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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
Q

Delayed secondary closure

A
  • Performed after visible granulation tissue present ( >/= 5d)
  • For more contaminated wounds
  • Less mobile skin
26
Q

Second intention healing - remember stages of wound healing

A
  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
Q

Goals of wound managment

A
  1. Restore function

2. Optimize cosmesis

28
Q

Sedation options

A
  1. Xylazine
  2. Romifidine - good to keep standing
  3. Detomidine
  4. Butorphanol
29
Q

If performing a closure

A

Aseptically prepare surrounding skin

30
Q

Mechanical cleansing

A

Reduces for. material and bacterial inoculum

  • Hydraulic Cleansing (Irrigation)
  • Direct Contact Cleansing
31
Q

Irrigation

A

Low pressure lavage - large, unattached particles
High pressure lavage - smaller particles
-35cc syringe with 19 g needle or ‘water pic’

32
Q

Disadvantage

A
  1. SC fluid dissemination
  2. Tissue damage
  3. Peripheral dissemination of bacteria
33
Q

Irrigation fluids

A
  1. Sterile physiologic solutions (LRS, Saline)
  2. +/- antiseptics
    - 1% betadine soln (1mL in 99mL diluent)
    - 0.5% chlorhexidine soln
  3. +/- abx
34
Q

Antiseptic and abx solns better in

A

fresh wounds

35
Q

Debridement considerations

A
  1. Removes devitalized tissue
  2. Reduces levels of bacterial contamination
  3. Serial debridement may be necessary
36
Q

Wet-dry or dry-dry bandages are safer than

A

surgical debridement

37
Q

Enzymatic debridement

A

sugar/honey

38
Q

Sugar/honey

A

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
Q

Biological debridement

A

Maggots

40
Q

Use non-adherent bandages if

A

healthy bed of granulation tissue

-Telfa

41
Q

Bandage layers

A
  1. Contact layer
    - adherent
    - non-adherent
  2. Intermediate layer
    - absorption, pressure, support-roll cotton
  3. Tertiary
    - support, water resistent
    - vet wrap
42
Q

Systemic antibiotics indicated in wounds that are

A

contaminated, dirty

43
Q

Topical abx

A
  • Good for fresh wounds to prevent further contamination
  • Less useful in older wounds
  • Good for control of surface bacterial on granulation beds
44
Q

Tetanus prophylaxis

A
  • Clostridium tetani
  • Infections in horses usually fatal
  • Unknown status or vax > 6 months prior should be vaccinated with toxoid
45
Q

Wound infection

A
  1. Most common closed wounds

2. Leukocytosis

46
Q

Wound infection

A
  1. Establish drainage
  2. Aggressive debridement
  3. Appropriate systemic antimicrobial tx
  4. Address possible foreign material
47
Q

Other wound therapies

A
  1. Extracorporeal Shockwave TX
  2. Topical Negative Pressure (VAC)
  3. LASER (LEPT)
  4. Gene therapy (humans)
  5. Dressings and topical agents
48
Q

TNP

A

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
Q

Low Energy Photon therapy

A 
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
Q

Wounds of distal limbs

A
  1. Improved primary closure with concurrent immobilization
  2. Dehiscence very common
  3. Exuberant granulation tissue very common
51
Q

Excessive granulation tissue

A
  1. sites of increased tension - distal limb, foreign body
  2. debridement, serially may be necessary
  3. Pressure bandage limits formation
52
Q

Granulation bed must be

A

lower than epithelial edge to allow contraction

53
Q

Heel Bulb laceration

A
  1. Vital synovial and soft tissue structures
  2. Tension relieving sutures
  3. Footie cast 10-14 days
  4. Stage suture removal if needed
54
Q

Laceration of extensor tendons prognosis

A

generally good

55
Q

Head wounds

A
  1. Need to seal mucosa to prevent fistula formation

2. Fracture frags may sequester

56
Q

Axillary wounds can lead to

A

SC emphysema =>
Pneumomediastinum =>
Pneumothorax

57
Q

Axillary wound treatment

A

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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