Lacerations and wound management

Older geldings on extensor surfaces

Skin will be thicker in where?

Reduced vasculature

Increased infection

Increased inflammation

Reduced regional temp

What is going to prolong healing wounds of extremities?

They run parallel and heal best so incisions should be made parallel to them

What is important to know about equine cleavage lines?

Below Carpus and tarsus

Where are distal limbs wound seen?

Tension - difficult to close

Close to ground - infection

Synovial structures - worry about easy infection

What are things to worry about distal limb wounds?

Improper assessment

Most wounds will not heal right due to what?

Reducation of bacterial loa and necrotic tissue

What is debridement used for?

Scalpel - least traumatic but be conservative

What is best to use for sharp debridement?

Woven gauze - gentle pressure

Lavage

Wet to wet

Wet to dry

What are mechanical methods of Debridement?

Non-cytotoxic fluid, w/ appropriate pressure to wash away debris and not push it in (19g needle 35ml syringe)

How should we lavage a wound?

Wet wound wet bandage will peal necrotic tissue off and leave healthy tissue - needs to stay wet!!!

What is a wet to wet dressing?

Dressing on wound is wet and rest of bandage will be dry and pull the moisture from wound away

What is wet to dry dressings?

A non-selective debridement only meant for very contaminated wounds

What is chemical debridement?

H2O2

Hypertonic saline

What do you use in chem debridement?

Maggots - digest only necrotic tissue and bacteria - selective and antimicrobial

What is biological debridement?

Least traumatic - leaves would fluid in contact w/ wound bed - make sure stays moist

What is autolytic debridement?

Bacteria w/out active multiplication or trauma

What is contamination of a wound?

Bacteria attached to tissue multiplying but no trauma

What is colonization of a wound?

Bacteria multiplying and invading healthy tissue overwhelming immune response

What is infection of a wound?

Qualitative assessment - types of bacteria and sensitivity testing

What is used most commonly when trying to see bacteria in wounds?

Cleaning the healthy normal skin not wound bed itself - doesn't penetrate necrotic tissue well

What do we use antiseptics on?

Loss of blood supply to wound bed

When do we use a triple antibiotic ointment?

Clean/ clean contaminated

What wound classifications are best candidates for primary or delayed primary closure?

Wound immediately and completely closed w/ aseptic technique - best functional and cosmetic results - minimal tissue loss

What is primary closure?

Near-far-far-near

Interrupted vertical/ horizontal mattress +/- stents

What suture patterns are used to reduce tension?

Hematoma/seroma - bacterial growth

What can failure to close dead space lead to?

Suture

Meshing the skin

Passive/active drains

Pressure bandage

What are methods to close deadspace?

Wound initially left open for debridement and reduction of bacteria, then closed

What is a delayed primary closure?

Relies on horse physiology and granulation tissue - used in wounds that cannot be closed

What is second intention healing?

Keeps wound bed moist and surrounding skin dry - Don't let wound dry out

What is the ideal wound dressing?

Hypertonic saline - debridement

Manuka honey - bactericidal & growth factor

Antimicrobial dressings

Hydrogels

Calcium alginate

What are types of wound dressings?

A cationic dressing that suppresses micro bacterial penetration and growth - no resistance possible

What is kerlix AMD?

Interacts w/ sodium in wound and makes exudate stimulating myofibroblasts and epithelial cells

What does calcium alginate do?

Brain

Eyes

Ears

Paranasal sinuses

Salivary ducts

Nerves

What are structures to be wary of w/ head wounds?

CT/MRI (not always available)

Rads

U/S

What are best for diagnostic aids of head wounds?

Chlorohex - use Betadine instead

You should never use ___ near the eyes?

Small diameter absorbable sutures in many layers - eyelid is very mobile

What kind of suture should be used on the eyelids?

Ears - mobile and cartilage

What structure will not heal very well on the head?

Bone sequestration and fistulas

What can happen to the paranasal sinuses in head wounds

Salivary duct and incisor involvement

What should you look for if the mandible is involved in a head wound?

Second intention

Nares will usually need to heal ___ if 7 days old?

Ribs and pneumothorax

What are we worried about if we have a thorax injury?

Broad spectrum antibiotics if pleural penetration

Stent bandages

How do you tx a thorax inj?

Bandage

Antibiotics

Refer - probs colic sx

What should you do if you have a peritoneal penetration?

SQ emphysema leading to pneumomediastinum - air filling sq/ pneumothorax

What do we worry about w/ axillary lacerations?

Pack wound w/ sling bandages

Limit horse movements - air must be reabsorbed

How do you tx axillary lacerations?

Primary closure

Lavage

IV antibiotics

Local IV regional perfusion

If there is a synovial structure involved what is treatment for a laceration?

DDFT sheath/ coffin joint

What structures are we most worried about in a heel bulb laceration?

Delayed primary closure - very contaminate - need to debride

If there is no synovial involvement how can we tx heel bulb laceration?

Poor

Chronic wounds will often heal w/ ____ functional and cosmetic results?

FB

Infection

What should be suspected if a wound does not heal in anticipated time frame?

Turn it to acute - stimulates healing

Why would we do sx debridement on a chronic wound?

There is at least 1cm or more of skin around the edge to hold the sutures

What do we need to make sure of when we close a wound?

Venous sinus

What is a normal sinus tract/ draining tract?

Abnormal passage or communication b/w two internal organs or from organ to skin

What is a fistula?

Trauma/ FB

Sinus tracts are typically secondary to what?

Distal limb kick from other horse leads to sequestrum of bone - body tries to push out

What is an example of a trauma induced sinus tract?

FB

U/S

If there is a chronic sinus tract you should always suspect __ and can dx w/?

Metalic FB

Radiographs are great for finding what kind of FB?

Dark purple

Sinus tracts will usually have a ____ membrane?

Sinus infection

Dental issues

Sinus tracts in the head can be due to what?

Dentigerous cyst (ear tooth)

Sinus tracts in the ear can be due to what?

Brucellosis - titer - zoonotic

What would we be concerned with if we saw draining tracts in the withers (Fistulos withers) and pole (Pole evil) regions?