IntroSx1- LA Wound Mgmt
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Cattle make ________ granulation tissue than horses.
less [cows don't get proud flesh, like horses do]
What are the steps in wound management? (4)
- control hemorrhage, if present
- remove contamination/ foreign material
- surgical repair when appropriate
- external coaptation to prevent further injury
How can you assess the amount of blood loss?
HR and MM color
What is the "golden period"?
time period when debridement will allow primary closure to proceed; severe tissue trauma or massive contamination will negate golden period
What is a major concern with anesthesia and head wounds/ head trauma?
neurogenic pulmonary edema
NEVER close a _________ type of wound.
What is a concern when there is bone showing through a wound?
development of a sequestrum [curette cortical surface of denuded bone]
How can you handle puncture wounds? (4)
- probe in the wound and take a radiograph- assess extent of wound
- inject/ pressurize synovial cavity suspected of involvment
- NEVER suture
- be aggressive with antibiotics
What are the concerns with deep lacerations? (2)
- contamination not easy to assess
- involvement of vital structures, which may be difficult to assess
What is a major concern/ sequela of degloving injuries?
- proud flesh
- total degloving has very very poor prognosis
The presence of foreign material reduces the ____________ necessary for __________.
bacterial numbers; infection to occur
What is a challenge of wound debridement in large animals?
don't have a layer of fascia we can completely remove; usually cannot surgically debride/ resect all contaminated tissue (use a drain!)
____________ areas are more resistant to infection than other body areas.
Head and urogenital region
Wound infection is most common in _________ and __________; it is rare in __________.
puncture wounds; sutured wounds; lacerations left unsustured
Damage to _________ is not a big deal in horses! Do not suture.
What type of antibiotics should you give when dealing with a wound?
- broad spectrum injectable (procaine penicillin IM, gentocin IV)
- not oral because they don't reach tissue levels by the time of closure
If you pressurize a synovial cavity and it IS involved in a wound, you should... (3)
- lavage joint or tendon sheath with at least 1L of sterile isotonic fluid
- inject aminoglycoside into synovial cavity
- aggressive antibiotics (regional limb perfusion?)
What are concerns with closure versus no closure of a wound?
- greatly increased chance of sepsis if you close a contaminated wound
- don't close very small wounds or very deep wounds
What is the maximum amount of time you should leave a penrose drain in?
72 hours if you get this question on boards (but realistically, 3-5 days)
What are challenges of approximation of wound edges in equine patients? (3)
- tension is always a concern (except head wounds)
- undermine skin aggressively
- release incisions/ meshing skin (watch blood supply,place more aggressively on parent skin than on flap with questionable blood supply, decreases tension and acts as drainage to decrease seroma/ infection)
How should you suture wounds when it is appropriate to do so?
- vertical mattress tension sutures
- don't over evert skin edges, don't make sutures too tight
- may use tie-over stentor quill sutures
- usually just closing skin, especially on distal limbs
What type of suture should you use to close skin?
- polypropylene best, can use nylon
- BUT use absorbable if location that will be difficult to remove suture
When and why is external coaptation necessary? (4)
- tension relief
- decreased movement to prevent proud flesh
- stability for extensor tendon lacerations
- minimizes excessive swelling
What are advantages of bandages? (3)
- provide pressure to decrease swelling, control hemorrhage, support closure
- wick exudate away from wound
- keep wounds clean
If you are placing a bandage cast, it is important to...
incorporate the foot in the fiberglass cast OR "tape the bejeezus out of the foot"
With heel bulb laceration, ALWAYS check for...
DIP joint involvement!
How do you handle proud flesh in distal limb lacerations and second intention healing?
frequent surgical removal of proud flesh, pressure wraps, and steroid ointment (Panalog)
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