INTRODUCTION AND MODULE 1: SURGERY OF THE INTEGUMENTARY SYSTEM OF DOGS AND CATS

Dr. William Stewart Halsted

The co founder of Johns Hopkins Hospital, the Halsted principles (or Tenets or Halsted) remain the gold standard for surgical technique.

Gentle Handling of Tissue, Meticulous Hemostasis, Preservation of Blood supply, Strict Aseptic Technique, Minimum Tension on Tissues, Accurate Tissue Apposition, Obliteration of Dead space

The Halsted principles (or Tenets of Halsted) remain the gold standard for surgical technique. (Enumerate)

Wound healing

It is a biologic process that restores tissues

continuity after injury

Both statement are true

Which statement is/are true about wound healing?

S1: Combination of physical, chemical, and cellular events that restore wounded tissue or replace it with collagen

S2: Begins immediately after injury or incision

Stratum Corneum,Stratum Lucidum, Stratum Granulosum,Stratum Spinosum and Stratum Basale (Germinativum)

Layers of the skin (sublayer)

Inflammation, Debridement, Repair and Maturation

Four phases of wound healing

True

True or False:

A wound care technique that involves keeping a wound in a moist environment to promote healing.

True

True or False:

It is based on the idea that cell growth thrives in moist conditions and can help wounds heal up to the tissues faster than wounds that are left to dry.

False

True or False:

Moist wound environment do not allow optimal healing.

Moist environment

What type of environment does debridement is hastened and selective, granulation tissue formation is promoted, and epithelization is faster.

72 hours to 96 hours

In moist environment it fosters autolytic debridement by endogenous enzymes that break down necrotic but not healthy tissues. Autolytic debridement occurs within __ to __ hours under occlusive bandages.

Statement 2

Which statement is/are true about WBC

S1: WBC phagocytosis increases bacterial load and

removes necrotic debris

S2: WBC migrate more readily in a moist environment

Granulation tissue, Angiogenesis and Reepithelization

Wound fluid contains cytokines and growth factors that stimulates: ____

Neutrophils and macrophages

Chemotactic factors in wound fluid attracts __ and _ that secretes additional enzymes, cytokines, and growth factors.

More wbc, improved phagocytosis and a lower pH

Moist wounds limit infection because ___ are found in the wound, there is ___ and ___.

Scabs

It does not form with moist wound healing; therefore, WBC are not trapped.

Topical medication

What medication is better in penetrating the wound

Macrophage activity, Fibroblast proliferation and Capillary ingrowth

Low oxygen tension under an occlusive bandage stimulates: ___

Twice

Rate of epithelization is ___ as fast for wounds kept moist with occlusive dressings than air-exposed wounds.

Both statement are true

Which statement is/are true?

S1: Epithelial cells travel faster and have a shorter distance for epithelization to occur in moist environment

S2: In air-exposed wounds, migrating epithelial cells must travel beneath a crusted scab and devitalized dermis to reach their destination.

Hydrophilic, occlusive, or semi occlusive bandages

Bandages that help keep a wound warm and moist = = Increased warmth enzymatic activity.

Less painful, Less pruritic, Tissue do not dessicate and Scar formation is less

Which statement is/are the true about moist wound:

Less painful, More painful, Less pruritic, More pruritic, Tissue do not dessicate, Tissue dessicate, Scar formation is more, Scar formation is less.

Faster healing, Reduced risk of infection, Less scarring, Pain reduction

and Improved mobility.

Which statement is/are the true about the benefits of moist wound healing:

Delayed healing, Faster healing, Reduced risk of infection, Increased risk of infection, More scarring, Less scarring, Increased Pain, Pain reduction Improved mobility, Delayed mobility.

Clean the wounds, Apply a thin layer of petroleum jelly or antibiotic

ointment, Use a wound dressing that provides moisture and nutrient

Which statement is/are the true about what you can do to keep wound moist:

Clean the wounds, Apply a thick layer of petroleum jelly or antibiotic ointment, Apply a thin layer of petroleum jelly or antibiotic ointment, Use a wound dressing that provides moisture and nutrient, Do not use a wound dressing that provides moisture and nutrient

Bacterial colonization of the wound surface, Folliculitis, Maceration of the wound border

Which statement is/are true about Potential disadvantages of moist wound healing:

Bacterial colonization of the wound surface, Infection of the wound surface, Folliculitis, Maceration of the wound border

Age of the animal, Malnourished animals, Hepatic disease, Hyperadrenocorticism, Diabetes mellitus, Uremia, Obesity and Cutaneous wounds

Host factors affecting wound healing

Old animals

In terms of the age of the animal, what age of an animal where it tend to heal slowly often because of concurrent disease or debilitation

Serum protein concentration below 1.5 to 2 g/dl

In malnourished animals, what serum protein concentration value tend to delayed wound healing and diminished wound strength

Hepatic disease

What factor affecting wound healing Cause clotting factors deficiency

Hyperadrenocorticism

What factor affecting wound healing Delays wound healing because of excess circulating glucocorticoids

Diabetes mellitus

What factor affecting wound healing Delayed wound healing and predisposition to infection

Uremia

What factor affecting wound healing Occurring within 5 days of injury impairs healing by altering enzyme systems, biochemical pathway, and cellular metabolism

Obesity

What factor affecting wound healing is Associated with a higher incidence of postoperative wound infection in human beings.

Cutaneous wounds

What wound are slower to heal in cats and dogs.

Half as strong

Sutured wounds in cats are only ____ as similar wounds in dogs after days of healing.

Secondary intention

Cat wounds that are allowed to heal by _____, heal slower, produce less granulation tissue that is more peripherally located and heal more by contraction of wound edges than dogs.

Periosteum, fascia and tendon and nerve sheath

Intact surfaces such as ___________ do not support granulation, therefore these surfaces heal slowly when exposed.

All statement are true

Which statement is/are true about Wound characteristics affecting wound healing.

S1: Fenestration or drilling holes in exposed cortical bone may improve granulation by releasing osteogenic or other factors.

S2: Foreign materials in wounds (e.g. dirt, debris, sutures, surgical implants) can cause intense inflammatory reactions interfering with normal wound healing.

S3: Release of enzymes designed to degrade foreign bodies, destroy wound matrix, prolongs inflammation and delays the fibroblastic phase of tissue repair.

S4: Wound infection interferes with the repair phase of

healing.

10 (to the fifth power) colony forming (CFU) per gram of tissue.

Contaminated tissues become infected if invasive bacteria multiply to _____ colony forming (CFU) per gram of tissue.

The degree of tissue trauma, Amount of foreign present, Delay between injury and treatment and Effectiveness of host defenses

Development of wound infection depends on:

Bacterial toxins and associated inflammatory infiltrates

What cause cell necrosis and vascular thrombosis.

Wound exudates

What can separate tissue layers and further delay healing.

Antiseptics

Exposure of the wound to what drug delays healing and may predispose to infections

Warmth tempeature (30C [86F])

What temperature allows wounds to heal more quickly and with greater tensile strength than if they are at room temperature.

Statement 3

Which statement is/are false?

S1: Moist wounds promote recruitment of vital host defenses and cells encouraging wound healing.

S2: Bandages keeps wounds moist and warm.

S3: Wounds (incisions) created with scissors, electrosurgery or lasers heal faster; with less necrosis at the wound margins than those made with sharp surgical instruments