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Eq SX Final > Wound - Morton > Flashcards

Wound - Morton Flashcards

1
Q

Stages of wound healing

A
  1. Inflammatory: 0-12 hours
  2. Debridement: 6 hours - 3 days
  3. Proliferative (reparative): 4-21 days
  4. Maturation: 21 days - 2 yrs
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2
Q

Inflammatory phase

A
  1. vascular phase
    - Vasoconstriction
    - Vasodilation
  2. WBC emigration
    - Neutrophils
    - Macrophages-essential for normal healing
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3
Q

Stage of wound healing that we have most influence on

A

Debridement

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4
Q

Wound strength peaks at

A

14-21d when peak fibroblast numbers are present

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5
Q

Granulation tissue formation happens at

A

Proliferative stage

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6
Q

Granulation tissue is strongly resistent to

A

infection

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7
Q

Wound contraction in proliferative stage continues until

A

-contact inhibition or tension in surrounding skin equals or exceeds force of contraction.

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8
Q

Proud flesh

A

exuberent granulation tissue, inhibits further contraction

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9
Q

Scars are always

A

weaker than surrounding tissue

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10
Q

Visceral healing mimics cutaneous wound healing but is

A

accelerated

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11
Q

Inflammatory and debridement lag phase

A

4-6 days

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12
Q

Proliferative phase (log phase)

A
  1. Strength increases with collagen content (14-21 days)
  2. No increase in collagen after 3 weeks
  3. Remaining strength due to collagen remodeling
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13
Q

Visceral healing at 14 days

A
  1. Urinary - 100%
  2. Stomach/SI - 75%
  3. Colon - 50%
  4. Skin - 20%
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14
Q

Factors inhibiting wound healing (systemic)

A
  1. Hypoproteinemia
  2. Anemia/blood loss
  3. Malnutrition
  4. Uremia
  5. Dehydration
  6. Edema
  7. Cushings
  8. Corticosteroids
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15
Q

Factors inhibiting wound healing (environmental)

A
  1. Infection - degree/virulence
  2. Type of injury - crushing vs sharp
  3. Ischemia
  4. Foreign material
  5. Radiation/chemo
  6. Antiseptics
  7. Temperature
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16
Q

Wound Classification

A

Class 1
- < 6 hours old, minimal trauma/contamination, minimal tension across edges
Class 2
- 6-12 hours old and/or significant contamination or trauma
Class 3
- > 12 hours old and/or gross contamination

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17
Q

Risk of infection increases with each

A

wound classification

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18
Q

Surgical wound classification

A
  1. Clean
    - Aseptic procedure, not entering GI/resp tract, no break in asepsis
    - ie: arthroscopy
  2. Clean-contaminated
    - GI/Resp tract entered, no spillage
    - ie: enterotomy, laryngotomy
  3. Contaminated
    - Major aseptic breaks, gross spillage
    - ie: abdominal abscess, traumatic wounds
  4. Dirty
    - Purulent
    - ie: perforated viscous, old traumatic wounds
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19
Q

Why classify wounds

A
  1. Determine treatment

2. Determine prognosis

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20
Q

Class 1 wounds can be

A

Immediately closed

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21
Q

Contaminated/dirt wounds require

A
  • prompt treatment

- should achieve clean-contaminated status

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22
Q

Options for wound closure

A
  1. Primary closure
  2. Delayed primary closure
  3. Delayed secondary closure
  4. Second-intention healing
  5. Skin grafting
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23
Q

Primary closure dependent on two main factors

A
  1. Adequate soft tissue vascularity

2. Bacterial inoculum below threshold to cause infection

24
Q

Delayed primary closure

A
  • Performed before onset of fibroplasia (3-5 days)

- decrease risk of infection, minimize scar, increase strength

25
Delayed secondary closure
- Performed after visible granulation tissue present ( >/= 5d) - For more contaminated wounds - Less mobile skin
26
Second intention healing - remember stages of wound healing
1. Fibroplasia incouraged by wound hygiene and debridement - bandaging and hydrotherapy 2. Granulation tissue necessary for wound contraction 3. Healthy granulation tissue resistant to infection
27
Goals of wound managment
1. Restore function | 2. Optimize cosmesis
28
Sedation options
1. Xylazine 2. Romifidine - good to keep standing 3. Detomidine 4. Butorphanol
29
If performing a closure
Aseptically prepare surrounding skin
30
Mechanical cleansing
Reduces for. material and bacterial inoculum - Hydraulic Cleansing (Irrigation) - Direct Contact Cleansing
31
Irrigation
Low pressure lavage - large, unattached particles High pressure lavage - smaller particles -35cc syringe with 19 g needle or 'water pic'
32
Disadvantage
1. SC fluid dissemination 2. Tissue damage 3. Peripheral dissemination of bacteria
33
Irrigation fluids
1. Sterile physiologic solutions (LRS, Saline) 2. +/- antiseptics - 1% betadine soln (1mL in 99mL diluent) - 0.5% chlorhexidine soln 3. +/- abx
34
Antiseptic and abx solns better in
fresh wounds
35
Debridement considerations
1. Removes devitalized tissue 2. Reduces levels of bacterial contamination 3. Serial debridement may be necessary
36
Wet-dry or dry-dry bandages are safer than
surgical debridement
37
Enzymatic debridement
sugar/honey
38
Sugar/honey
Must lavage and mechanically debride first 1. Antibacterial 2. Draws macrophages 3. Decreases edema (Osmotic) 4. Accelerates debridement 5. Use until healthy granulation tissue is present
39
Biological debridement
Maggots
40
Use non-adherent bandages if
healthy bed of granulation tissue | -Telfa
41
Bandage layers
1. Contact layer - adherent - non-adherent 2. Intermediate layer - absorption, pressure, support-roll cotton 3. Tertiary - support, water resistent - vet wrap
42
Systemic antibiotics indicated in wounds that are
contaminated, dirty
43
Topical abx
- Good for fresh wounds to prevent further contamination - Less useful in older wounds - Good for control of surface bacterial on granulation beds
44
Tetanus prophylaxis
- Clostridium tetani - Infections in horses usually fatal - Unknown status or vax > 6 months prior should be vaccinated with toxoid
45
Wound infection
1. Most common closed wounds | 2. Leukocytosis
46
Wound infection
1. Establish drainage 2. Aggressive debridement 3. Appropriate systemic antimicrobial tx 4. Address possible foreign material
47
Other wound therapies
1. Extracorporeal Shockwave TX 2. Topical Negative Pressure (VAC) 3. LASER (LEPT) 4. Gene therapy (humans) 5. Dressings and topical agents
48
TNP
Topical negative pressure 1. Removes excess interstitial fluid and exudate 2. Mechanical force across tissues 3. Deforms extra cellular matrix 4. Promotes reduction in wound size
49
Low Energy Photon therapy
``` aka: LASER therapy Cold laser 1. Increased blood flow 2. Improved lymphatic function (dec. edema) 3. Accelerated tissue repair (inc ATP) 4. Rapid collagen formation (dec scar) 5. Analgesic ```
50
Wounds of distal limbs
1. Improved primary closure with concurrent immobilization 2. Dehiscence very common 3. Exuberant granulation tissue very common
51
Excessive granulation tissue
1. sites of increased tension - distal limb, foreign body 2. debridement, serially may be necessary 3. Pressure bandage limits formation
52
Granulation bed must be
lower than epithelial edge to allow contraction
53
Heel Bulb laceration
1. Vital synovial and soft tissue structures 2. Tension relieving sutures 3. Footie cast 10-14 days 4. Stage suture removal if needed
54
Laceration of extensor tendons prognosis
generally good
55
Head wounds
1. Need to seal mucosa to prevent fistula formation | 2. Fracture frags may sequester
56
Axillary wounds can lead to
SC emphysema => Pneumomediastinum => Pneumothorax
57
Axillary wound treatment
NO PRIMARY CLOSURE Pack and seal - one way valve leads to SQ emphysema Limit movement Change daily

Eq SX Final (16 decks)

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