Wounds Flashcards
1
Q
Classification of Operative Wounds
A
Clean
Clean-Contaminated
Contaminated
Dirty
2
Q
Clean Wound
A
Surgically created wound
No infection encountered
Aseptic technique maintained
No structure normally containing bacteria opened
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
4
Q
Contaminated Wound
A
Surgical wound but Hollow viscus is opened with gross spillage
Major break in technique
5
Q
What is an example of Contaminated Wound?
A
Traumatic wound
6
Q
Dirty Wound
A
Contain pus
Contain contents of perforated hollow viscus
7
Q
What is the goal of aseptic technique?
A
minimize the incidence of surgical wound infection
8
Q
What is the Rule of Thumb for surgical wound infections?
A
Risk doubles every hour
9
Q
What factors lead contamination to infection?
A
Microbial pathogens
Local wound environment
Host Defense mechanisms
10
Q
Sources of Operative Wound infections
A
The operating room environment
The operating team
Surgical instruments and supplies
11
Q
What is the most common source of operative wound infections?
A
Patient’s endogenous flora
12
Q
Surgical Site Infection
A
Infection at the surgical site occuring within 30 days of surgery or up to 1 year with implants
13
Q
Prophylactic Antibiotic administration
A
Administration prior to wound contamination
14
Q
Therapeutic Antibiotic Administration
A
treatment of an infection already present
15
Q
At what time do you administer prophylactic antibiotics?
A
30-60 minutes prior to skin incision
16
Q
When do you administer Prophylactic antibiotics?
A
When unexpected contamination occurs during surgery or surgery is longer than expected
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
18
Q
What are the four quadrants of bacteria?
A
Gram positive
Gram negative
Aerobes
Anaerobes
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
20
Q
What are the common wound etiologies?
A
Lacerations Bite Wounds Degloving injuries Sinus tracts Burns toxins Nonhealing wounds
21
Q
Bite wound considerations
A
Which ones need to be treated aggressively? Size Number of animals Location Clinical assessment of severity
22
Q
Passive (Penrose) drain
A
manages dead space
Monitor character of wound exudate
23
Q
Active Drain
A
Monitor the character of peritoneal fluid
24
Q
Degloving Injuries
A
Shearing forces which sever cutaneous vessels supplying skin
25
Physiologic Degloving
Skin devitalized but still in place
26
Anatomic Degloving
Skin avulsed from underlying tissue
27
What are the types of Burns?
Thermal
Chemical
Electrical
28
Examples of Thermal Burns
House fires
Hot liquids
Direct contact to a hot object
29
What are the topical treatments for Burns?
Aloe vera
| Silver sulfadiazine
30
Why do we use Aloe vera to treat burn wounds?
Anti-inflammatory
31
Why do we use Silver Sulfadiazine to treat burn wounds?
Antibacterial
32
What is the initial treatment for burn wounds?
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Cool injured tissue
Topical treatment of Aloe Vera and Silver Sulfadiazine
Analgesics
Fluid Resuscitation
Wound debridement
Hydrotherapy
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33
Causes of Non-healing wounds?
```
Foreign bodies
Immunodeficiency
Pathogens
Concurrent disease
Nutritional status
Drugs
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34
What types of foreign bodies are not tolerated and must be removed?
Porous and organic materials
35
What types of foreign bodies are tolerated and do not have to be removed unless they are contaminated?
Glass
gravel
steel or lead pellets
carbon
36
What are the sources of contamination for a Traumatic wound?
Endogenous flora
Accident site
Hospital
37
What are examples of the locations of endogenous flora?
Skin
| Excretions (feces)
38
What are the factors influencing development of infection?
Number and type of bacteria
Hose defense mechanisms
Exogenous factors: Foreign bodies and soil infection potentiating factors
39
"Golden Period"
time from contamination until bacteria invade and replicate to greater than 1000000/gm of tissue
generally 6-8 hours
40
Infection potentiating factors
Negatively charged particles with large surface area
Inactivate Neutrophils
Bind to positively charged antibiotics
Clays and organic soil components`
41
Initial Management of Traumatic Wounds
Thorough examination of the wound
Debridement
Wound Lavage
42
What do you use KY jelly for during wound preparation?
Used to lubricate the wound and makes it easier to remove hair from the wound
43
Use of a Bulb Syringe
useful for keeping tissues moist but ineffective for removing bacteria and foreign bodies
44
Use of Water Pik
produce pressure high enough to damage tissue and drive bacteria into wound
45
Wound Lavage Solutions
```
Tap Water
Balanced electrolyte solutions
Wound cleansers
Antiseptic solutions
Antibiotics
```
46
When do you use Balanced electrolyte solutions?
used once granulation tissue fills the wound
47
When do you use Antiseptic solutions?
Wounds in lag phase or still contaminated/infected
| All are cytotoxic
48
What are the antiseptic solutions?
Chlorohexidine
Povidone-Iodine
Dakin's solution (dilute bleach)
49
When do you use Antibiotics for wound lavage?
acute wounds prior to bacteria invading tissue
50
When do you use Povidone-Iodine?
Broad spectrum: gram positive and gram negative, viruses, yeasts, and fungi
51
What are the disadvantages of Povidone-Iodine?
Forms inactive complexes with organic matter
| Systemic absorption - toxicity
52
What is the mechanism of action of Povidone-Iodine?
Works on cell walls
53
What are the advantages of Chlorhexidine?
Activity less affected by organic matter
Long residual action: twice daily application and residual activity increases with repeated applications
Side-effects uncommon
54
What Chlorhexidine solution is more tissue friendly?
Chlorhexidine gluconate
55
What Chlorhexidine is more frequently used?
Chlorhexidine diacetate
56
In what species are hypersensitivity reactions to Chlorhexidine common in?
Cats
57
What happens if Chlorhexidine is diluted in anything but sterile water?
It forms a precipitate
58
Debridement
Removal of devitalized tissue and foreign bodies
59
What are the methods of debridement?
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Surgical
Autolytic
Chemical
Mechanical
Biosurgical
```
60
Autolytic debridement
Moisture retentive dressings
61
Mechanical debridement
Adherent primary dressing
62
What are the two types of Biosurgical debridement?
Chronic/non healing wounds
| Maggot Therapy
63
What are the two types of surgical debridement?
Layered
| "En bloc"
64
What is the most commonly used method of surgical debridement?
Layered surgical debridement
65
"En bloc" surgical debridement
complete excision of wound as with tumor excision
66
What are the indications for Chemical debridement?
Poor anesthetic risks
Minimal debridement of open wounds
when surgical debridement may damage important structures
adjunct to other methods
67
Trypsin
debriding agent
68
Castor Oil
Minimizes tissue desiccation
69
Balsam of Peru
Stimulates capillary formation
70
When is mechanical debridement indicated?
wound in lag phase with heavy contamination or thick viscous exudate
71
Mechanical debridement
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
Open Wound Management indication
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
When do you use Negative Wound Pressure Therapy?
Acute wounds: Used after surgical debridement to promote more rapid granulation tissue formation
Chronic wounds: improve local environment to enhance second intention healing
74
Negative Pressure Wound Therapy
Constant or intermittent suction applied to wound
| Used on wounds in late lag phase or early proliferative phase of wound healing
75
What are the benefits of Vacuum-Assisted Closure?
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
Calcium Alginate
Nonwoven felt-like material derived from seaweed
Extremely hydrophilic-fluid absorption
Promotes autolytic wound debridement and wound healing
Aids in hemostasis
77
When do you use Calcium Alginate?
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
Honey Properties
Cleanses wound
Hygroscopic
Promotes granulation tissue formation
Antibacterial/Antifungal
79
What are the reasons for the Antibacterial/ Antifungal properties of Honey?
Osmotic effect
Low pH
"Inhibine" production
Unidentified phytochemical component in some honeys
80
What is the primary antibacterial effect of sugar due to?
Osmolality
81
Sugar properties
Cleanses wound and reduces edema
| Promotes granulation tissue formation
82
What is the most important cell for wound healing?
Macrophages
83
What are the actions of Maltodextrin?
Chemotactic for PMNs, lymphocytes, macrophages
Provides energy for cells
Stimulates more rapid granulation tissue formation and epithelialization
Antibacterial properties
84
When do you use Maltodextrin?
Deep wounds
85
Wet to Dry dressing indications
Necrotic tissue and/or foreign bodies
| High viscosity exudate
86
How does Wet to Dry dressing work?
Liquify viscous exudate enhancing entrapment in dressing
| Used with fibrinous exudate which will mobilize the exudate into the dressings to be removed
87
When is Dry to Dry Dressing used?
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
Disadvantages of Adherent Dressings
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
Porous Non or Low Adherent Dressings indications
Protect sutured wounds
| Wound in reparative stage: Healthy granulation tissue, Serosanguineous exudate, Epithelial migration from margins
90
Nonadherent dressings advantages
Keep wound moist
Allow excess fluid to drain
Do not damage newly formed reparative tissue when bandage is changed
91
Moisture Retentive Dressing
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
Oclusive
will seal around the wound and not let anything in or out
93
Semi-oclusive
will allow some exudate in and out
94
MVTR
Moisture Vapor Transmission Rate
95
Moisture Vapor Transmission Rate
Ability to transmit moisture, vapor, and gases from wound to atmosphere
96
What are the examples of Biological Dressings?
Equine Amnion
Xenografts and Allografts
Extracellular matrix-derived: Collagen, PSIS, and PUBS
97
What is the disadvantage of Equine Amnion?
Limited storage time for 6 months and only available during a certain time of the year
98
PSIS
Porcine Small Intestinal Submucosa
99
Porcine Small Intestinal Submucosa
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
What is an advantage of PSIS?
will take on the characteristics of the surrounding tissue
101
What are the indications for PSIS?
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
Primary Closure
Immediate closure of wound
103
What type of wounds can you use Primary closure on?
Clean wounds
| Clean-contaminated wounds
104
Clean contaminated wounds
intact host defense mechanisms
Healthy wound
Appropriate antimicrobial treatment
105
What are the advantages of using CO2 laser?
Good visualization
| Good Hemostasis
106
What are the disadvantages of using a CO2 laser?
Takes longer as opposed to cold steel
107
Delayed Primary Closure
Wound left open for 2-5 days
| Closed prior to visible formation of granulation tissue
108
What types of wounds are Delayed Primary Closures performed on?
Traumatic wounds that need to be debrided or assessed
109
Secondary Closure
Wound closure after granulation tissue covers the wound
110
What types of wounds are secondary closures performed on?
Deep narrow wounds
| Wide wounds
111
What suture pattern do you use on a wound without a lot of tension with a short or irregular wound?
Cruciate
112
What suture pattern do you use on a wound without a lot of tension with a straight wound?
Ford Interlocking
113
What are the disadvantages of Second intention wound healing?
the cosmetic appearance or the quality of healing
114
How well does a wound with less than 25% circumference of the leg heal?
should heal well
115
How well does a wound with 25-33% circumference of the leg heal?
Most heal well
116
How well does a wound with 33-50% circumference of the leg heal?
will probably heal with wider scar
| Consider techniques to facilitate closure
117
How well does a wound with a greater than 50% circumference of the leg heal?
Consider reconstruction
| Extended healing time or inadequate healing
118
What are the reasons for cessation of wound contraction?
Wound has healed
Tension in surrounding skin exceeds pull of myofibroblasts
Collagen deposition in chronic wound interferes with pull of myofibroblasts
119
What are the complications of second intention healing?
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
Primary contraction
Retraction of skin edges after tissue is cut
121
What is the ability to undermine the skin influenced by?
1. Species: differences in blood supply to skin
| 2. Breed - dogs - some have more loose skin than others
122
What is the purpose for using walking sutures?
Advance the skin over the wound
Distribute tension
Decrease dead space
123
What are the techniques for enhancing local movement of skin?
Skin stretching: Skin expanders, Skin stretching devices, presuturing
Releasing incisions
Multiple punctate relaxing incisions
Adjustable horizontal mattress sutures
124
Presuturing
takes advantage of the properties of mechanical creep and stress relaxation
125
What types of wounds do you use Adjustable Horizontal Mattress?
wounds with established granulation tissue and skin at edge of wound is thicker and holds suture better
126
What do you use with Adjustable Horizontal Mattress?
Monofilament suture material
Buttons
Split-shot
