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RUSVM Small Animal Surgery 2017 > Wounds > Flashcards

Wounds Flashcards

1
Q

Classification of Operative Wounds

A

Clean
Clean-Contaminated
Contaminated
Dirty

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2
Q

Clean Wound

A

Surgically created wound
No infection encountered
Aseptic technique maintained
No structure normally containing bacteria opened

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3
Q

Clean Contaminated Wound

A

Surgically created wound but Hollow viscus or organ normally containing bacteria is opened but no contents are spilled
Minor break in technique

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4
Q

Contaminated Wound

A

Surgical wound but Hollow viscus is opened with gross spillage
Major break in technique

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5
Q

What is an example of Contaminated Wound?

A

Traumatic wound

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6
Q

Dirty Wound

A

Contain pus

Contain contents of perforated hollow viscus

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7
Q

What is the goal of aseptic technique?

A

minimize the incidence of surgical wound infection

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8
Q

What is the Rule of Thumb for surgical wound infections?

A

Risk doubles every hour

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9
Q

What factors lead contamination to infection?

A

Microbial pathogens
Local wound environment
Host Defense mechanisms

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10
Q

Sources of Operative Wound infections

A

The operating room environment
The operating team
Surgical instruments and supplies

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11
Q

What is the most common source of operative wound infections?

A

Patient’s endogenous flora

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12
Q

Surgical Site Infection

A

Infection at the surgical site occuring within 30 days of surgery or up to 1 year with implants

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13
Q

Prophylactic Antibiotic administration

A

Administration prior to wound contamination

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14
Q

Therapeutic Antibiotic Administration

A

treatment of an infection already present

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15
Q

At what time do you administer prophylactic antibiotics?

A

30-60 minutes prior to skin incision

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16
Q

When do you administer Prophylactic antibiotics?

A

When unexpected contamination occurs during surgery or surgery is longer than expected

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17
Q

What type of antibiotics should be administered for therapeutic treatment of surgical wounds?

A

An antibiotic that covers the four quadrants of bacteria

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18
Q

What are the four quadrants of bacteria?

A

Gram positive
Gram negative
Aerobes
Anaerobes

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19
Q

How do you minimize perioperative infections?

A

Protect incision lines
Wash hands between patients, gloves preferred
Remove catheters and drains as soon as no longer needed

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20
Q

What are the common wound etiologies?

A 
Lacerations
Bite Wounds
Degloving injuries
Sinus tracts
Burns
toxins
Nonhealing wounds
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21
Q

Bite wound considerations

A 
Which ones need to be treated aggressively?
Size
Number of animals
Location 
Clinical assessment of severity
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22
Q

Passive (Penrose) drain

A

manages dead space

Monitor character of wound exudate

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23
Q

Active Drain

A

Monitor the character of peritoneal fluid

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24
Q

Degloving Injuries

A

Shearing forces which sever cutaneous vessels supplying skin

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25
Q

Physiologic Degloving

A

Skin devitalized but still in place

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26
Q

Anatomic Degloving

A

Skin avulsed from underlying tissue

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27
Q

What are the types of Burns?

A

Thermal
Chemical
Electrical

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28
Q

Examples of Thermal Burns

A

House fires
Hot liquids
Direct contact to a hot object

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29
Q

What are the topical treatments for Burns?

A

Aloe vera

Silver sulfadiazine

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30
Q

Why do we use Aloe vera to treat burn wounds?

A

Anti-inflammatory

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31
Q

Why do we use Silver Sulfadiazine to treat burn wounds?

A

Antibacterial

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32
Q

What is the initial treatment for burn wounds?

A 
Cool injured tissue
Topical treatment of Aloe Vera and Silver Sulfadiazine
Analgesics
Fluid Resuscitation 
Wound debridement 
Hydrotherapy
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33
Q

Causes of Non-healing wounds?

A 
Foreign bodies
Immunodeficiency 
Pathogens
Concurrent disease
Nutritional status
Drugs
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34
Q

What types of foreign bodies are not tolerated and must be removed?

A

Porous and organic materials

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35
Q

What types of foreign bodies are tolerated and do not have to be removed unless they are contaminated?

A

Glass
gravel
steel or lead pellets
carbon

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36
Q

What are the sources of contamination for a Traumatic wound?

A

Endogenous flora
Accident site
Hospital

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37
Q

What are examples of the locations of endogenous flora?

A

Skin

Excretions (feces)

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38
Q

What are the factors influencing development of infection?

A

Number and type of bacteria
Hose defense mechanisms
Exogenous factors: Foreign bodies and soil infection potentiating factors

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39
Q

“Golden Period”

A

time from contamination until bacteria invade and replicate to greater than 1000000/gm of tissue
generally 6-8 hours

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40
Q

Infection potentiating factors

A

Negatively charged particles with large surface area
Inactivate Neutrophils
Bind to positively charged antibiotics
Clays and organic soil components`

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41
Q

Initial Management of Traumatic Wounds

A

Thorough examination of the wound
Debridement
Wound Lavage

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42
Q

What do you use KY jelly for during wound preparation?

A

Used to lubricate the wound and makes it easier to remove hair from the wound

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43
Q

Use of a Bulb Syringe

A

useful for keeping tissues moist but ineffective for removing bacteria and foreign bodies

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44
Q

Use of Water Pik

A

produce pressure high enough to damage tissue and drive bacteria into wound

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45
Q

Wound Lavage Solutions

A 
Tap Water
Balanced electrolyte solutions 
Wound cleansers
Antiseptic solutions 
Antibiotics
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46
Q

When do you use Balanced electrolyte solutions?

A

used once granulation tissue fills the wound

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47
Q

When do you use Antiseptic solutions?

A

Wounds in lag phase or still contaminated/infected

All are cytotoxic

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48
Q

What are the antiseptic solutions?

A

Chlorohexidine
Povidone-Iodine
Dakin’s solution (dilute bleach)

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49
Q

When do you use Antibiotics for wound lavage?

A

acute wounds prior to bacteria invading tissue

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50
Q

When do you use Povidone-Iodine?

A

Broad spectrum: gram positive and gram negative, viruses, yeasts, and fungi

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51
Q

What are the disadvantages of Povidone-Iodine?

A

Forms inactive complexes with organic matter

Systemic absorption - toxicity

52
Q

What is the mechanism of action of Povidone-Iodine?

A

Works on cell walls

53
Q

What are the advantages of Chlorhexidine?

A

Activity less affected by organic matter
Long residual action: twice daily application and residual activity increases with repeated applications
Side-effects uncommon

54
Q

What Chlorhexidine solution is more tissue friendly?

A

Chlorhexidine gluconate

55
Q

What Chlorhexidine is more frequently used?

A

Chlorhexidine diacetate

56
Q

In what species are hypersensitivity reactions to Chlorhexidine common in?

A

Cats

57
Q

What happens if Chlorhexidine is diluted in anything but sterile water?

A

It forms a precipitate

58
Q

Debridement

A

Removal of devitalized tissue and foreign bodies

59
Q

What are the methods of debridement?

A 
Surgical 
Autolytic 
Chemical 
Mechanical
Biosurgical
60
Q

Autolytic debridement

A

Moisture retentive dressings

61
Q

Mechanical debridement

A

Adherent primary dressing

62
Q

What are the two types of Biosurgical debridement?

A

Chronic/non healing wounds

Maggot Therapy

63
Q

What are the two types of surgical debridement?

A

Layered

“En bloc”

64
Q

What is the most commonly used method of surgical debridement?

A

Layered surgical debridement

65
Q

“En bloc” surgical debridement

A

complete excision of wound as with tumor excision

66
Q

What are the indications for Chemical debridement?

A

Poor anesthetic risks
Minimal debridement of open wounds
when surgical debridement may damage important structures
adjunct to other methods

67
Q

Trypsin

A

debriding agent

68
Q

Castor Oil

A

Minimizes tissue desiccation

69
Q

Balsam of Peru

A

Stimulates capillary formation

70
Q

When is mechanical debridement indicated?

A

wound in lag phase with heavy contamination or thick viscous exudate

71
Q

Mechanical debridement

A

Devitalized tissue and foreign bodies trapped in primary bandage layer
Necrotic tissue and debris pass into or attach to dressing as fluid is absorbed by bandage

72
Q

Open Wound Management indication

A

wound considered inappropriate for closure after initial wound lavage and debridement
unable to remove all devitalized tissue/foreign bodies
Viability of tissue questionable
Concerns about infection due to contamination
Amount of wound exudate
Tissue edema/swelling
Patient condition

73
Q

When do you use Negative Wound Pressure Therapy?

A

Acute wounds: Used after surgical debridement to promote more rapid granulation tissue formation
Chronic wounds: improve local environment to enhance second intention healing

74
Q

Negative Pressure Wound Therapy

A

Constant or intermittent suction applied to wound

Used on wounds in late lag phase or early proliferative phase of wound healing

75
Q

What are the benefits of Vacuum-Assisted Closure?

A

Increased tissue blood flow
Decreased interstitial edema
Decreases bacterial burden in wound
may help remove inflammatory cytokines from wound
Accelerated granulation tissue formation
Less frequent bandage changes

76
Q

Calcium Alginate

A

Nonwoven felt-like material derived from seaweed
Extremely hydrophilic-fluid absorption
Promotes autolytic wound debridement and wound healing
Aids in hemostasis

77
Q

When do you use Calcium Alginate?

A

wound that is healthy but secreting moderate to heavy exudate in early stages of healing
A wound that is not adequately debrided but not amenable for closure

78
Q

Honey Properties

A

Cleanses wound
Hygroscopic
Promotes granulation tissue formation
Antibacterial/Antifungal

79
Q

What are the reasons for the Antibacterial/ Antifungal properties of Honey?

A

Osmotic effect
Low pH
“Inhibine” production
Unidentified phytochemical component in some honeys

80
Q

What is the primary antibacterial effect of sugar due to?

A

Osmolality

81
Q

Sugar properties

A

Cleanses wound and reduces edema

Promotes granulation tissue formation

82
Q

What is the most important cell for wound healing?

A

Macrophages

83
Q

What are the actions of Maltodextrin?

A

Chemotactic for PMNs, lymphocytes, macrophages
Provides energy for cells
Stimulates more rapid granulation tissue formation and epithelialization
Antibacterial properties

84
Q

When do you use Maltodextrin?

A

Deep wounds

85
Q

Wet to Dry dressing indications

A

Necrotic tissue and/or foreign bodies

High viscosity exudate

86
Q

How does Wet to Dry dressing work?

A

Liquify viscous exudate enhancing entrapment in dressing

Used with fibrinous exudate which will mobilize the exudate into the dressings to be removed

87
Q

When is Dry to Dry Dressing used?

A

used as an adherent topical dressing to aid wound debridement
especially highly exudative wounds (serous fluids)
Degloving injuries
Bite wounds
Lacerations
Deep “cavity” wounds

88
Q

Disadvantages of Adherent Dressings

A

Bacteria can flourish in moist environment
Wet dressings can cause maceration of surrounding skin
If bandage soaks through bacteria can move into or out of bandage

89
Q

Porous Non or Low Adherent Dressings indications

A

Protect sutured wounds

Wound in reparative stage: Healthy granulation tissue, Serosanguineous exudate, Epithelial migration from margins

90
Q

Nonadherent dressings advantages

A

Keep wound moist
Allow excess fluid to drain
Do not damage newly formed reparative tissue when bandage is changed

91
Q

Moisture Retentive Dressing

A

Typically hydrocolloid or polyurethane dressings
Better than adherent dressings for wounds in late debridement/ proliferative phase because they optimize the body’s inherent wound healing abilities
Maintain the normal physiologic ratios of proteases, protease inhibitors, growth factors, and cytokines

92
Q

Oclusive

A

will seal around the wound and not let anything in or out

93
Q

Semi-oclusive

A

will allow some exudate in and out

94
Q

MVTR

A

Moisture Vapor Transmission Rate

95
Q

Moisture Vapor Transmission Rate

A

Ability to transmit moisture, vapor, and gases from wound to atmosphere

96
Q

What are the examples of Biological Dressings?

A

Equine Amnion
Xenografts and Allografts
Extracellular matrix-derived: Collagen, PSIS, and PUBS

97
Q

What is the disadvantage of Equine Amnion?

A

Limited storage time for 6 months and only available during a certain time of the year

98
Q

PSIS

A

Porcine Small Intestinal Submucosa

99
Q

Porcine Small Intestinal Submucosa

A

a natural resorbable biocompatible scaffold which potentiates appropriate tissue remodeling
Reinforces wound tissue and is absorbed by the body as it is replaced by host tissues

100
Q

What is an advantage of PSIS?

A

will take on the characteristics of the surrounding tissue

101
Q

What are the indications for PSIS?

A

Degloving injuries and other large skin defects containing healthy tissue
Biological dressing until definitive reconstruction
Dermal substitute to “guide” wound repair when used in reparative stage of wound healing: inhibits wound contraction, Epithelialization will predominate over contraction, Complete healing may take longer than second intention healing

102
Q

Primary Closure

A

Immediate closure of wound

103
Q

What type of wounds can you use Primary closure on?

A

Clean wounds

Clean-contaminated wounds

104
Q

Clean contaminated wounds

A

intact host defense mechanisms
Healthy wound
Appropriate antimicrobial treatment

105
Q

What are the advantages of using CO2 laser?

A

Good visualization

Good Hemostasis

106
Q

What are the disadvantages of using a CO2 laser?

A

Takes longer as opposed to cold steel

107
Q

Delayed Primary Closure

A

Wound left open for 2-5 days

Closed prior to visible formation of granulation tissue

108
Q

What types of wounds are Delayed Primary Closures performed on?

A

Traumatic wounds that need to be debrided or assessed

109
Q

Secondary Closure

A

Wound closure after granulation tissue covers the wound

110
Q

What types of wounds are secondary closures performed on?

A

Deep narrow wounds

Wide wounds

111
Q

What suture pattern do you use on a wound without a lot of tension with a short or irregular wound?

A

Cruciate

112
Q

What suture pattern do you use on a wound without a lot of tension with a straight wound?

A

Ford Interlocking

113
Q

What are the disadvantages of Second intention wound healing?

A

the cosmetic appearance or the quality of healing

114
Q

How well does a wound with less than 25% circumference of the leg heal?

A

should heal well

115
Q

How well does a wound with 25-33% circumference of the leg heal?

A

Most heal well

116
Q

How well does a wound with 33-50% circumference of the leg heal?

A

will probably heal with wider scar

Consider techniques to facilitate closure

117
Q

How well does a wound with a greater than 50% circumference of the leg heal?

A

Consider reconstruction

Extended healing time or inadequate healing

118
Q

What are the reasons for cessation of wound contraction?

A

Wound has healed
Tension in surrounding skin exceeds pull of myofibroblasts
Collagen deposition in chronic wound interferes with pull of myofibroblasts

119
Q

What are the complications of second intention healing?

A

The quality of the healing might not be that great
May get chronic lymphatic accumulation in the lower limb
Epithelialization can be thin and damaged easily

120
Q

Primary contraction

A

Retraction of skin edges after tissue is cut

121
Q

What is the ability to undermine the skin influenced by?

A
  1. Species: differences in blood supply to skin

2. Breed - dogs - some have more loose skin than others

122
Q

What is the purpose for using walking sutures?

A

Advance the skin over the wound
Distribute tension
Decrease dead space

123
Q

What are the techniques for enhancing local movement of skin?

A

Skin stretching: Skin expanders, Skin stretching devices, presuturing
Releasing incisions
Multiple punctate relaxing incisions
Adjustable horizontal mattress sutures

124
Q

Presuturing

A

takes advantage of the properties of mechanical creep and stress relaxation

125
Q

What types of wounds do you use Adjustable Horizontal Mattress?

A

wounds with established granulation tissue and skin at edge of wound is thicker and holds suture better

126
Q

What do you use with Adjustable Horizontal Mattress?

A

Monofilament suture material
Buttons
Split-shot

RUSVM Small Animal Surgery 2017 (17 decks)

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