✔️12 - Open Wound Management 🟢

clean; dry

Wounds should be covered with a _____ and _____ bandage

1. Immediately after injury

2. When the animal is brought for treatment

When should wounds be covered with a clean, dry bandage? (2)

before

Life-threatening injuries should be treated, and the animal's condition stabilized [before/after] further wound management is undertaken

1. Temporarily cover the wound to prevent further trauma and contamination.

2. Assess the traumatized animal and stabilize its condition.

3. Clip and aseptically prepare the area around the wound.

4. Culture the wound.

5. Debride dead tissue and remove foreign debris from the wound.

6. Lavage the wound thoroughly.

7. Provide wound drainage.

8. Promote healing by stabilizing and protecting the cleaned wound.

9. Perform appropriate wound closure

What are the fundamentals of wound management? (9)

classified

When appropriate during stabilization, the bandage over an open or superficial wound should be removed and the wound should be assessed and _____.

1. Contaminated or infected

2. Class 1-3

3. Type of wound

How can we "classify" an open/superficial wound? (3)

6-8; 105

The "golden period" is the first _____ hours between wound contamination at injury and bacterial multiplication to greater than _____ CFU per gram of tissue

105

A wound is classified as infected rather than contaminated when bacterial numbers exceed _____ CFU per gram of tissue

a thick, viscous exudate

Infected wounds often are grossly dirty and covered with _____

contamination

Presence of microbes on a surface

colonization

Surface microorganisms are replicating

infection

Invasion and replication of microbes within the tissue

microbial burden

______ = (Number of Microorganisms x Virulence)/Host Resistance

1

Class _____ wound classification:

-0-6 hours old

-Minimal contamination & tissue trauma

2

Class _____ wound classification:

-6-12 hours old

-Microbial levels may not have reached critical level consistent with development of infection

3

Class _____ wound classification:

-Older than 12 hours

-Microbial levels may have reached critical level consistent with development of infection

1. Abrasion

2. Puncture Wound

3. Laceration

4. Avulsion or Degloving Injury

5. Thermal Burn

6. Decubital Ulcers

What are the types of wounds? (6)

abrasions

_____ are superficial and involve destruction of varying depths of skin by friction from blunt trauma or shearing forces

minimally

Abrasions are sensitive to pressure or touch and bleed [minimally/excessively]

reepithelialization

Abrasions heal rapidly by _____

puncture wounds

Characterized by small skin opening with deep tissue contamination and damage

velocity; mass

Puncture wound depth and width vary depending on the _____ and _____ of the object creating the wound

missile velocity

The extent of puncture wound tissue damage is directly proportional to _____

true

T/F - Pieces of hair, skin, and debris can be embedded in puncture wounds

1. Penetrating foreign objects (stick, wire, bone)

2. Bite wounds

3. Gunshot injuries

Mechanisms of puncture wound injury include? (3)

lacerations

Created by tearing, which damages skin and underlying tissue (muscle, tendons)

irregular edges

Lacerations may be superficial or deep and have _____

concurrent avulsion

Typically, lacerations have minimal peripheral trauma to the wound edges, unless its a _____ injury

avulsions/degloving injuries

Characterized by the tearing of tissues from their attachments and the creation of skin flaps

degloving injuries

Avulsion injuries on limbs with extensive skin loss are called _____

wound bed; distal limbs

Avulsions/degloving injuries have exposed _____ and are common on _____

anatomic degloving

Skin and various levels of underlying tissue are torn off the limb

physiologic degloving

Skin surface is intact but separated or avulsed from underlying subcutaneous tissue and blood supply

necrosis

Physiologic degloving results in delayed _____ of the skin

thermal burns

-May be partial- or full-thickness

-Caused by heat or chemicals

1. Fire

2. Cage dryers

3. Heating pads

4. Heat lamps

5. Hot Liquids

6. Malicious incidents

Mechanisms of thermal burn injury include? (6)

1. Severe fluid loss

2. Electrolyte loss

3. Protein loss

Deep and extensive thermal burn injuries may cause systemic compromise due to what? (3)

high

Risk of infection and sepsis is [low/high] with thermal burns

delayed microvascular damage

Strict classification of burns is no longer in favor due to _____

crush injuries

Can be a combination of other types of wounds with extensive damage and contusions to skin and deeper tissue

1. Result of compression of the skin & soft tissues between a bony prominence and a hard surface

2. Results in skin loss over the bony prominence

3. May extend into deeper soft tissue and bone

4. Often seen in this recumbent animals

Describe decubital ulcers. (4)

1. Greater Trochanter

2. Lateral Elbow

3. Lateral Hock

What are the common sites of decubital ulcers? (3)

1. Primary Wound Closure (First Intention Healing)

2. Delayed Primary Closure

3. Healing By Contraction & Epithelialization (Second Intention Healing)

4. Secondary Closure (Third Intention Healing)

What are the types of wound closures? (4)

primary wound closure

What is associated with 1st intention healing?

healing by contraction & epithelialization

What is associated with 2nd intention healing?

secondary closure

What is associated with 3rd intention healing?

primary wound closure (first intention healing)

-Wound edges are apposed and allowed to heal by first intention

-Occurs in most surgical wounds

-Class 1 and some class 2

1. Clean sharply incised wounds

2. Minimal Trauma

3. Minimal Contamination

4. Within hours of injury

Primary wound closure indicated in... (4)

delayed primary closure

-Appositional closure within 3-5 days

-Before granulation tissue has been produced in wound bed

-Class 2 wounds

1. Mildly Contaminated

2. Minimal Trauma

3. Require some cleansing, debridement, & open wound management before closure

Delayed primary closure indicated in...(3)

healing by contraction & epithelialization (second intention healing)

-Wound left open to heal by contraction &

epithelialization

-Eventually produces a continuous epithelial

surface.

-May be inefficient and fail produce a functional

outcome

1. Dirty wounds

2. Contaminated wounds

3. Traumatized wounds

Healing by contraction & epithelialization (second intention healing) indicated for...(3)

cleansing & debridement; primary or delayed closure

Healing by contraction & epithelialization (second intention healing) indicated for dirty, contaminated, and traumatized wounds...where _____ are necessary, but _____ is prohibited

secondary closure

With healing by contraction & epithelialization, continually assess to see if _____ could be used to expedite the process

secondary closure (third intention healing)

-Appositional closure more than 3-5 days after wounding

-Granulation tissue has formed in the wound bed

-Allows for Third Intention Healing

1. Severely Contaminated

2. Severely Traumatized

3. Infected

Secondary closure (third intention healing) indicated in...(3)

granulation tissue

With secondary closure, development of _____ in the wound bed provides a microbial resistant, vascular substrate that facilitates healing

over

Secondary closure is performed _____ the granulation tissue

debridement

Some _____ may be necessary to facilitate closure in secondary closure

1. Reduce microbial burden

2. Prevent further contamination

We perform immediate wound care to...(2)

1. Copious irrigation (even with tap water)

2. Coverage of the wound with antimicrobial agent

3. Bandage to protect wound

In an initially unstable patient, we can perform immediate wound care in what ways? (3)

dilution

The solution to pollution is _____!

anesthesia

_____ is often required for initial wound inspection and care

cultured

Severely contaminated or infected wounds should be _____ after initial inspection

clipped; prepped

The area surrounding a wound should be widely _____ and _____

lubricant; saline

Wound may be protected from clipped hair and detergents by applying a sterile, water-soluble _____ (K-Y Jelly) or by placing _____-soaked sponges in the wound and covering with a sterile pad or towel

closed

Wound may be temporarily _____ with sutures, towel clamps, staples, or Michel clips

mineral oil

Hair may be clipped from the wound margin with scissors dipped in _____ to prevent hair from falling into the wound

1. Povidone-iodine

2. Chlorhexidine gluconate

What skin scrubs are used to prep clipped skin? (2)

wound infection

Detergents in antiseptic scrubs cause irritation, toxicity, and pain in exposed tissue and may potentiate _____

alcohol

_____ is very damaging to exposed tissue and should be used only on intact skin

lavage

With initial wound management, gross contaminants are removed and copious ____ is done using a warm, balanced electrolyte solution, sterile saline, or tap water

1. Sterile isotonic saline

2. Balanced electrolyte solution (lactated Ringer's solution)

What are the preferred lavage solutions? (2)

tap water

_____ is effective and less detrimental than

distilled or sterile water for lavage

mechanically

Wound lavage reduces bacterial numbers _____ by loosening and flushing away bacteria and associated necrotic debris

noncytotoxic

Lavage may be facilitated by the use of _____ wound cleansers - applied to loosen debris and soften necrotic tissue during bandage changes

surfactants

Noncytotoxic wound cleaners act as _____, disrupting the ionic bonding of particles and organisms to the wound and allowing them to be easily rinsed off with saline or balanced electrolyte solutions

antibiotics; antiseptics

Use of _____ or _____ (e.g., chlorhexidine or povidone-iodine) in the lavage solution reduce bacterial numbers

tissue damage

Antibiotics and antiseptics may cause _____

established

Antiseptics have little effect on bacteria in _____ infections

lavaging

_____ is preferred to scrubbing the wound with sponges

sponges

_____ inflict tissue damage that impairs the wound's ability to resist infection and allows residual bacteria to elicit an inflammatory response

wound irrigation

Bacteria are effectively removed from the wound surface by high-pressure lavage

7 - 8; higher

Traditionally, for wound irrigation, a 35- or 60-ml syringe and an 18-gauge needle have been thought to generate approximately _____ psi of pressure. However, it has been shown that it generates pressures substantially [lower/higher] than this.

1-liter bag of fluid within a cuff pressurized to 300 mmHg

The most consistent delivery method to generate 7 to 8psi for wound irrigation is a _____

more

Higher pressure (70 psi), generated by pulsatile lavage instruments (i.e., Water Pik [Teledyne], Surgilav, or Pulsavac débridement system) is [more/less] effective in reducing bacterial numbers and removing foreign debris and necrotic tissue

1. Drive bacteria and debris into loose tissue planes

2. Damage underlying tissue

3. Reduce resistance to infection

Though higher pressure wound irrigation is more effective for reducing bacterial numbers and removing foreign debris and necrotic tissue, it may have what negative effects? (3)

do not

Bulb syringes or fluid bottles with holes made in the cap [do/do not] generate enough pressure to remove bacteria and debris adequately

1; 300

Wound lavage using __#__L of 0.9% saline in pressure bag, maintained at ______ mmHg with extension tubing and an 18-gauge needle

necrotic

Healing is delayed if _____ tissue is left in the wound

debridement

Devitalized tissue is removed from the wound by _____

debridement

______ involves removal of dead or damaged tissue, foreign bodies, and microorganisms that compromise local defense mechanisms and delay healing

obtain fresh clean wound margins and wound bed for primary or delayed closure

What is the goal of debridement?

1. Surgical excision

2. Autolytic mechanisms

3. Enzymes

4. Wet-dry bandages

5. Biosurgical methods

What are the ways devitalized tissue is removed? (5)

48 hours

The extent of devitalized tissue is usually obvious within _____ of injury

layers

Devitalized tissue should be surgically excised in _____ beginning at the surface and progressing to the depths of the wound

1. Sharp dissection

2. Electrosurgery

3. Laser

Surgical debridement is done by what 3 methods?

1. bones

2. tendons

3. nerves

4. vessels

5. bone sequestra

When doing a surgical debridement, what 5 things must be preserved?

muscle

_____ should be debrided until it bleeds and contracts with appropriate stimuli

subcutaneous tissue

Extensive debridement of _____ should be avoided as it may delay wound healing, particularly in cats, and may place wounds at a higher risk for infection