15 bandaging and open wound management large animal

5 days

When does granulation tissue appear in the wound healing process?

4-6 days

When does epithelialization occur in the wound healing process?

FIRST STOP BLEEDING

What is always your FIRST GOAL when performing an initial exam for wound management in large animals?

1. b. history

2. j. initial exam, blood loss?

3. a. patient restraint

4. i. visual assessment

5. h. clean wound/surrounding tissue

6. g. wound anesthesia

7. k. wound exploration/lavage

8. l. wound debridement

9. f. wound closure

10. e. wound dressing

11. d. bandage

12. c. aftercare

Put the steps in order of large animal wound management (she's lengthy i know):

a. patient restraint

b. history

c. aftercare

d. bandage

e. wound dressing

f. wound closure

g. wound anesthesia

h. clean wound/surrounding tissue

i. visual assessment

j. initial exam, blood loss?

k. wound exploration/lavage

l. wound debridement

Physical exam

What should you perform on EVERY patient?

If the horse has gotten a tetanus shot within 2 mo. no booster needed (anything over 2 months needs a tetanus toxoid booster)

You are managing a horse with a wound. If the horse has gotten a tetanus shot within _________ months, no booster is needed.

Teiler's disease (a viral hepatitis that affects horses, aka serum hepatitis)

What is the risk of using tetanus anti-toxin in large animals?

Twitch and tranquillizers (Ace, Alpha 2 agonists like Xylazine and Detomidine, opoids like butorphanol)

Name a few restraint mechanisms for horses:

Xylazine, detomidine

Name the alpha 2 agonist (drugs which stimulate alpha 2 adrenergic receptors which decrease sympathetic nervous system = low bp, hr, etc.) drugs which are used as tranquilizers in horses?

Could be synovial structure involvement, blood supply could be involved like jugular vein or carotid artery

Why do you need to be concerned with wound location in large animals?

10^5 organisms/gram of tissue

How many organisms typically have to be involved per gram of tissue for a wound to be considered "infected"?

Foreign material present in wound, necrotic tissue, hematoma, blood supply compromise, immunosuppression

Typically, 10^5 organisms per gram of tissue are needed for a wound to be considered "infected". Name some instances where, if these things happen, less bacteria will be needed for infection.

2 inches

How far around a wound should you clip the hair?

Alcohol (on open wounds)

What antiseptic should you NOT use to clean wounds?

FALSE: most lacerations are sutured with the horse STANDING

TRUE OR FALSE: Most lacerations are sutured with the horse in lateral recumbency.

Use lidocaine/mepivacaine and local blocks (peripheral nerve block)

Why can you suture most lacerations standing in horses? What can you use?

10-15 psi (achieved using 18 ga needle on 35 or 60 mL syringe) using saline or lactated ringers

What pressure (in psi) is typically used to lavage horse wounds? What solution is used?

Perform synoviocentesis, sample the fluid, pressurize the structure, and inject antibiotics (amikacin).

ALSO you can inject sterile saline. EX: if you have a wound on the medial side, sterilely prep and insert needle with saline on LATERAL side. if it communicates with the joint, saline will come out of the wound on the medial side. if it doesn't communicate saline will come shooting back out of your needle on the lateral side

When exploring a wound in a large animal, how can you determine if there is synovial involvement?

Amikacin

Which antibiotic do you inject into a wound if you suspect there is synovial involvement?

1. sharp (with scalpel)

2. mechanical (wet-to-dry bandages, but NOT once epithelization has started)

3. autolytic (moist wound healing, WBC/enzymes degrade necrotic tissue)

What are the 3 most common mechanisms of wound debridement in large animals?

DO NOT DO once epithelization has started, around 4-6 days

At what stage of the healing process should you not use mechanical debridement in large animals?

To debride superficial layer

What is sharp debridement used for?

Observe clean versus serrated cuts (ex metal versus barbed wire). If there is higher energy on impact, there will be more tissue damage and vascular compromise

Why is it important to know the mechanism of injury when managing horse wounds?

Give tetanus toxoid (tetanus vaccine to prevent) AND tetanus anti-toxin (treatment for tetanus)

You go to a farm to treat a horse with a wound. The owner has just gotten the horse and does not know anything about its vaccine history. What should you do?

1. primary

2. delayed primary

3. delayed secondary

4. second intention healing

Name the 4 types of wound closure

Primary

Which type of wound closure is done immediately (within first 12 hours) and the owner should be warned of possible dehiscence

Delayed primary

Which type of wound closure is done within 3-5 days of the injury, before granulation tissue forms and after a period of debridement. There may be mild to moderate contamination

Delayed secondary closure

Which type of wound closure is done after granulation tissue is present, though exuberant granulation tissue must be excised first. This is not common

Second intention healing

Which type of wound closure is not actually closed by the veterinarian, as is often present with large wounds after granulation tissue is present. There may be chronic, contaminated, skin loss. Likely to dehisce (inform owner)

1. Jackson-Pratt

2. Penrose

What are the two different types of drains used in large animal to prevent accumulation of exudate that will compromise closure?

Jackson-Pratt

This type of drain is considered "closed", and fluid is sucked away from the surgical site so the device does not have to be ventral

Penrose

This type of drain is considered "open", and must be placed in the most ventral location as it uses gravity to drain fluid out of the lowest point

Nonabsorbable mono: nylon (ethilon) and polypropylene (prolene)

What suture material should you use in superficial skin in a horse?

Simple interrupted

What suture pattern should you use in non-tension areas in a horse?

Vertical mattress and near-far-far-near

What suture pattern should you use in high tension areas in a horse?

Gauze: wet-to-dry bandages, 4x4 gauze, or Kerlix AMD

What wound dressing is appropriate to use when you want to debride heavily contaminated and exudative wounds in large animals?

Gauze (Kerlix AMD) used to debride heavily contaminated and exudative wounds

What type of wound dressing (which can be used in primary layer) is this and on what type of wounds should it be used?

Telfa pads

What wound dressing is appropriate to use over surgical wounds or suture wounds, as it is nonadherent and nonocclusive?

This is TELFA, used on surgical or sutured wounds

What type of wound dressing is this and on what type of wounds should it be used?

Hypertonic saline dressing (Curasalt)

What wound dressing is appropriate to use for aggressive wound debridement but only within the first few days?

Calcium Alginate (Curasorb)

What dressing is appropriate to use for moderately exudative wounds or over substantial tissue loss, as it creates a gel which promotes moist wound healing?

ON LEFT LIMBS: counterclockwise

ON RIGHT LIMBS: clockwise

(imagine a swimmer doing a breaststroke)

In which direction should you bandage horse limbs? Left? Right?

Start medially

On which side of the leg should you start when bandaging equine limbs? Medial or lateral?

1. wear gloves and apply nonadherent first layer

2. hold in place with kling gauze, LOOSELY wrapped

3. apply thick outer bandage

4. apply brown gauze TIGHT over thick bandage to decrease edema

5. Apply vet wrap over brown gauze, make sure there are no wrinkles

6. place Elasticon loosely to the top and bottom margins of the vet wrap to prevent debris from getting into the bandage

Describe how to apply veterinary equine bandages

Standing wraps (support while standing in stable/transport), polo wraps (during exercise), pillow wraps (thick additional padding often under standing wraps)

Name a few re-usable bandage materials often used by owners

Not enough padding, wrapped in wrong direction

What is the issue with this bandaging technique?

uneven pressure, swipes, and poor application

What is the issue with this bandaging technique?

Figure eight the bandage, racing stripe with elasticon, use gauze to pad accessory carpal and point of hock

How can you minimize pressure over bony prominences over joints?

TRUE

TRUE OR FALSE: When splinting horse legs proper padding is very important as PVC pipes and duct tape are often used

Wrap tight on hoof, loose on skin with LOTS of duct tape on bottom of foot. ALSO do not make too tight over coronary band or you may have to cut it down

When bandaging the hoof, what is important to remember?

1. exuberant granulation tissue formation

2. pressure sores

3. bandage bows (extensor/flexor tendon inflammation due to too little padding or being wrapped too tightly)

Name a few complications of bandaging horses?

Multiple bandages are applied one on top of the other to provide maximum support and protection

What is a "stack wrap"?

Essentially acts as a crutch, putting the pressure on the claw which is uninjured and elevating the injured side

Why do you apply "claw blocks" to cattle on the UNAFFECTED claw?

Dew claws

What is one structure on cattle that horses do not have which you have to be aware of so you do not wrap directly over them as it could be painful with too much pressure?

1. dehiscence (WARN OWNERS EVERY TIME)

2. exuberant granulation tissue aka proud flesh

3. involvement of synovial structures

4. bone sequestrum

5. cellulitis

Name the complications of wound healing in large animals:

Distal limbs (carpus, tarsus and below)

Where do you most commonly see proud flesh?

Sharp debridement, topical steroids, skin grafting

Name a few ways to treat proud flesh?

Horses

Proud flesh is more common in horses or cows?

TIME: prognosis is better if treated early

What is the biggest factor with synovial structures being involved with wounds in horses?

Bone sequestrum

You see a nonhealing wound and do an x-ray to see this. What is happening?

Cellulitis

This complication of wound healing occurs when there is severe wound edema in limbs associated with a relatively small wound, typically because of infection of the subcutaneous tissues

AGGRESSIVE therapy: systemic antibiotics, anti-inflammatories, bandaging

Name some treatments for equine cellulitis