wound management/pain

3 phases of wound healing

Lag, Repair,Maturation

Lag phase

Begins immeditaly and lasts 3-5 days
weakest phase

Repair phase

Begins 3-5 days after injury and continue for several weeks.

Maturation

Begins after 3 week s
remodeling of collagen fibers

Factors influencing wound healing

Age, Neurologic problmes, orthopeduc problems,nutrition status

wound factors

orgin of wound, surgically created, traumatically induced, contamination of wound

Clean wound

wound made under aseptic conditions. (surgical)

Clean-contaminated

created with control - surgical entry into a contaminated area, minimal contamination, easy to removeGI tract, respiratory tract, urogenital tract

Contaminated

traumatic wound with bacterial contamination pavement, soil, saliva from bite, GI tract or urogenital tract (surgical procedures)

Dirty(infected)

older wounds with infection. Abscess from bite wound, puncture wound from foreign material, necrotic tissue

Concurrent treatment factors

radiation therapy, chemotherapy, corticosteriods.

Primary closure with primary intention

Surgically created wounds with sutures or staples (en bloc),Must happen before granulation tissue forms

Delayed primary closure

Wound treated as open wound management,Contamination or excess drainage may require 2 - 3 days before primary closure can occur.,Wound closure occurs before granulation tissue forms

Secondary closure (third intention healing)

For heavily contaminated wounds, necrotic wounds,Form a health bed of granulation tissue, which will close on itself.

second intention wound healing

Allowed to heal by granulation tissue & epithelialization, Length of time to heal required to heal completely

Dead space

space between tissues created by wound allowing fluid to build up,Can delay or prevent normal wound healing,Fluid accumulation increases risk of infection

Passive drain

Allow fluid to flow along drain surface,Must exit in a dependent location to gravitate toward exit of incision.

Signs of wound infection

Swelling, heat, and redness of surrounding tissue

Choice of antimicrobial depends on

depends on severity of infection, type of organism, condition of wound and health of patient

Abrasions

partial thickness skin wounds (HBC),Heal well by re-epithelialization, moist wound environment speeds epithelialization.

Lacerations

tearing of skin & deeper tissues

Degloving injuries

large section of skin is torn off (dragging)

Penetrating Wounds

Bites, bullets, arrows, sticks, antlers

Burns

classified on basis of how deep into the tissues the injury reaches & how large affected area is.

First degree burn

Superficial and confined to outermost layer of skin (epidermis)Signs - red skin, painful, re-epithelializes within 1 week with topical management

Second degree burns

Full thickness epidermal, partial thickness dermis,Appears yellow-white, black, may slough and leak plasma, painful or not painful,Heal by epithelialization in 10 - 21 days, may need surgical intervention

Third degree burns

full thickness injury of epidermis and deep dermis,Thick, leathery, black layer of dead tissue called eschar

Fourth degree burns

Beyond dermis, including muscle, tendons and bones.Critically ill, intensive care to survive

Decubitus ulcers

develop over bony prominences as result of skin compression on hard surfaces for long periods of time in lateral position

Pressure sores

usually from bandages left on to long or inappropriate placement.

Bandage applied for

Management of soft tissue,Stabilization of bone and joint injuries

Functions of bandage

Protect from environment or patient,Aids in debridement, manages exudate, provides hemostasis,Decreases hematoma/seroma formation, provides support and comfort,Stabilizes fractures or joints, keeps splints or casts in position, restricts motion,Prevents weight baring, decreases swelling

Primary layer

direct contact with the wound,Most important for wound protection and healing because directly influences the wound environment,May be adherent or nonadherent, non-occlusive, semi-occlusive or occlusive,Depends on phase of wound healing & exudate present

Secondary layer

Provides padding (cast padding),Absorbs and holds exudate and provides some immobilization and support,Must be thicker to allow absorption of fluid into bandage without strike-through

Tertiary

Holds and protects other two layers (cling/vetwrap),Determines amount of pressure and support applied,Must not be occlusive or moisture will accumulate within bandage

Distal limb bandages

Protect wounds, stabilize bone or joint injuries

Robert jones

Temporarily immobilizes limbs distal to elbow or stifle joints,Has extremely thick secondary layer (cotton rolls and cast padding),Is tightly compressed to put uniform compression on limb,Sounds like a ripe melon if applied properly

Modified robert jones

Most common in small animals,Thinner secondary layer, outer layer is not overly tightened,Splints and casts easily incorporated into bandage,Toes or toe nails are excluded from bandage for daily inspection,Leaving to much toe exposed can lead to compromised blood flow and swelling,Doughnuts made of soft, non-abrasive material placed over bony protuberances or compromised tissue - decreases pressure sores