Second Intention Healing (not done)

T/F optimal conditions throughout healing phases can be provided by one type of bandage or medication?

False

What do you need to do during the inflammatory phase?

Hemostasis

Keep wounds clean

Prevent trauma

Why do you need isotonic fluids for irrigation?

Fresh tissues will imbibe water

How do you differentiate fresh tissue from granulation?

Granulation will not absorb water

What are some common ingredients in antimicrobials that are appropriate for inflammatory and debridement phase?

Chlorhexidine

Povidone iodione

SSD

Nitrofurazone

Polymixin, neomycin, bacitracin

What tissue should you debride?

Devitalized or contaminated

What is a key benefit to granulation tissue?

Impervious to bacterial penetration

Why is immobilization important?

Prevents further trauma and motion

When does fibrosis begin and how long does it take?

Day 5 when fibroblasts appear on wound bed

Needs at least 7 days for a complete bed of granulation tissue to set in

During the fibrosis phase, what should you do to areas without healthy granulation tissue?

Evaluate for viability

Why would there be exposed bone in a granulation tissue-bed?

Bone sequestrum

What is required for bone sequestrum to occur?

Avascular bone

Infection

What are factors that favor exuberant granulation tissue (BAD THING)?

Bandages

Moist environments from ointments, infection, bandages changed infrequently

Motion

Why is exuberant granulation tissue bad?

Epithelialization will not occur

How do you remove exuberant granulation tissue?

Sharp scalpel excision

No nerve fibers, but it is vascular

What can prevent exuberation?

If left unbandaged and allowed to form a scab

Contraction and epithelialization will proceed underneath the scab

What should you do before applying any medication to a wound?

Ask, what do I need this medication to do

T/F owners can not resist the urge to treat wounds topically?

True

What should be included on discharge instructions?

Do not put anything on this wound without contacting me first

How can the wound be resurfaced after a full wound bed?

Contraction and epithelization on its own

Skin grafting

Surgical closure

What is wound contraction?

Process by which a wound diminishes in size by sliding of full thickness skin

When does wound contraction begin?

Wound bed is granulated level with the skin

What are reasons for lack of available skin other than original injury?

Skin flap was cut off

Improper management of wound edema leaving a larger leg with insufficient skin to cover the defect

What can stop contraction of the wound?

Exuberant granulation tissue

Motion (causes tension)

Medications with things like steroids

When will a wound epithelialize?

Wound bed is granulated to the level of the skin