Wound Managment and Bandaging 2

Question 1

what are the 3 phases of wound healing?

Answer 1

inflammatory, proliferative, maturation

Question 2

when does the inflammatory phase occur in wound healing?

Answer 2

immediate-3/5 days

Question 3

what happens during the inflammatory phase of wound healing?

Answer 3

blood clot formation, macrophages and neutrophils go to the site to prevent infection, growth factors are released, and angiogenesis occurs

Question 4

angiogenesis

Answer 4

formation of new blood cells

Question 5

when does the proliferative phase of wound healing occur?

Answer 5

2-3 days after injury

Question 6

what happens during the proliferative phase of wound healing?

Answer 6

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

Question 7

what type of environment is important to have for healing wounds?

Answer 7

a moist environment = enhanced cell migration
scabs help create this environment

Question 8

when does the maturation phase of wound healing occur?

Answer 8

around 3 weeks after injury and can last months

Question 9

what happens during the maturation phase of wound healing?

Answer 9

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)

Question 10

what are some patient factors that could affect wound healing?

Answer 10

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)

Question 11

recumbent

Answer 11

decreased mobility

Question 12

what is wound classification?

Answer 12

classifying a wound based on the degree of contamination and/or length of time wound has been open

Question 13

what are the 4 different wound classifications?

Answer 13

clean, clean contaminated, contaminated, dirty

Question 14

clean wound classification

Answer 14

wound made under aseptic conditions
ex: surgical incision

Question 15

clean contaminated wound classification

Answer 15

surgical incision into a hollow organ

Question 16

contaminated wound classification

Answer 16

open and traumatic wound
ex: dropped surgical instrument on floor and then used it right away in a patient’s body

Question 17

dirty wound classification

Answer 17

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

Question 18

what are some factors that could affect wound healing due to concurrent treatment?

Answer 18

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

Question 19

what should be done as immediate care for managing a wound?

Answer 19

stabilize the patient first (they will probably be in shock), prevent contamination, clean and lavage the wound

Question 20

what are the steps to clean and lavage a wound?

Answer 20

1. cover the wound with moist sterile gauze or sterile water-soluble lubricant
2. clip hair around wound
3. clean with an antiseptic (don’t get it in the wound though cause of cytotoxicity)
4. lavage with warm isotonic crystalloid fluid (LRS) which removes lubricant, foreign debris, and loose necrotic tissue

Question 21

what are the different types of debridement?

Answer 21

surgical, non-surgical, mechanical, and biological

Question 22

what are the 2 methods for surgical debridement?

Answer 22

1. en bloc excision: remove entire wound creating a new cleaner wound (for small wounds)
2. layered/staged excision: remove necrotic tissue and questionable tissue is reassessed, best approach for distal limb wound and larger wounds

Question 23

what are the 2 ways to perform non-surgical debridement?

Answer 23

1. enzymatic agents: Trypsin, Collagenase
   best for chronic non-healing wounds
2. 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

Question 24

how can sugar be helpful for debridement?

Answer 24

it creates a hyperosmotic environment and draws macrophages into the wound

Question 25

how can honey be helpful for debridement?

Answer 25

it creates a hypertonic environment, an energy source for healing cells, and antibacterial properties
make sure to only use medical grade Manuka honey

Question 26

how is mechanical debridement performed?

Answer 26

by using adherant primary layers

Question 27

what are the 3 methods for mechanical debridement?

Answer 27

dry-to-dry, wet-to-dry, and wet-to-wet

Question 28

how is the dry-to-dry mechanical debridement method performed?

Answer 28

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

Question 29

how is the wet-to-dry mechanical debridement method performed?

Answer 29

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

Question 30

how is the wet-to-wet mechanical debridement method performed?

Answer 30

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

Question 31

when is biological debridement used?

Answer 31

when surgery is contraindicated

Question 32

how is biological debridement performed?

Answer 32

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

Question 33

what factors are taken into consideration when choosing which type of wound closure to implement?

Answer 33

wound origin (surgical or traumatic), size, type, level of contamination, and location

Question 34

1st intention wound closure

Answer 34

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

Question 35

2nd intention wound closure

Answer 35

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

Question 36

3rd intention wound closure

Answer 36

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

Question 37

what are some characteristics of granulation tissue?

Answer 37

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

Question 38

dead space

Answer 38

separation of soft tissue that is accompanied by fluid or air

Question 39

when would a drain be needed for a wound?

Answer 39

when the wound is highly exudative or there is excessive dead space

Question 40

what are the different types of wound drains?

Answer 40

passive, active, negative pressure wound therapy

Question 41

passive wound drain

Answer 41

Penrose
remove after 3-5 days
works through gravity and capillary action
placed on ventral aspect of wound

Question 42

active wound drain

Answer 42

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

Question 43

what are the signs of wound infection?

Answer 43

edema, erythema, heat

Question 44

how can you determine the severity of a wound infection?

Answer 44

more systematic signs mean it is more severe
systematic signs: lethargy, fever, pain

Question 45

what type of antimicrobial should be used for wound infection?

Answer 45

if the infection isn’t systematic use topical, otherwise use IV