Second Intention Healing

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

What are the benefits of primary healing?

Always faster, cheaper, and more cosmetic

What is required for successful second intention healing?

Knowledge of phases of wound healing

The requirements for each phase

What it the therapeutic goal of second intention healing?

Provide optimum conditions for each phase of wound healing

This requires daily assessment and adjustment

T/F all wounds heal the same way?

True

What happens to the vasculature during the inflammatory phase?

Initial vasoconstriction to stop bleeding

Then vasodilation and increased vascular permeability

When is granulation tissue laid down?

Proliferative phase

How does the wound heal after granulation tissue forms?

Contraction and epithelialization

What is required for epitheliziation?

The wound must be completely flat. That’s why you need to trim granulation tissue so bad

Where is epithelialization slower?

Distal limbs compared to the trunk

What are some facts about healing wounds?

there are indications to both start and stop treatments

Medications can be helpful in some phases and hurtful in others

Bandages need to be adjusted as wounds progress from one stage to the next

When are wet to dry bandages useful?

Debridement phase

What is the goal of wet to dry bandages?

Start wet with chlorhex or betadine or saline

After it dries you can remove it and the bad tissue, debris, etc will go with it

T/F the wound will fibrose in the shape the limb is in when granulation starts?

True

How can you manage wound edema?

Pressure bandages, NSAIDs, sweat bandages, restrict motion

What is Mag-paste?

Hypertonic ointment that can be used to help draw out fluid when used with a sweat bandage'

Place compression bandage over

Remove after 24 hours

What are the guidelines for selecting wound medications?

Do not use wound medication without a specific indication

Know what th emedications label says

research the ingredients to see what they acually do

Do not rely on marketing information

When are antimicrobial creams most effective?

During the debridement phase, not needed during proliferative or fibrosis stage

When should you not use panalog?

When you want epithelialization because it has a steroid

Good for inhibiting granulation tissue from overgrowing

What are telfa pads good for?

Non-stick so they do not pull off epithelial tissue once epithelialization begins

What does scarlet oil do?

No one knows MOA but it is antimicrobial and helps granulation tissue . Common for older vets t

What is calcium alginate dressings used for?

Stimulation of granulation tissue

What does cica-care help with?

Placed during remodeling to decrease scarring

What does vetericyn or dakins solution do?

It is dilute bleach that can be used to help lavage

When are IV antibiotics probably not indicated?

Open non-synovial wounds

When is tetanus toxoid or vaccination status indicated?

Always

Do you need antibiotics if a wound is fully granulated in?

NO it is impervious to bacterial penetration

T/F contraction and epithelialization are independent but can take place at the same time?

True

Why is contraction better than epithelialization?

It is stronger and more cosmetic

When does a wound stop contracting?

When skin tension exceeds contracting force of fibrils

What does the amound of contraction depend on?

Available skin

How much contraction occurs a day?

0.5mm/day

What type of contact layer do you need when a wound is epithelizing?

Non-adherent

What should you do if you can not see an epithelial rim?

Ask yourself why (probably exuberant granulation tissue)

What is a common problem with wound medications?

Toxic to cells that cause contraction and epithelialization

What are some wound medications that are bad for contraction and epithelialization?

Petrolatum, alcohol, nitrofurazone, steroids, copper sulfate

T/F a wound that is fully granulated in should be contracting and epithelializing and if not you need to figure out why?

True