✔️15 - LA Bandaging & Open Wound Management 🟢

5

Granulation tissue appears at day __#__

4-6

Epithelialization seen at day __#__

1. History

2. Initial Exam - Blood loss???

3. Patient Restraint

4. Visual Assessment

5. Clean Wound & Surrounding Tissues

6. Wound Anesthesia

7. Wound Exploration/Lavage

8. Wound Debridement

9. Wound Closure

10. Wound dressing

11. Bandage

12. Aftercare

What are the important parts of wound management? (12)

stop the bleeding!

What should we do first?

12

In equine, primary closure should be done within __#__ hours

blood loss

Heart rate, respiratory rate, membrane color, and CRT are taken into consideration when there is _____

vascular compromise

Higher energy at impact -> Tissue damage -> _____

1. time elapsed

2. blood loss

3. prior treatment/vaccine status

4. mechanism of injury

What do we consider during our initial examination? (4)

give tetanus toxoid and tetanus anti-toxin

If there is no tetanus vaccination history (+/- > 12 months), what do we do?

give a tetanus toxoid booster

If the horse was vaccinated for tetanus >/= 2 months ago, what do we do?

no booster needed

If the horse was vaccinated for tetanus <2 months ago, what do we do?

restraint

Twitch or tranquilizers can be used for patient _____

tranquilizers

Acepromazine, Alpha 2 agonists such as Xylazine and Detomidine, and opioids such as butorphanol are _____

Acepromazine

_____ causes - vasodilation, contraindicated with hypovolemia

Xylazine; Detomidine

_____ and _____ are alpha 2 agonists

Butorphanol

_____ is an opioid

1. wound location (blood supply; synovial structure involvement)

2. contamination/ infection

What should we consider when doing a visual assessment? (2)

10^5

Wound infection is at _____ organisms/gram of tissue

less

With more foreign material, necrotic tissue, hematoma, blood

supply compromise, or immunosuppression, [more/less] bacteria is needed for infection

2

When clipping, we should apply sterile lube to the wound and clip at least __#__ inches around it

antiseptics

Povidone iodine and chlorhexidine are _____

sterile saline

What is the best antiseptic for lavage?

no - painful

Should alcohol be used for cleaning a wound/surrounding tissues? Why?

edema in tissues

Garden hose causes _____

standing

Many lacerations are sutured with the horse _____

1. Lidocaine

2. Mepivacaine

What 2 medications can be used for wound anesthesia?

1. Peripheral nerve blocks

2. Local infiltration

What are 2 local anesthesia options?

away from

It is ideal to block [toward/away from] the wound

cut edge

When doing a block, if needed, insert the needle at the _____ of the tissue instead of adjacent to it

1. Digital palpation

2. Sterile probe

3. Radiographs (sterile probe or contrast material)

What are the 3 methods of wound exploration?

10-15 psi

When lavaging a wound, what should the pressure be?

18g needle on a 35ml or 60ml syringe

What size syringe and needle should be used for wound lavage?

debris

Using a water pik can drive _____ into the wound

normal saline or LRS

What solution(s) do we use for wound lavage?

synoviocentesis

-Sterile prep AWAY from the wound

-Avoid going through edema/cellulitis and introducing bacteria

1. Cytology

2. Total Protein

3. +/- culture

We can sample fluid from a wound and perform what tests? (3)

Amikacin

What antibiotic can be injected into a wound (synovial involvement)?

joint

Synovial involvement is associated with the _____

1. sharp

2. mechanical

3. autolytic

What are the common types of wound debridement? (3)

sharp

_____ wound debridement: Scalpel blade - debride most superficial layer

mechanical

_____ wound debridement:

• Wet to dry bandage

• Not once epithelialization has started

autolytic

_____ wound debridement:

• Moist wound healing

• WBCs and enzymes degrade necrotic tissue, leave healthy tissue alone

1. Chemical

2. Enzymatic

3. Biological

What are the 3 less common types of wound debridement?

primary

_____ wound closure:

• Close immediately

• Warn owner of possible dehiscence

• <12 hours

delayed primary

_____ wound closure:

• Close after a period of debridement

• Within 3-5 days of the injury (before granulation tissue forms)

• Mild/moderate contamination

delayed secondary

_____ wound closure:

• Close after granulation tissue is present

• Excise exuberant granulation tissue first

second intention healing

• No closure

• Large wounds

• Chronic, contaminated, skin loss

• After granulation tissue is present

• Likely to dehisce?

drainage

_____ in closed wounds is important to prevent accumulation of exudate that will compromise closure

closed

[Closed/open]:

• Jackson-Pratt drain

• Doesn't have to be ventral

open

[Closed/open]:

• Penrose drain

• Must be placed at most ventral

location

1. Minimal tissue reactivity, sufficient strength

2. Non-absorbable monofilament

3. Nylon (Ethilon) and Polypropylene (Prolene)

What are the characteristics of the suture material used for wound closure? (3)

simple interrupted

What suture pattern(s) do we use in non-tension areas?

1. Vertical Mattress

2. Near-Far-Far-Near

What suture pattern(s) do we use in high tension areas?

0.5cm

Sutures are placed _____ from wound edge

overtighten

REMEMBER THE CELL - don't _____!

1. gauze

2. telfa pad

3. hypertonic saline dressing (Curasalt)

4. calcium alginate (Curasorb)

What are the 4 types of wound dressings?

gauze

What wound dressing is associated with the following?

• Wet-to-dry bandages, 4x4 gauze or Kerlix AMD

• Debridement of heavily contaminated and exudative wounds

• Wet gauze with saline (+/- dilute chlorhexidine or povidone iodine) and place next to the wound under a bandage

Telfa Pad

What wound dressing is associated with the following?

•Surgical wounds or sutured wounds

• Non-adherent, non-occlusive

Hypertonic Saline Dressing

What wound dressing is associated with the following?

• Curasalt

• Aggressive wound debridement, first few days only

Calcium Alginate

What wound dressing is associated with the following?

• Curasorb

• Moderately exudative wounds and/or substantial tissue loss

• Creates a gel that promotes moist wound healing

1. Even tension

2. Appropriate tension

3. Cover the required areas

What are the guidelines for bandaging? (3)

counterclockwise

We bandage [clockwise/counterclockwise] on the left limbs

clockwise

We bandage [clockwise/counterclockwise] on the right limbs

medial

When bandaging, start on the _____ side of the leg and wrap toward the head

dorsal cannon bone

While bandaging, we put tension as we pass over the _____

true

T/F - When bandaging, we should evenly overlap each swipe and apply even tension/pressure

gloves

When putting on a veterinary bandage, we should start in a clean and dry environment and wear _____

non-adherent

The first layer of a bandage is _____

kling

We hold the nonadherent layer of a bandage in place with _____ gauze, loosely wrapped

thickness

_____ is important when it comes to the outer bandage

1. Sheet cotton

2. Gamgee

3. Combiroll

What are the disposable outer bandage options? (3)

tight

Brown gauze should be _____

wrinkles

When applying vet wrap, there should be no _____

Elasticon

_____ keeps debris out of the bandage and should be played loosely

re-usable bandage material

Pillow wraps, no bows, quilts, polo wraps, and standing wraps are all _____ used by owners

1. Not enough padding

2. Wrapping the wrong direction

3. Uneven pressure

4. Uneven swipes

5. Poor application

What are 5 common bandaging errors?

stack

When bandaging joints, we can do a _____ wrap or center over the joint

1. Figure eight the bandage

2. "Racing stripe" with elasticon

What are 2 ways we can minimize pressure over boney prominences?

gauze

We can use _____ to pad the accessory carpal bone and point of hock

proper padding

With splints, _____ is VERY important

PVC pipe

Splints are often n made of _____ and duct tape or white tape (not stretchy)

hoof; skin

A foot bandage should wrap tight on the _____ and loose on the _____

true

T/F - A foot bandage may or may not have padding

duct tape

There should be lots of _____ on the bottom of the foot when placing a foot bandage

1. Exuberant granulation tissue formation

2. Pressure sores

3. "Bandage bows"

What are the 3 complications of bandaging?

Exuberant granulation tissue formation

What complication is being described below?

• Initially good, then bad

Pressure sores

What complication is being described below?

• Can cause wounds

• May have white hairs later

"Bandage bows"

What complication is being described below?

• Extensor or flexor tendon inflammation

• No actual disruption of the tendon

• Too little padding, wrapped too tight

foot

In ruminant, it is common to bandage for _____ procedures

padding

Ruminants need _____ under splints

unaffected

A claw block goes on the [affected/unaffected] claw

dew claws

When bandaging ruminants, watch out for _____, as they are painful with too much pressure

1. Avoid wrapping directly over them

2. Figure 8 technique or use donuts for protection

How can we avoid pain from pressure on dew claws? (2)

true

T/F - Ruminants are difficult to confine, so we should use lots of duct tape

dehiscence

_____ is a complication of wound healing in large animals and we should warn owners about it every time

exuberant granulation tissue ("proud flesh")

• Distal limb wounds - Carpus/tarsus and below

• Ruminants - less common, but can occur

1. Bandaging after granulation tissue is present - hypoxia

2. Movement

3. Large wound, second intention healing

4. Bone sequestrum

5. Wound irritation - Owner's wound ointments

What are the predisposing factors to exuberant granulation tissue ("proud flesh")? (5)

1. Sharp debridement

2. Topical Steroids

3. Skin grafting

What are the treatments for exuberant granulation tissue ("proud flesh")? (3)

Entederm

_____ treatment can be used for exuberant granulation tissue ("proud flesh")

true

T/F - Small, seemingly innocuous wounds can be VERY serious