Wounds, Bandaging, Casting Flashcards
If the vaccine status of a horse presenting with a wound is unknown, what needs to be done? What if you know the horse is unvaccinated?
Unknown: Booster with tetanus toxoid
Unvax’d: Tetanus toxoid + Tetanus antitoxin
How much blood (%) does a horse have?
8-10% BW
When is the golden period of wounds in horses?
Does not exist in horses
In other animals = period of time before there is less then 10^5 bacteria/g of tissue
What type of closure/healing is it if it occurs 2-5 days after the injury before granulation tissue is formed?
Delayed primary closure
What do you do if you anticipate complications due to dead space?
Place drain
If you anticipate flap necrosis upon closure of a large non-penetrating thoracic wound, what can you do?
Use flap as ‘natural band-aid’, debride and close
Wait 3-5 days for tissue to declare itself
Manage client expectations
What are the 3 phases of wound healing?
Inflammation/Lag
Proliferative
Remodeling
What initiates (3 things) angiogenesis during wound healing?
Decreased O2 tension
Low pH (in wound)
High lactate
What type of collagen is layed down during wound healing?
Type III (40%) which shifts to type I as wound remodels
What is the single most important factor for successful wound healing? What are the 3 types of this?
Debridement
Sharp, Irrigation (hydraulic), Direct contact
When lavaging a wound it is important to use the appropriate ______ and appropriate _______.
Volume
Pressure
T/F: Ointments are likely to slow the epithelialization of a wound.
True
Which antimicrobial dressing contains the active agent PHMB to which microbes are unable to become resistant?
Kerlix AMD
Dr. Little’s fav
Name these 5 joints
Tibiotarsal
Intertarsal
Fetlock
Pastern
Coffin
Which structure is indicated by the blue scribbles?
Collateral cartilage
What 2 structures are you concerned about with a pastern laceration?
Tendon sheath (of digital flexor)
Pastern joint
What structure are you concerned about with a puncture wound to the sole/frog?
Navicular bursa
What structure are you concerned about with a heel bulb laceration?
Coffin joint
What type of wound closure would you choose?
Second intention (debride and bandage)
What type of wound closure would you choose given this occured a few hours ago?
Delayed primary
(debride, lavage, banadage q24-48 hrs, then close)
Why do eyelid lacterations have to be repaired surgically?
Globe must stay protected (function of lid maintained)
What must you ensure when closing an eyelid laceration?
Must align eyelid margin
Protect eye from trauma during suturing
Keep suture from irritating eye when repair is complete
Close in 2 layers (conjunctiva and skin)
Why would you use stent sutures when closing a lip laceration?
To minimize risk of pull through during healing
Also remember at least 2-layer closure
What is proud flesh? How is it treated?
Excessive granulation tssue
Tx: Resection and bandage, delayed secondary closure, skin grafts
Excessive granulation tissue is most likely to occu in which of the following locations?
a. Metacarpus
b. Pectoral region
c. Thorax
d. Head and neck
a. Metacarpus
What is the single most important factor for a successful skin graft?
Recipient bed preparation
Which type of graft, full thickness or split thickness, will look better? Which has better survivability?
Full looks better
Split has beeter survivability
T/F: When preparing a punch graft, the recipient holes are made with a smaller punch biopsy.
True
What are the 3 main reasons for graft failure?
Infection
Hemorrhage (fluid accumulation)
Motion
What can you do to conform a split thickness sheet graft to an irregular surface?
Meshing
How is the sheet graft secured?
Along the wound margin with glue, sutures, or staples
What is the most common reason for skin graft failure in horses?
a. Motion
b. Fluid accumulation
c. Bandaging
d. Infection
d. Infection
You place a bandage. On days 1 and 2 there is no lameness and the bandage looks great. On day 3 the patient is lame. What should you do?
a. Patient is sore from surgery, as expected, continue monitoring
b. Patient likely kicked the wall and is now sore, recheck tomorrow
c. Give Bute toda and recheck tomorrow if not better
d. Remove bandage and reevaluate wound/incision site immediately
d. Remove bandage and reevaluate wound/incision site immediately
In which direction must you roll bandaging material on a limb?
Inwards- pullign flexor tendons medially
What is used to secure primary and secondary bandage layers?
Conforming roll gauze (Kling or brown)
How much should each of the bandage layers overlap?
a. 25%
b. 50%
c. 75%
d. 100%
b. 50%
In order to protect the ________ distally and soft tissue structures proximally, ______ should extend from the tertiary layer on either side. Distally, the _____ ______ should be covered by the secondary bandaging material.
Coronary band
Cotton
Heel bulb
When creating a stack bandage, which bandage is placed first?
Distal
What can you do to cover a wound that cannot be bandaged, for example near the hip?
Stent bandage
How often must a sweat bandage be changed and the limb washed?
a. Every 6 hours
b. Daily
c. Every 48 hours
d. When it is dry
b. Daily
At least daily - tell clients q 12 hours
What type of PVC can you use for splinting?
Schedule 40
What’s this?
Kimzey Leg Saver splint
If you are placing a bandage and splint for a radial fracture, Where will you place the palmar and lateral splints? Which side of the limb is most likely to open up due to the fracture becoming open?
Palmar: Heel to elbow
Lateral: Hoof to withers
Medial
Fracture to which limb structure is the exception to the immobilization rule? Why?
Olecranon
The shoulder cannot be stabilized
Would make a stack bandage with a palmar splint to fix limb in extension
What can be used to stabilize radial and tibial fractures, as well as ruptured gastrocnemius, in farm animals?
Thomas-Schroeder Splint
- Plus cast*
- NOT FOR EQUINE!!!*
Which material is preferred for casting?
a. Plaster of Paris
b. Fiberglass casting tape
c. Clay
b. Fiberglass casting tape
What are the 3 main complications of immbolization (e.g. through casting)?
Articular cartilage degeneration
Loss of bone density
Decreased muscle strength
How long should the stockinette be in relation to the cast?
2.5x longer
Where do you drill a hole when placing a distal limb cast?
Toe of the hoof wall
Then place Gigli wire through hole
Where do you start placing casting tape for a distal limb cast?
Proximally
Down then up
Why is it important to incorporate the hoof into the cast for large animals?
To ensure maximal diversion of weight from the limb and ground forces away from the limb to the cast
What landmark do you use for the top of a distal limb cast?
Top of splint bones
Where is extra padding required on a distal limb cast? What are you protecting?
Top of the cast to protect sesamoid bones
Back of cast to protect flexor tendons
Bottom of the cast to protect the coronary band/beel bulbs
Why must you use a cast saw in perpendicular fashion?
It is an oscillating saw which will cut the skin if dragged down the limb
Why should a bandage be placed after cast removal?
Protect any wounds
Protect skin which is sensitive now
Provide some support
What is the most common reason for cast failure?
Poor placement
What is the most common clinical sign indicating cast failure?
Lameness
