliferative phase of wound healing occur?
2-3 days after injury
what happens during the proliferative phase of wound healing?
fibroblasts, growth factors, and collagen continue working at the site to create a scab, granulation tissue starts developing, new epithelium begins to grow, the wound contracts as new tissues grow, strength increases
what type of environment is important to have for healing wounds?
a moist environment = enhanced cell migration
scabs help create this environment
when does the maturation phase of wound healing occur?
around 3 weeks after injury and can last months
what happens during the maturation phase of wound healing?
collagen fibers remodel and align, the site gains its maximum strength (which will only ever be able to be at 80% of its original strength)
what are some patient factors that could affect wound healing?
age (older animals have less collagen), endocrinopathies (endocrine disease) and viral diseases (ex: FeLV/FIV), diabetes mellitus, orthopedic or neurologic problems, nutrition status (ex: patients with low protein or albumin will have longer healing times)
recumbent
decreased mobility
what is wound classification?
classifying a wound based on the degree of contamination and/or length of time wound has been open
what are the 4 different wound classifications?
clean, clean contaminated, contaminated, dirty
clean wound classification
wound made under aseptic conditions
ex: surgical incision
clean contaminated wound classification
surgical incision into a hollow organ
contaminated wound classification
open and traumatic wound
ex: dropped surgical instrument on floor and then used it right away in a patient’s body
dirty wound classification
old traumatic wounds, wounds that punctured viscera, or a internal foreign body ruptured an organ
any wound open after 4 hours is considered dirty or if the wound has >100,000 microorganisms per 1 mL of fluid/1 g of tissue on it
what are some factors that could affect wound healing due to concurrent treatment?
if an animal is having oncologic radiation, chemotherapy, or corticosteroids wound healing will take longer
chemotherapy suppresses bone marrow function (where new blood cells are made) and corticosteroids decrease the body’s immune system over time
what should be done as immediate care for managing a wound?
stabilize the patient first (they will probably be in shock), prevent contamination, clean and lavage the wound
what are the steps to clean and lavage a wound?
- cover the wound with moist sterile gauze or sterile water-soluble lubricant
- clip hair around wound
- clean with an antiseptic (don’t get it in the wound though cause of cytotoxicity)
- lavage with warm isotonic crystalloid fluid (LRS) which removes lubricant, foreign debris, and loose necrotic tissue
what are the different types of debridement?
surgical, non-surgical, mechanical, and biological
what are the 2 methods for surgical debridement?
- en bloc excision: remove entire wound creating a new cleaner wound (for small wounds)
- layered/staged excision: remove necrotic tissue and questionable tissue is reassessed, best approach for distal limb wound and larger wounds
what are the 2 ways to perform non-surgical debridement?
- enzymatic agents: Trypsin, Collagenase
best for chronic non-healing wounds - non-enzymatic hypersomotic agents: 20% hypertonic saline, sugar, honey, dextran dressings
creates -cidal effect through dehydration, draws exudate and debris away, not good for prolonged use
how can sugar be helpful for debridement?
it creates a hyperosmotic environment and draws macrophages into the wound
how can honey be helpful for debridement?
it creates a hypertonic environment, an energy source for healing cells, and antibacterial properties
make sure to only use medical grade Manuka honey
how is mechanical debridement performed?
by using adherant primary layers
what are the 3 methods for mechanical debridement?
dry-to-dry, wet-to-dry, and wet-to-wet
how is the dry-to-dry mechanical debridement method performed?
putting a piece of dry gauze on the wound and then ripping it off
painful!!
it is a form of non-specific tissue debridement so healthy granulation tissue will be stripped off too
how is the wet-to-dry mechanical debridement method performed?
by putting a piece of gauze moistened with saline on a wound and allowing it to dry before pulling it off
painful!
used when exudate is viscous or dried foreign material is present
how is the wet-to-wet mechanical debridement method performed?
by putting a piece of gauze moistened with saline on a wound and pulling it off while it’s still wet
not as painful
can lose foreign material back into wound since it won’t stick to the wet gauze as well
when is biological debridement used?
when surgery is contraindicated
how is biological debridement performed?
by using green blow fly larvae (maggots) to secrete enzymes that will dissolve necrotic material
healthy epithelium can also be destroyed so bandage off the area so the maggots can only get to the wound
healthy dermis and SQ tissue won’t be destroyed
what factors are taken into consideration when choosing which type of wound closure to implement?
wound origin (surgical or traumatic), size, type, level of contamination, and location
1st intention wound closure
apposing wound edges with sutures or staples
used in fresh clean wounds with little soft tissue loss
epithelialization begins in 1 or 2 days
no granulation tissue present
2nd intention wound closure
for larger, older (>6 hrs), infected wounds
heals by granulation tissue and epithelialization
takes longer to heal
newly epithelialized wounds are fragile!!
can lose function due to excessive scarring and contraction
3rd intention wound closure
combo of 1st and 2nd intention
wound is allowed to form granulation tissue and then it is surgically closed
good for old wounds (> 6 hrs) that are large, infected, and necrotic or if primary closure didn’t hold
what are some characteristics of granulation tissue?
it is new connective tissue and blood vessels that form on the surface of a wound during healing
pink/ red color and moist
usually raised higher than surrounding tissue and may be bumpy
dead space
separation of soft tissue that is accompanied by fluid or air
when would a drain be needed for a wound?
when the wound is highly exudative or there is excessive dead space
what are the different types of wound drains?
passive, active, negative pressure wound therapy
passive wound drain
Penrose
remove after 3-5 days
works through gravity and capillary action
placed on ventral aspect of wound
active wound drain
Jackson-Pratt
used for larger wounds or fluid pooling in the abdomen
rigid fenestrated drain
fluid collection through closed-suction or vacuum action with negative pressure
tube goes into wound/ abdomen and is attached to a bulb that is squeezed before being attached to the tube
can use to measure exudate/ fluid or check to see if anti-bacterial medicine is working sense you can test the abdominal fluid for amount of bacteria
what are the signs of wound infection?
edema, erythema, heat
how can you determine the severity of a wound infection?
more systematic signs mean it is more severe
systematic signs: lethargy, fever, pain
what type of antimicrobial should be used for wound infection?
if the infection isn’t systematic use topical, otherwise use IV
