Wound Management
When is a wound classified as infected rather than contaminated?
When bacterial numbers exceed 10^5 CFU per gram of tissue.
What are the goals of bandage?
protects wound and speeds wound healing
What are the most commonly used needles in vet med?
3/8 and 1/2 circle needle
What are the guidelines for equine patients with wounds that have not had a tetanus vaccine?
give tetanus toxoid and anti-toxin
When closing large body wounds what is the number 1 complication that should be discussed with owners?
dehiscence
What type of healing is indicated when a wound is closed after granulation tissue has already formed in the wound bed?
Secondary Closure
third intention healingWhat are the three basic layers of a modified Robert Jones bandage and the functions of each layer.
Primary layer: debrides, delivers meds, transfers wound exudate, forms occlusive seal, minimizes pain, prevents excessive loss of body fluids
Secondary Layer: absorbs and sequesters deleterious agents, retards bacterial growth, pads wound from trauma, splints wound to prevent movement, holds primary bandage layer in place
tertiary layer: holds other layers in place, protects against external bacterial colonization, cosmesis
What could you replace the three square knots with at the end of your simple continuous pattern?
aberdeen knot
What are the complications associated with wound healing in large animals?
dehiscence
proud flesh
involvement of synovial structures
bone sequestrum
cellulitis
What type of needle would you use to close a muscle layer of a large body wound?
taper point
What are the wound healing characteristics of abrasions?
Heal rapidly be reepithelialization
What does the use of more padding in a cast accomplish?
less well immobilized
What is the mechanism of absorption of suture: organic, synthetic, and nonabsorbable?
Organic: gradually digested by tissue enzymes and phagocytized
Synthetic: hydrolysis
Non-absorbable: ultimately encapsulated or walled off by fibrous tissue
What are the guidelines to applying an equine bandage?
even tension, appropriate tension, cover required areas
When suturing a wound on a leg, how do you prepare the site and why?
sterile gloves should be worn, a drape should be applied distal to the limb in case you drop your suture
A patient presents with a mildly contaminated open wound that the owner noticed just now but thinks happened about 8 hours ago when she had him outside on a stake unsupervised. What would you classify this wound as and how would you treat it?
Class 2
6-12 hours old
microbial levels may have reached critical levels consistent with development of infection
Treat by delayed primary closure.
appositional closure within 3-5 daysWhat factors go into deciding to use a cast in the treatment of a fracture?
-stable minimally displaced fractures
-young rapidly healing animals-only injuries distal to the elbow/stifle
-unable to repair with surgical techniques
List the major considerations for suture selection and summarize the classification of suture.
You are in your clinical rotations and an equine patient presents with a wound around its knee, what should you do to assess the severity of the wound?
pressurize the structure to determine if there is synovial involvement. If there is, the prognosis is worse.
What causes dehiscence of a wound?
-fluid accumulation
-infection
-inflammation
You are in your fourth year rotations and a patient presents with a dirty wound that your preceptor classifies as a Class 3 Wound. Your preceptor asks you to go get irrigation solution. What materials are you grabbing? Would you add any antiseptic to the solution? How would
Sterile isotonic saline or a balanced electrolyte solution (LRS)
Probably would not add antiseptic.
1 liter bag of fluid within a cuff pressurized to 300mmHg
antiseptics have little effect on bacteria in established infections and may damage tissue
Your patient presents with a wound in on the most proximal aspect of its hip, explain the steps you would take to apply a bandage.
Walk me through the closure of an abdominal procedure such as an OVH and what types of suture/pattern you would use for each layer.
Linea alba: sutures placed in external rectus sheath, simple continuous pattern or interrupted, slowly absorbable, monofilament suture with a cutting/reverse cutting needle (
subcutaneous: simple continuous, monofilament suture, absorbable, taper needle
subcuticular: monofilament suture, absorbable, cutting/reverse cutting needle
skin:monofilament, nonabsorbable, cutting/reverse cutting needle
An equine patient presents to you with a deep wound on the fetlock that has a viscous exudate coming out of it. What wound dressing would you use when bandaging this wound?
gauze: wet to dry, 4x4, or kerlix AMD
wet gauze with saline and place next to the wound under a bandage
Your patient presents with a heel bulb laceration that does not seem to have any granulation tissue but is slightly contaminated and does not exceed past the distal interphalangeal joint. Walk me through the treatment for this horse.
delayed primary closure with a wet to dry bandage and close the wound in 1-2 days
abaxial nerve block
foot cast- stall rest, change elasticon at the top every 1-2 days and remove in 2-3 weeks