585952
| Pregunta | Respuesta |
| What are the three main classification of a wound | Open closed burned |
| What are the sub classifications of and open wounds? | incisions lacerations punctures |
| what are the sub classifications of closed wounds? | abrasions contusions |
| what is primary healing? | The healing without granulation tissue |
| What are the 4 phases of wound healing? | 1.Inflammatory phase 2.Debridement phase 3.Repair phase 4.Maturation phase |
| what are the inflammatory and debridement phases of healing more commonly known as? | The lag phase |
| what are the requirements for a wound to be able to heal under primary intention? | -fresh -clean -adequate vascularisation -minimal tension |
| what is the golden period? | The period in which bacteria haven't yet multiplied 10^5, usually taken to be 6-8 hours (note different tissues have different periods, the head for example can last 24 hours) |
| What are the signs of the inflammatory stage? | red hot swollen painful |
| What are the choices of lavage material? | -tap water -saline -lactated ringers -povidone iodine at 0.1% -chlorhexidine at 0.05% |
| How should a wound be prepared for primary closure? | -remove gross contaminants -remove any hair entering the wound -the surrounding hair should be soaked with water or K-Y jelly -'high' pressure lavage (8ppsi- 19g needle and 35ml syringe or a low setting on a water pik) |
| how should pain relief be applied to the wound? | local or regional anaesthesia, a perineural anaesthesia may be practical to anesthetize the wound if it is in the extrematies (note that local anesthetics prevent adherence of leukeocytes to the endotheleum which slows healing down, adding adrenalin to the LA may counteract this?) |
| what are worries about a deep wound? | -nerves -vessels -bones -joints -body cavity (throax/ab) |
| how and for how long can grafts be stored? | 3-4 days if refrigerated in McCoys 5A medium with 10% horse serum. |
| how should a new graft be protected? | with a non adherent dressing which isn't lifted for 4 days, the minimum dressing is a tie over one |
| how should exuberant granulation tissue be treated in a skin graft? | chemical cautery (caustic powder) or steroids |
| what should you do if you see epithelium sloughing after a skin graft? | dont panic new will form |
| What is better about split thickness grafting? | It is often better accepted although harder to do and requires specialist equipment. It is less cosmetic than full thickness grafts, the hair often grows to an excessive length. The donor sites often scar (i.e. develop hyper pigmentation). |
| How is skin harvested for a split thickness skin graft? | power or hand dermatomes |
| where can a full thickness skin graft be harvested from? | cranial pectoral area |
| what are the pros and cons of a full thickness skin graft? | only small areas can be grafted due to the donor site, they are cosmetic however and easy to do |
| what are the pros and cons of island grafting | Islands grafts are good as little expertise are required, no specialist equipment is required and a GA is unnecessary. They are however tedious, not cosmetic and requires a granulation bed so cannot graft a new wound with these. |
| how are pinch grafts done and where are the sites? | they are done with a scaple blade and donor sites are; pectoral, perineum and neck beneath the main. |
| For a punch graft where can skin be harvested from? | neck beneath the main and ventral pectoral areas only. |
| What about the underlying structures can damage a skin graft? | bone beneith it which hasn’t got periosteum, tendon with no paratenon and cartilage without perichondrium will prevent a graft from up taking |
| what are the most common bacteria on a horses graft bed? | streptococci, pseudomonas and proteus |
| what fluid accumulations can stop a graft binding and why? | seromas, haematomas or exudate. It stops the graft binding with fibrin. |
| what are the most common reasons for a graft failing? | -fluid accumulation -movement -infection |
| what are the stages to a graft up taking? | The grafts start out by imbibition, then after 4 days they gain blood vessels, odema starts to reduce down a bit although they are still fragile, at day 10 they are firmly united. About 7-8 weeks later the nerves re innervate, they may need buster collars or bandages to prevent self mutilation. |
| whats the difference between a free and a pedicle graft? | A free graft contains no blood vessels whilst pedicle grafts do |
| What the most common type of skin graft used in a horse? | a pedicle graft |
| what are the three types of island graft? | tunnel, punch and pinch grafts |
| how are island grafts classified? | they're pedicle grafts |
| what are the indications of a skin graft? | Insufficient skin to increase healing speed by contraction or epithelisation. It can be cheaper than frequent rebandaging. |
| when should a wound be referred? | open joint/synovial cavity, sever lameness, tendon damage, foreign body, deep penetration, fractures and if the if the owner requests it. |
| what are the malignant things that granulation tissue may turn into? | sarcoids, pythiosis and fibrosarcomas. |
| what things are used in treating exuberant granulation tissue? | pressure bandages, immobilization, topical anti microbials, cryosurgery, topical agents such as Cu sulphate or white lotion, biological dressings, skin grafting and surgical excision (doesnt contain nerves remove back to skin level). Honey can be useful as it sucks water out and is an anti microbial. |
| why is granulation tissue required? | epethelial cells to migrate, is resistant to infection and induces contraction |
| how may wound tension be relieved? | stenting, drains and tension relieving incisions. |
| how long can it take for a sequestrum to form? | 3-6 weeks |
| why are scabs bad? | they prevent epithelisation as they are dry, they should there fore be removed and the wound kept moist |
| what are the 10 things which may prevent wound healing? | -infection -foreign body -necrotic tissue -movement -loss of blood supply -poor tissue O2 -tissue deficit -continued trauma -local factors -health status issues -tumor transformation -iatrogenic factors |
| if a wound has granulation tissue how old must it be and how old is it to have epithelisation? | granulation tissue- 4 days epithelisation- 10-14 days |
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