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FCP > Wounds > Flashcards

Wounds Flashcards

1
Q

What is bacterial infection ?

A

more than 10^5 bacteria per gram of tissue

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2
Q

list the subtypes of surgical site infections

A

-incisional
-superficial - skin and sub cut
- deep
-organ/space

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3
Q

List the 4 classifications of degree of contamination , describe

A

-Clean - non-traumatic , non-inflamed , operative wound resp, gastrointestinal, genitourinary and oro-pharyngeal tracts not entered
-Clean-contaminated - operative wound resp, gastrointestinal, genitourinary tract are entered , under controlled conditions without unusual contamination
-Contaminated -open fresh accidental wound , in which gastrointestinal contents or infected urine is spilled or a major break in aseptic technique.
-Dirty -old traumatic wound with purulent discharge , dead tissue ,foreign bodies ,perforated or faecal contamination.

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4
Q

How to reduce infections as well as factors effecting infections ?

A

-aseptic technique - patient prep, surgeon prep and theatre , sterilisation , disinfect
-age - young animals struggle to have decent immune response , older cell division occurs slower wound take longer to heal
-physical condition - if unwell immune system might not be as responsive
-concurrent metabolic issues - corticosteroids make wound healing harder so longer exposure
-current medication - chemotherapy or corticosteroids make wound healing harder so more prone to infection

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5
Q

In what circumstances would it be appropriate to use antibiotics .

A

-surgery <90 min
-prosthetic implantation
-pre-existing prosthesis patient undergoing surgical procedure
-severely infected or traumatised wound

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6
Q

prophylactic antibiotics

A

basically = prevention antibiotics

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7
Q

Prophylactic antibiotic examples and advantages .

A

-cephalosporin - known as Zinacef - good against gram positive
-Amoxicilin - known as Augmentin good against gram positive and anaerobic
-metronidazole - for anaerobic

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8
Q

What are the 3 phases of wound healing ?

A

-haemostasis and inflammation
-proliferation
-maturation

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9
Q

Describe the phase of haemostasis.

A

-injury occurs causing tissue damage
-bv leak
-activates clotting cascade intrinsic and extrinsic
-platelet aggregation and release cytokines
-stabilisation of platelet plug by fibrin formation - stops blood loss

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10
Q

Describe the inflammatory phase of wound healing .

A

-overlaps with haemostasis
-occurs for the first 72 hours after injury
-vasodilation - need good blood supply for wbc
-cytokines in fibrin clot attract wbc - firstly neutrophills then macrophages
-carry out phagocytosis

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11
Q

Describe the proliferation phase of wound healing .

A

-can overlap with inflammatory phase
-formation of granulation tissue formed from macrophages, fibroblasts and new bv
-fibroblasts proliferate and produce new extracellular matrix, elastin and collagen ( starts give wound strength )
-then get formation of new epithelial tissue
-myofibroblasts contract cause wound to contract and shrink
-contact inhibition occurs

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12
Q

Define contact inhibition.

A

when epithelial cells come into contact it inhibits further cell division so end up with smooth layer of epithelial tissue

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13
Q

Describe the maturation phase of wound healing .

A

-remodelling occurs
-type III (immature ) collagen replaced by type I (mature) collagen
-cross linking of collagen
-change in components of extracellular matrix
-increase tensile strength
- takes weeks to months

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14
Q

State and describe factors effecting wound healing . ( patient , wound , concurrent treatment )

A

-age - takes longer older rate of cell division and tissue remodelling is slower
-co-morbities e.g cushings , diabetes slow down wound healing
-nutritional status - healing high energy demand
-infection
-location -tension , movement , blood supply
-corticosteroids - delay all stages of wound healing
-radiation cause tissue fibrosis and vascular scarring

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15
Q

Define abrasion

A

loss of epidermis and some dermis
blunt trauma / shearing

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16
Q

Define evulsion .

A

-like degloving
-tearing of tissues from attachments

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17
Q

Define incision

A

created by sharp object
minimal trauma

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18
Q

Define laceration

A

tearing of wound creating irregular defect
jagged and tears underlying tissue

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19
Q

Define puncture

A

penetrating wound
iceberg situation

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20
Q

What is the sub dermal plexus?

A

terminal branches of cutaneous arteries found in hypodermis and subcutis ( sit below dermis

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21
Q

How to assess a wound ? for SA

A

-type of wound
degree tissue damage
depth
vital struc - bones , joints , tendons ,nerves
tip of the iceberg

-wound age
golden period = 6-8 hrs
contaminated or infected

-level of contamination
foreign material
dead tissue
bacterial innoculum ( bite vs clean glass)
take into account age and nature of wound

-lavage/debridement
gross contamination - tap water
flush hartmanns (35ml/60ml syringe ,18G needle = 7-8 psi )
no added antiseptics
debridement - dressings , surgical

-managment
primary intention
second intention healing
third intention

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22
Q

Define primary intention healing .

A

close straight away surgically

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23
Q

Define secondary healing

A

heal on its own via epithelialisation and contraction

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24
Q

Define third intention healing

A

delayed surgical closure
close over healthy granulation bed once debride

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25
Q

List and describe factors effecting bacterial contamination and infection

A

-vascular supply - reduced ability to fight infection
-dead tissue - increase bacteria growth
-foreign body -reduced ability to figth infection
-type of contamination - getting bitten more bacteria involved than cut on some glass
-type of bacteria

26
Q

What are we getting rid of when we debride

A
  • dead contaminated tissue
    -chronic granualtion tissue
27
Q

What causes chronic granulation tissue ?

A

cells get stuck in the granulation phase and overgrow granulation tissue so the epithelial cells can’t grow over the top . therefore we must remove it to expose a healthy granulation bed.

28
Q

What measure of syringe,needle ,pressure and solution is used for lavage in SA

A

-20-35ml
-18G
-7-8psi
-heartmans

29
Q

Why do we have to be weary of pressure with a lavage ?

A

push bacteria and contaminates deeper into the wound tissue instead of drain out .

30
Q

What’s a common overall treatment for unhealthy granulation bed ?

A

-surgical debridement - scrap off
-lavage
-wet-dry -dressing

31
Q

how often is a wet-dry dressing changed ?

A

every 24 hrs

32
Q

What is topical negative pressure wound therapy ?

A

-pump that reduces air pressure under dressing - draws off exudate and reduce odema , increase blood flow , stimulate granulation tissue ( promotes healing )

33
Q

Why is honey a useful debridement agent ?

A

-low ph - help draw out fluid
-osmotic effect - draws fluid out

34
Q

why is manuka honey a good antimicrobial agent ?

A

-antioxidant
-acidic bacteria can’t grow that can’t take the environment

35
Q

Name types of immobilising bandages and splints

A

-robert jones bandage
-gutter splint
-plaster of paris on a roll
-fibreglass impregnated with resin

36
Q

Describe the different layers of a bandage

A

-primary layer - incontact layer aids healing and protects
-secondary layer - supportive or padding layer(absorbs excessive exudate ) and then conforming ( helps hold in place and absorb exudate )
-tertiary layer -cohesive layer

37
Q

Splint areas forelimb equine

A

region 1 = distal metacarpus , align dorsal cortices placed dorsally ( heel wedge )
region 2 = distal radius- mid-metacarpal ,want to align cortices vertically to keep carpus fully extended and stabilise metacrapal-phalangeal joint , placed lateral , caudally with heavier bandage
region 3= proximal -middle radius , prevent abduction of limb , placed laterally and full robert jones
region 4 =anything proximal from region 3 , no stabilisation needed - heavy distal limb bandage will have pendulum effect - destabilise fracture

38
Q

Splint areas for hindlimb horse

A

region 4 - lots of muscle so natural stabilisation
region 3 - tbia , placed laterally , stop abduction ( tibial fractures poor prognosis )
region 2 middle and proximal metatarsal - heavy bandage, plantar splint and maybe lateral splint as well
region 1 distal metatarsals /proximal phalanges - plantar splint for vertical alignment

39
Q

What are the 3 phases of bone healing ?

A

inflammatory
restorative
remodelling

40
Q

Describe what occurs in the inflammatory phase of bone healing .

A

-lysis of dead soft tissue and osteocytes — attract wbc –macrophages clear debri
-blood clot a fracture site -hematoma ( neovascularisation )

41
Q

Describe the restorative phase of bone healing

A

-soft callus formation - fibrous tissue and cartilage , new bv , starts to stabilise
-hard callus formation -cartilage undergoes endochondral ossification ( osteoblasts )

42
Q

Describe the remodelling phase of Bone healing .

A

-end of bones are enveloped by fusiform mass = callus
-remodelling - oesteoclasts

43
Q

Briefly describe two types of healing that can occur in the restorative phase ?

A

-1st intention minimal bone callus formation there’s just direct formation of bone - (when this occurs -good blood supply , immediate stabilisation , absence infection )
-2nd intention - most common - natural type of healing, there is callus formation ( when this occurs - late treatment ,infection , poor blood supply )

44
Q

State and briefly describe forces applied to bones .

A

-axial compression - push down along its long axis
-tension - pulled , stretched - by ligaments and muscle insertion
-bending - due to asymmetrical bone loading
-Torsion - twist

  • occur to either weight bearing or muscle contraction
45
Q

Which side is a plate always applied to ? and why

A

the tension side because it will not be broken by tensile forces but will be by successive compressions

will break if compressed but not break if stretched

46
Q

What is an IM pin good at stopping ?

A

bending

47
Q

What is good at stopping rotational forces ?

A

interlocking nail, external fixator , plate

48
Q

What is good at stopping tension forces ?

A

lag screw
tension band

49
Q

What sort of management do you use mainly for necrotic and sloughing phase

A

debride devitalised tissue

50
Q

What sort of management do you want to use for sloughing , granulating , epitheliaslising phase ?

A

maintain moist , clean environment
* depends what stage of sloughing as at some points there will be loads of exudate so need something to absorb it instead of making it more moist

51
Q

What do foam dressings do ? when might you use them ?

A

-absorb moisture take away but maintain a constant level of moisture ( optimum for healing if change regularly enough - if not can cause maceration )
-in sloughing phase when there’s lots of exudate and subsequent phases to maintain moisture

52
Q

What do hydrogel dressings do ? when use ?

A

add moisture
epithelial /granulation

53
Q

What are silver dressings good for ?

A

-killign bacteria

54
Q

Why use manuka honey ?

A

-antibacterial effects
-osmotic effect - draws fluid from wound

55
Q

When would you use a tie-over dressing ?

A

for areas of the body that are awkward to bandage

56
Q

Name some splints

A

-PCV drain pipe
-Kimzey leg saver

57
Q

What does proud flesh mean ?

A

excess granulation tissue

58
Q

Why do we use splints ?

A

to immobilise joints so wound/fracture can heal

59
Q

TRUE/FALSE = need periosteum bone layer to allow granulation tissue to form

A

TRUE

60
Q

What is faraging ?

A

drill holes in bone to encourage granulation tissue over the bone ( trying to get into bone marrow cavity )

61
Q

Define sequestrum.

A

piece of bone broken off from rest, dead piece of bone

FCP (24 decks)

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