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Equine Surgery: QOD > Wounds > Flashcards

Wounds Flashcards

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1
Q

Mechanical debridement of wounds consist of

A

Wet-to-dry, wet-to-wet dressing, manual debridement with gauze or irrigation

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2
Q

Best choice of suture for closure of contaminated wounds

A

Totally not sure about this one. A monofilament absorbable suture - Monocryl? But PDS if under a lot of tension

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3
Q

Most important factor in management of contaminated/Infected wounds

A

Removal of devitalised tissue

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4
Q

Granulation tissue consist of

A

Collagen (type III), capillaries, fibroblasts

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5
Q

Describe the phases of wound repair

A

Inflammatory: Haemostasis and inflammation Tissue Formation: Angiogenesis, Fibroplasia, Tissue Formation, Epithelialisation, Contaction Remodelling/Maturation: Replacement of hyaluronan in provisional cellular matrix with proteoglycans in extracellular matrix Alignment of collagen fibres Gain in strength of wound

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6
Q

2 main cell types in wound healing inflammatory phase

A

Platelets and neutrophils

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7
Q

Differences between low and high pressure lavage in wound irrigation

A

Low pressure lavage is ideal; 10-15psi. Can used 35ml syringe with 19 gauge needle, holes punched in the top of a saline bottle. Encourages debris and bacteria to wash away from the wound High usually uses a single water jet. pressure lavage is bad: eg. WaterPik. Causes more tissue trauma and may force debris/bacteria further into tissues. However, this can be utilised in circumstances, such as abdominal lavage

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8
Q

What are the 3 purposes of drains

A

Facilitate elimination of dead space Evacuate existing fluid and gas accumulation Prevent anticipated formation of fluid collections

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9
Q

What are the advantages and disadvantages of penrose drains?

A

Advantages: Economical Can be used in lots of situations Disadvantages May kink Not useful in body cavities Passive only, no suction possible

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10
Q

What are the advantages and disadvantages of Jackson-Pratt drain

A

Advantages: Closed or open system Excellent for body cavities Less reactive Disadvantages: Attaching container can be difficult depending on location

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11
Q

What locations should be used to drain a) fluid and b) air from the thorax?

A

a) Ventral (2 inches above elbow) 7th intercostal space (front of rib) b) Dorsal 12th intercostal space (front of rib)

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12
Q

What complications can occur with drains

A

Foreign body response Ascending infections Portion of drain left in wound Loss of function/blockage Linkage of drain Suture dehiscence Damage to vessels and nerves

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13
Q

Which dressings can be used for heavily infected wounds?

A

Hypertonic saline dressing Honey Antimicrobial dressing Should use surgical debridement first

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14
Q

What are the advantages of calcium alginate dressings?

A

Calcium in dressing interacts with sodium in wound, providing wound exudate, stimulating fibroblasts and epithelial cells and speeds wound homeostasis Calcium modulates epithelial cell proliferation and migration Conform, vertical wicking, good for moderately to heavily exudative wounds Can moisten if insufficient exudate Change 3-7 days so fewer chances for contamination and reduced cost

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15
Q

Define bacterial contamination, colonisation and infection

A

Contamination: Bacteria without multiplication or trauma to host Colonisation: Attached to tissue and multiplying but not causing trauma to host Infection: Bacteria invade healthy tissue and multiply, overwhelming host’s response

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16
Q

What are the four classes of wound?

A

Clean: Surgical and do not involve resp, GI or urogenital Clean contaminated: Surgical with lumen of resp, GI or urogenital Contaminated: Traumatic, gross contamination, necrotic debris Infected: Large numbers of bacteria, inflammation, edema, suppuration

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17
Q

What is a keloid?

A

Similar to hypertrophic scar but extends beyond original wound margin and rarely regresses. May be due to increased number of epidermal Langerhans’ cells. Treatment: Steroid injection, surgical excision, radiation therapy, compression and tension reduction used

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18
Q

Name 3 tension relieving suture patterns

A

Horizontal Mattress Far-near-near-far Walking suture

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19
Q

Describe a V-Y Plasty

A

V-shaped incision with the point of the V directed away from the defect to be closed Close the original defect Close V incision by converting it to a Y Longer legs of the V make a greater degree of tension relief Use for eyelid scar revision and closing elliptical defects

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20
Q

What is a method of closing a circular skin defect

A

a.Suture along relaxing skin lines of tension then remove dog ears b. Convert to X or Y c. Excise 2 triangles on opposite sides, creating a fusiform defect; height of triangle should be equal to dimeter of the circle; removes skin of 1.5x original defect d. Double S-shaped incision with bi-winged excision e. Bow tie f. Combined V incision

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21
Q

Describe a bipedicle flap

A

Single longitudinal incision parallel to defect, or one incision on each side Skin flaps approximately same width as original defect Two sources of blood supply remain Burrow’s triangles can be used to help with excess laxity/dog ears Original defect is closed New incision(s) are left open

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22
Q

What is the difference between a rotation flap and a transposition flap

A

Rotation flap: Create semicircular incision and move tissue laterally to cover defect Transposition flap: Rectangular, single pedicle flap created adjacent to defect and rotated on it’s pedicle. Can be rotated up to 180 degrees but rotation shortens flap

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23
Q

What are the 3 purposes of drains

A

Facilitate elimination of dead space Evacuate existing fluid and gas accumulation Prevent anticipated formation of fluid collections

How well did you know this?
1
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2
3
4
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24
Q

What are the advantages and disadvantages of penrose drains?

A

Advantages: Economical Can be used in lots of situations Disadvantages May kink Not useful in body cavities Passive only, no suction possible

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1
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2
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25
What are the advantages and disadvantages of Jackson-Pratt drains
Advantages: Closed or open system Excellent for body cavities Less reactive Disadvantages: Attaching container can be difficult depending on location
26
What locations should be used to drain a) fluid and b) air from the thorax
a) Ventral (2 inches above elbow) 7th intercostal space (front of rib) b) Dorsal 12th intercostal space (front of rib)
27
What complications can occur with drains
Foreign body response Ascending infections Portion of drain left in wound Loss of function/blockage Linkage of drain Suture dehiscence Damage to vessels and nerves
28
Which dressings can be used for heavily infected wounds
Hypertonic saline dressing Honey Antimicrobial dressing Should use surgical debridement first
29
What are the advantages of calcium alginate dressings
Calcium in dressing interacts with sodium in wound, providing wound exudate, stimulating fibroblasts and epithelial cells and speeds wound homeostasis Calcium modulates epithelial cell proliferation and migration Conform, vertical wicking, good for moderately to heavily exudative wounds Can moisten if insufficient exudate Change 3-7 days so fewer chances for contamination and reduced cost
30
Define bacterial contamination, colonisation and infection
Contamination: Bacteria without multiplication or trauma to host Colonisation: Attached to tissue and multiplying but not causing trauma to host Infection: Bacteria invade healthy tissue and multiply, overwhelming host's response
31
What are the four classes of wound
Clean: Surgical and do not involve resp, GI or urogenital Clean contaminated: Surgical with lumen of resp, GI or urogenital Contaminated: Traumatic, gross contamination, necrotic debris Infected: Large numbers of bacteria, inflammation, edema, suppuration
32
What is a keloid
Similar to hypertrophic scar but extends beyond original wound margin and rarely regresses. May be due to increased number of epidermal Langerhans' cells. Treatment: Steroid injection, surgical excision, radiation therapy, compression and tension reduction used
33
Name 3 tension relieving suture patterns
Horizontal Mattress Far-near-near-far Walking suture
34
Describe a V-Y Plasty
V-shaped incision with the point of the V directed away from the defect to be closed Close the original defect Close V incision by converting it to a Y Longer legs of the V make a greater degree of tension relief Use for eyelid scar revision and closing elliptical defects
35
What is a method of closing a circular skin defect
a. Suture along relaxing skin lines of tension then remove dog ears b. Convert to X or Y c. Excise 2 triangles on opposite sides, creating a fusiform defect; height of triangle should be equal to dimeter of the circle; removes skin of 1.5x original defect d. Double S-shaped incision with bi-winged excision e. Bow tie f. Combined V incision
36
Describe a bipedicle flap
Single longitudinal incision parallel to defect, or one incision on each side Skin flaps approximately same width as original defect Two sources of blood supply remain Burrow's triangles can be used to help with excess laxity/dog ears Original defect is closed New incision(s) are left open
37
What is the difference between a rotation flap and a transposition flap
Rotation flap: Create semicircular incision and move tissue laterally to cover defect Transposition flap: Rectangular, single pedicle flap created adjacent to defect and rotated on it's pedicle. Can be rotated up to 180 degrees but rotation shortens flap
38
State the advantages and disadvantages or polyglactin 910 and polydioxanone
Polyglactin 910: - Advantages: - Good size to strength ration - Greater initial breaking strength and stiffness than polyioxanone - Minimal tissue reaction - Excellent handing - Disadvantages: - May cut through friable tissue (esp. if not coated) Polydioxanone: - Advantages: - Maintains tensile strength over prolonger period - (Less memory than polyglyconate) - Disadvantages: - Moderate knot security - Moderate handling
39
What suture material should be used in the urinary tract
Polyglyconate or polydioxanone (if likely to be exposure to urine) Poliglecaprone possible but not yer evaluated
40
List the reasons for graft failure
Infection Fluid accumulation Motion Inflammation
41
Define serum imbibition and inosculation
Imbibition: Newly applied graft nourished by plasma-like fluid that passively enters open vessels of graft via capillary action Inosculation: After 48hrs, new capillaries generated in recipient bed traverse fibrin layer to anastomose with those if graft
42
Where can grafts be taken from
Full-thickness sheet grafts: Pectoral region Split-thickness sheet grafts: Ventral abdomen and ventrolateral thorax behind elbow Island grafts: Ventrolateral abdomen, perineum, area beneath mane
43
What is the Modified Meek grafting technique
A combination of split-thickness sheet grafting and island grafting. Split-thickness sheet graft obtained and Meek micrografting equipment converts this to many micr grafts on a piece of gauze
44
How should grafts be stored
Lay on sterile gauze swab with epidermis next to gauze Roll up gauze-graft with gauze outside of roll Place in sterile container with 1-1.25mL of storage medium per cm2 of graft Check pH indicator: Cherry red to orange-yellow indicates excessive catabolites (apply graft or replace half of medium) Can usually store until wound permits grafting
45
Name and define the types of septic arthritis/osteomyelitis in foals
S-Type Infections: Synovial membrane and fluid foals \<1 week Multiple joints, most commonly stifle and hock Acute lameness Linked with FPT E-Type Infections: Articular epiphyseal complex (source of growth) Several weeks of age Multiple or single joints Linked with FPT May also have pneumonia/diarrhea P-Type Infections: Physis +/- joint involvement Weeks to a few months of age Healthy foals Distal physes of MCIII/MTIII and tibia common One site usually Streptococcus, Rhodococcus, Actinobacillus, E. coli, Salmonella
46
What are the most common bacteria found in septic joints in foals and adults
Foals, type P: Streptococcus, Rhodococcus, Actinobacillus, E. coli, Salmonella Adults after Injection/surgery: Staphylococcus spp. Traumatic injury: E.coli (most common) Salmonella (most common) Staphylococcus Pseudomonas Yeast Other fungi
47
What are the methods of local antibiotic delivery
IO IA (+/- pump) RLP Antimicrobial infused biomaterials
48
What biomaterials can be used in local antibiotic delivery and define whether the are absorbable or non-absorbable
Biodegradable: Collagen sponge Plaster of paris Hydroxyapatite Dextran gel Non-biodegradable: PMMA
49
How do you treat implant infections
Local AB delivery:AB beads: PMMA good elution but non-absorbable (remove but rarely cause problem if left) RLP: Daily for as long as possible Whole systemic daily dose Large vessels, immediate compression, topical NSAIDs, Bandaging Drainage of infected tissues: Ultrasound guided incision Surgical drain Remove implants when sufficiently stabilized If not sufficiently stable: Remove implants, debride bone and replace autoclaved implants Remove and manage fracture/arthrodesis with transfixation cast Dynamic compression or tension device can restabilize site; empty screw holes filled with AB-impregnated collagen/dextran gel, POP
50
What is the ethology of dentigerous cysts
Incomplete closure of first branchial cleft during embryologic development
51
List the treatment options for sarcoids
Surgical Excision: Least successful alone Recurrence: 15.8-82% Laser Ablation: Less spread of cells Recurrence: 38% Combine with chemotherapy Cryotherapy: Success: 60-100% Recurrence: 91% (success 9%) in another study Thermocouples help 3x -30 degrees: Success: 68% to 85% if treatments repeated Hyperthermia: Spontaneous regress of non-treated tumors also Radiotherapy:Iridium-192 implants Success: 87.5-100% Single dose Brachytherapy: 86.6% Hair/pigment loss, fibrosis, cataract formation, corneal ulceration Gold-198 implants Expensive Hospitalization Potentially hazardous General anesthesia may be needed Immunotherapy: Mycobacterium cell wall extracts Live whole-cell bacille Calmett-Guerin (BCG) Propionibacterial cell wall extracts Stimulated cell-mediated immuniting Multiple intralesional injections Higher success for smaller tumors Severe local tissue swelling Anaphylactic shock possible Spontaneous regresson of untreated tumors can occur Recurrence: 0-40% Vaccination (tumor tissue) successful Intralesional Cisplatin: Success: 87% Recurrence: 66% Avoids systemic toxicity if in oil Epinephrine can be added to emulsion (1:1000) 1mg cisplatin per cubic centimeter, minimum 4 treatments Cytoreduction may help; injection does not affect wound healing Intralesional TNF + xanthate successful Topic Application of Chemotherapeutics:5-fluorouracil (5-FU): Daily treatment Success: 66% AW3-LUDES AW4-LUDES: Success: 35% Scarring occurs Avoid eye Bloodroot and zinc Spontaneous regression of untreated tumors Autogenous tumor vaccine (11/12 success) If large, aggressive tumor, recommend combination of modalities: Excision/laser ablation + chemotherapy/radiation therapy
52
What are the treatment options for cutaneous habronemiasis
May resolve with cooler weather Ivermectin (kill larvae but do not resolve skin lesion); oral ivermectin may increase pruritus Large masses may require cytoreduction Inralesional corticosteroids Topic organophosphates or bandaging may prevent reinfection Organophosphates, corticosteroids, DMSO, nitrofurazone have been used together Ophthalmic form: oral ivermectin, topic corticosteroid eye drops (check cornea first), curettage
53
What are the histologic feature of mast cell tumours
Benign, solitary, nodular cutaneous form is most common (inflammatory reaction to dysplastic mast cells and recruited eosinophils and granuloma develops) Malignant (abnormal mast cells with increased nuclear-to-cytoplasmic rations, anisokaryosis and increased mitotic figures) and congenital forms possible
54
What are the types of melanoma
Melanocytic nevi: Large pleomorpic melanocytes with increased mitotic figures, binucleate cells and variable cytoplasmc pigmentation, single/multiple discrete nodules in grey and non-greys Dermal melanomas: Benign. Homogenous dendritic cells with condensed chromatin, dense pigmentation but no mitosis. Originate in deeper dermis, small single/multiple nodlues Dermal melanomatosis: Benign. Confluent multiple large melanomas. Risk increases with age. Risk of metastases Malignant melanomas: Rare. Invasive, poor prognosis
55
Which structures can be affected in a heel bulb laceration
Skin SubQ Hoof wall DFTS DDFT Navicular bursa Navicular bone Palmar cartilages DIP jt SDFT Collateral suspensory ligaments of naivuclar bone P3
56
Name 3 nasty things that can occur with axillary lacerations
SubQ emphysema Pneumomediastinum Pneumothorax
57
How is the proteolytic activity of chronic wound fluid different from acute wound fluid
Urokinase-type plasminogen activator and urokinase-type plasminogen activator receptors active in chronic wounds (plasminogen activator in acute wounds)
58
What are differential diagnoses for chronic non-healing wounds
FB Sinus tract Fistula Sequestrum Infection Sarcoid Habronemiasis Pythiosis Other tumor
59
What is the difference between a sinus tract and a fistula
FISTULA Abnormal communication between two internal organs or from organ to body surface: Synovial fistula Enterocutaneous or parietal fistula Orocutaneous or esophageal fistula SINUS TRACT Cavity or channel: Normal, eg. Venous sinus Pathologic, eg. Channel permitting escape of pus through skin
60
Define creep (in relation to skin, not a person ) and what are the 2 types of creep?
Stress constant and strain increases with time Mechanical creep: Biomechanical property of skin, allowing it to stretch beyond it's normal limits of extensibility under constant load Straightening of collagen fibers parallel to stretching force Biological creep: Skin increases area by increasing epidermal mitotic activity, upregulation of blood vessels and increasing dermal cell numbers Tissue expanders, hernias, subcutaneous masses
61
# Define relaxation
Strain constant and stress decreases with time
62
What is the minimum distance from the skin edge of a traumatic wound that skin sutures should be placed?
0.5cm
63
Which is preferable: Increasing suture number or suture material size?
Increasing suture numbers
64
What are the advantages and disadvantages of simple interrupted sutures?
Advantages: Excellent tissue apposition Can vary width if irregularly shaped wound Can adjust tension on individual sutures Greater tensile strength and less compromise of microvasculature than simple continuous patterns Can combine with other patterns Disadvantages: Placement too far back or too much tension leads to to inversion
65
What are the advantages and disadvantages of simple continuous sutures?
Advantages: Quick I would add that in line alba this is stronger but Auer didn't list this Disadvantages: Knot failure or suture breakage results in breakdown Cannot vary tension Increased edema Compromised circulation Prolonged inflammatory phase of wound healing Lack of precise apposition

Equine Surgery: QOD (13 decks)

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