Wound Management

Define epidermins

outer layer of the skin

What does the epidermis provide?

barrier against water and infection

Define the dermis

layer under the epidermis

What does the dermis contain?

contains collagen, elastic tissue, and reticular fibers that provide strength and elasticity

What are the types of wounds?

abrasions, lacerations, degloving injuries, puncture wounds, burns, and decubitus ulcers

What is an abrasion?

partial thickness wounds of the epidermis; deep dermis is exposed

How do abrasions heal?

heal by re-epithelialization and can be enhanced by keeping the surface moist/protected

What is a laceration?

sharply incised edges with minimal tissue trauma

Are lacerations superficial or deep?

superficial (skin) and deep (muscle/tendons)

What is a puncture wound?

have small openings, deep tissue damage

What is the treatment for puncture wounds?

exploration, debridement, lavage, primary closure, and/or drain

What is a degloving injury?

often the result of being hit by a car and dragged

What animals commonly deal with degloving injuries?

small animals

What is the treatment for degloving injuries?

debridement, lavage, and management of open wound

What is a decubital ulcer?

the result of compression of soft tissue and skin between the body and surface an animal is lying upon

What is the treatment for decubital ulcers?

Prevention is best!

Minimal debridement, Closures often fail, and Skin flaps preferred in some cases

What are the three phases of wound healing (in order)?

Inflammatory (lag) phase, proliferative phase, and maturation

What predominates are part of the inflammatory phase of wound healing?

neutrophils and macrophages

What are the predominates of the proliferative phase of wound healing?

granulation and epithelialization

How long does the inflammatory (lag) phase last?

immeadiately (1-2 days, up to 5 days)

How long does the proliferative phase last?

starts day 2-3 (overlaps inflammatory phase goes on for several weeks)

Maturation gains maximum strength – but never quite regains normal _______.

tissue strength

What does granulation tissue do to promote wound healing?

Fills tissue defect, Protects the wound, Provides barrier to infections, and Provides surface for new epithelial cells to form across

What type of special fibroblasts does granulation tissue provide a source to?

myofibroblasts

What are myofibroblasts responsible for?

wound contraction

What are some factors about the patient that need to be included in wound healing?

patients age, orthopedic/neurological problems, nutrition status, degree of contamination of wound, length of time wound has been opened and any types of treatment already used.

Define “Clean Wound”

created under “aseptic conditions” such as a surgical incision.

Define “Clean-Contaminated Wound”

created when a nonsterile organ (GI or genitourinary tract) is entered with little or no spillage of contents or when a minor breach in aseptic technique occurs when treating a clean wound

How old is a clean conaminated wound?

less than 6 hours old

How old is a contaminated wound normally?

more than 6 hours old

Define “Contaminated Wound”

result from spillage of organ contents into the incision, a major breach in aseptic technique, or presence of foreign debris

Define a “Dirty/Infected Wound”. How many organisms do we see per gram of tissue?

old or infected with >105 organisms per gram of tissue

• wound greater than 12 hours old

What is included in contaminated wounds?

bites, road rash, and punctures

What is incuded in small animal wound management?

stabilization, preventing contamination, and cleaning/lavage

What is used when doing a primary wound closure?

closure with sutures

What are the results with primary closures?

intention healing

What are primary closures used for with wound healing?

used to close clean or clean-contaminated wounds

What is delayed primary closure?

close ccurs 2-5 days after injury, before grnulation tissue is formed

What is delayed primary closure used for?

used for close clean-contaminated or contaminated wounds

When would we use a secondary closure for a wound?

with severely contaminated/traumatized wounds

With which wound closure foes granulation tissue develop? How low dose closure take?

secondary closure; after 5 days or longer

What wound management is a part of the second intention wound healing?

open wound management

What can second intention wound healing produce?

produce contraction over joints, muscles, or tendons with impaired function and may not be desirable

What are some ways to determine the type of wound closure needed?

time since injury, extent of foregin contamination , degree of bacterial contamination, visibility or tissue, location/tension of wound, and damages to the neurovascular supply

Wound drainage often means there is a sign of _______.

dead space

What is a type of passive drain? How do they work?

penrose drain; work by capillary action

What are penrose drains used for?

used to drain subcutaneous wounds and are gravity dependent

What is an active drain? How do they work?

a rigid fenestrated drain; work by closed-suction

What does NPWT stand for?

Negative Pressure Wound Therapy

What is another name for a pressure sore?

decubitus ulcer

What are signs of infection?

Swelling, heat, and redness of surrounding tissues

When using fiberglass casting material which piece of PPE is imperative to wear?

wear gloves

When sending your patient home with a bandage, what are you going to tell your owner to watch for?

Check the site twice a day,

send an instruction sheet home with the client

give face-to-face instructions

show the client how to check the bandage

call the client and ask how things are going (follow up).

How much overlap should there be each time you wrap around the limb?

50% overlap

Is adherent or nonadherent primary layer preferred? Why?

nonadherent because it is moisture retaining and enhances epithelialization

What can sugar/makuna honey do to help with a wound?

decreases inflammation, stimulates macrophages migration, accelerates sloughing of dead tissue, forms protective protein layer

How often do we change a bandage that include sugar or manuka honey?

change 1-3x a day

Where are tape stirrups typically placed?

On the lateral aspect of the limb

What is place between the tape stirrups so that they don’t stick together when still working?

tongue depressor

If a bandage is not smooth when put on an animal, what can it cause?

pressure sores

What is the second layer when bandaging?

padding/absorbent layer - roll cotton in LA and cast padding in SA

What is the first layer of bandaging called/used for?

telfa pad; absorbent and covers the primary contact layer

What happens if you the second layer on too loose? What about too tight? Will this cause any harm to patient’s?

Too loose - bunching of the cotton and too tight - it rips

• won’t cause any harm to pets :)

What is the tertiary layer for bandaging called/used for?

for support - kling/stretch gauze

Can you put the tertiary layer on too tight?

yes; lave 1 inch on bottom with cotton an 1 inch on top, can cut off circulation

T/F the tertiary layer allows moisture to enter and exit.

True

What are the two types of protective layers for bandaging?

vetrap and elasticon

When using vetrap how are we wrapping the bandage? What can wrinkles cause?

start an 1 inch above cotton and 50% overlay; no wrinkles! will dig into skin overtime

What do we tell the owners when we send them home with their pet having a bandage on their foot/leg?

toes should be touching, if they start to spread apart the bandage is too tight

What can a wet tertiary layer cause? What is another word for it?

wound is at risk for contamination from the environment because bacteria can wick through the moist bandage material; Strike-Through

Once the tertiary layer is wet it ____________.

must be changed

How is a robert jones bandage normally used?

commonly used for temporary immobilization of fractures distal to the elbow/stifle before surgery

Why can we not stabilize a shoulder?

we can’t get to the shoulder joint

When stabilizing a body part, what has to be wrapped in order for that area to be stabilized properly?

a joint above and a joint below

the modified robert jones bandage is used most commonly with what animals?

small animals

Why is the modified robert jones bandage less bulky and used more often with our smaller animals?

is less bulky due to less padding used in the second layer

What are ehmer slings used for?

to immobilize a hind limb after reduction of craniodorsal coxofemoral luxation & to prevent weight-bearing after surgery on the pelvis

What does the correct application of the ehmer sling result in?

internal rotation & adduction of the coxofemoral joint

What is another name for ehmer sling?

ehmer for the femur

When removing ear bandages what do we want to be careful with?

be careful to not cut the ear pinna