Wounds & Wound Healing Flashcards
The most commonly encountered classification of operative wounds
Clean wound
A surgically created wound where:
No infection is encountered
Asepsis is maintained
No structure containing bacteria is opened (other than skin)
Clean wound
A surgically created wound in which:
Hollow viscus or organ containing bacteria is opened BUT no contents are spilled
A minor break in asepsis has occurred (like a hole in the surgeon’s glove)
Clean-contaminated wound
A surgically created wound in which:
A hollow viscus or organ is opened and GROSS SPILLAGE has occurred
A major break in asepsis has occurred
OR:
ANY TRAUMATIC WOUND
Contaminated wound
A surgically created wound in which:
The opened structure contains PUS
or
Contents of a perforated hollow viscus
I.E. Peritonitis
DIRTY wound
The risk of infection during surgery _______ every hour
DOUBLES
A _________ wound implies infection
DIRTY
What is the most common source of operative wound infection?
The patient’s endogenous flora (skin, GIT)
When are prophylactic antibiotics indicated?
When the patient is very old or immunosuppressed
When the surgery is estimated to last over 1 hour
When risk of infection is high/would have catastrophic results
When the surgeon is inexperienced
How long should prophylactic antibiotics be continued perioperatively?
Not longer than 24 hours (and longer will mask infection development)
What type of antibiotics are preferred for prophylactic use?
SINGLE AGENT (not broad spectrum!)
Ex: Cefazolin or Cefoxitin
Open traumatic wounds should initially be considered
______ at best
Contaminated
How does healing of superficial wounds differ in dogs and cats?
In cats, SQ tissue plays an important role in healing and immune response.
(If SQ in cats is damaged, wound will take longer to heal)
What is a common organism found in bite wounds in cats?
How is it treated?
Pasteurella
Tx with Penicillin Abx
What type of suture material is most appropriate for
a clean-contaminated wound?
Short/intermediate lasting ABSORBABLE MONOfilament suture
(because suture can increase risk of infection)
Burn wounds significantly ______ the metabolic state
INCREASE
Fluid resuscitation is indicated in burns greater than ________% TBSA
(total body surface area)
15%
What is the difference between a sinus and fistula draining tract?
Sinus tract = communication between MESOTHELIAL surfaces and skin
Fistula tract = communicatoin between 2 EPITHELIAL surfaces
A non-healing sinus tract is most commonly caused by _________
PLANT material foreign bodies
What is the “Golden Period” in relation to wound infection development?
How long is it generally?
The time from contamination to when bacteria invade and replicate
to > 105 / gram of tissue
Generally 6 - 8 hours
What is an IFP and where are they most likely found?
Infection Potentiating Factors
which are negatively charged particles with large surface ares that
inhibit phagocytosis and bacterial killing by the host
Most commonly found in soils and clays (grass awns)
What is the best way to lavage a traumatic wound without causing
iatrogenic tissue damage?
Using Chlorhexidine (0.05%) under moderate pressure (7 - 8 psi)
and a syringe and needle (18 - 20G)
BEWARE using Chlorhexidine in CATS (hypersensitivity rxns)
What are the disadvantages of using Providone-Iodine for wound lavage?
The residual activity is TOO SHORT (4 - 6 hours)
Forms inactive complexes with organic matter
Can be systemically absorbed –> TOXICITY and METABOLIC ACIDOSIS
What is the most commonly used method of surgical debridement?
LAYERED debridement
(start at surface and work your way down until ok to have closure)
What kind of wound dressing is used for Autolytic wound debridement?
Moisture retentive dressing
Which method of wound debridment helps mobilize questionable tissue (either white or black eschar)?
Enzymatic wound debridment (uses Granulex)
What type of wound dressing is used for mechanical wound debridement?
ADHERENT primary dressing
When is mechanical wound debridement primarily indicated?
Wounds in the LAG phase with
heavy contamination or
thick viscous exudate
Negative wound pressure therapy (VAC) for open wound management
works best when used on wounds in the __________ phase or
__________ phase of wound healing
LATE LAG (Debridement) Phase
or
EARLY PROLIFERATIVE Phase
of wound healing
What is the major benefit of VAC (Negative wound pressure therapy)?
Accelerated granulation tissue formation
(48 hours instead of 4 - 5 days)
Which of the following does NOT promote granulation tissue formation?
Calcium Alginate
Honey
Sugar
Maltodextrin
Calcium Alginate (C-Salt)
What are the indications for WET-to-DRY adherent dressings?
Necrotic tissue
Foreign bodies
High viscosity exudate
What are the indications for DRY-to-DRY adherent dressings?
Wounds with high fluid production which need debridement
(Degloving, bite wounds, lacerations, deep cavity wounds)
These dressings are better than adherent dressing for wounds in
LATE debridement/proliferative phase of wound healing
Non- adherent moisture retentive dressings (autolytic wound debridement)
What is the most commonly used type of PASSIVE drain?
Penrose drains
What is the most commonly used type of ACTIVE drain?
Jackson-Pratt drain
What are the 4 classifications of wound closure?
Primary
Delayed Primary
Secondary
Second Intention (Contraction and Epithelialization)
What classification of wound closure is described by the following?
Immediate closure of a wound after a procedure
Primary closure
What classification of wound closure is described by the following?
A wound closed BEFORE formation of granulation tissue
that is left open for 2 - 5 days
Delayed Primary Closure
What classification of wound closure is described by the following?
Wound closure AFTER granulation tissue is formed and covers the wound
Secondary CLOSURE
What classification of wound closure is described by the following?
Healing by union by adhesion of granulating surfaces,
when the edges of the wound are far apart
and cannot be brought together.
AKA: Contraction and epithelialization
SECOND INTENTION healing
