Podcast
Questions and Answers
In second intention wound healing, what is a crucial aspect of successful management?
In second intention wound healing, what is a crucial aspect of successful management?
- Relying solely on advanced technology for wound care.
- Having a comprehensive understanding of the distinct phases of wound healing. (correct)
- Maintaining a consistently moist wound environment throughout the healing process.
- Immediately applying potent antimicrobials to prevent infection.
What principle should guide daily assessment and adjustment in second intention wound healing?
What principle should guide daily assessment and adjustment in second intention wound healing?
- Determining what is happening in the wound, and what is needed to progress the wound to the next stage. (correct)
- Focusing on long-term cosmetic outcomes rather than immediate healing needs.
- Following a predetermined treatment protocol regardless of the wound's appearance.
- Ensuring the wound is consistently treated with the same topical medication.
In the inflammatory phase of wound healing, what is the correct order of the vascular events that occur?
In the inflammatory phase of wound healing, what is the correct order of the vascular events that occur?
- Vasoconstriction, increased vascular permeability, vasodilation
- Vasodilation, vasoconstriction, increased vascular permeability
- Increased vascular permeability, vasodilation, vasoconstriction
- Vasoconstriction, vasodilation, increased vascular permeability (correct)
Why is it important to avoid hydrotherapy on fresh wounds undergoing second intention healing?
Why is it important to avoid hydrotherapy on fresh wounds undergoing second intention healing?
Why is the use of systemic antimicrobials not indicated once a wound bed has fully granulated?
Why is the use of systemic antimicrobials not indicated once a wound bed has fully granulated?
What is the rationale for using sweat bandages to manage limb edema during the inflammatory phase of wound healing?
What is the rationale for using sweat bandages to manage limb edema during the inflammatory phase of wound healing?
A granulation tissue bed with areas of the wound with no granulation tissue indicates which of the following?
A granulation tissue bed with areas of the wound with no granulation tissue indicates which of the following?
What is the primary concern regarding exuberant granulation tissue?
What is the primary concern regarding exuberant granulation tissue?
What is the most important aspect to consider when choosing a wound medication during the contraction and epithelization phases?
What is the most important aspect to consider when choosing a wound medication during the contraction and epithelization phases?
During which phase of second intention wound healing is skin contraction observed?
During which phase of second intention wound healing is skin contraction observed?
During the fibroplasia phase of wound healing, what key cellular activity is essential for successful tissue repair?
During the fibroplasia phase of wound healing, what key cellular activity is essential for successful tissue repair?
What could the the lack of an epithelial rim during wound healing indicate?
What could the the lack of an epithelial rim during wound healing indicate?
A practitioner observes bone exposed within a horses's heavily granulated wound. What are the primary concerning processes that would need to be addressed?
A practitioner observes bone exposed within a horses's heavily granulated wound. What are the primary concerning processes that would need to be addressed?
What is the maximum rate that skin contraction should be occuring, in mm/day?
What is the maximum rate that skin contraction should be occuring, in mm/day?
Why is second intention healing often the least preferred method of wound healing?
Why is second intention healing often the least preferred method of wound healing?
Under which condition will a wound undergoing second intention healing usually not become exuberant?
Under which condition will a wound undergoing second intention healing usually not become exuberant?
An owner is concerned about limb edema. What bandage should the practitioner recommend to remove the swelling?
An owner is concerned about limb edema. What bandage should the practitioner recommend to remove the swelling?
What can you expect if an animal's limb is large and edematous when granulation tissue begins to form?
What can you expect if an animal's limb is large and edematous when granulation tissue begins to form?
After contraction ceases, how is the remainder of the wound covered?
After contraction ceases, how is the remainder of the wound covered?
What is FALSE about epithelization?
What is FALSE about epithelization?
What type of contact layer should be used when a wound is epithelizing?
What type of contact layer should be used when a wound is epithelizing?
What is the next action be taken if a wound is contracted and epithelizing?
What is the next action be taken if a wound is contracted and epithelizing?
You are presented with a 2 week old wound that has exposed bone in the wound bed. What is the MOST likely underlying reason for the exposed bone?
You are presented with a 2 week old wound that has exposed bone in the wound bed. What is the MOST likely underlying reason for the exposed bone?
All of the following medications are toxic to the cells causing contraction and epithelization, EXCEPT:
All of the following medications are toxic to the cells causing contraction and epithelization, EXCEPT:
After assessing a skin wound, what is the BEST question to ask yourself before applying any topical medication?
After assessing a skin wound, what is the BEST question to ask yourself before applying any topical medication?
Which of the following phrases is the BEST discharge instruction when discussing how to care for a second intention skin wound?
Which of the following phrases is the BEST discharge instruction when discussing how to care for a second intention skin wound?
Which characteristic of second-intention healing contributes most significantly to its higher cost compared to primary intention healing?
Which characteristic of second-intention healing contributes most significantly to its higher cost compared to primary intention healing?
What is the MOST important initial step when managing a fresh wound during the inflammatory and debridement phases?
What is the MOST important initial step when managing a fresh wound during the inflammatory and debridement phases?
When managing a wound on the distal limb of a horse, why should exuberant granulation tissue be addressed by a vet as soon as possible?
When managing a wound on the distal limb of a horse, why should exuberant granulation tissue be addressed by a vet as soon as possible?
What characteristic of granulation tissue makes it an impervious barrier to bacteria?
What characteristic of granulation tissue makes it an impervious barrier to bacteria?
Which factor is MOST important to consider when deciding whether to bandage a wound?
Which factor is MOST important to consider when deciding whether to bandage a wound?
A practitioner advises a client to apply a sweat bandage. What does the bandage wrap accomplish?
A practitioner advises a client to apply a sweat bandage. What does the bandage wrap accomplish?
A horse that is known for being difficult with bandaging has a heavily granulated wound. What is MOST important for the practitioner to consider?
A horse that is known for being difficult with bandaging has a heavily granulated wound. What is MOST important for the practitioner to consider?
Which of the following is NOT a key aspect of second intention wound healing in horses?
Which of the following is NOT a key aspect of second intention wound healing in horses?
What should a practitioner do if there is a deficiency of fibroblasts in a wound?
What should a practitioner do if there is a deficiency of fibroblasts in a wound?
Why is knowledge more important than technology when treating second intention wounds?
Why is knowledge more important than technology when treating second intention wounds?
What is the MOST important consideration when managing a wound in the inflammatory and debridement phase?
What is the MOST important consideration when managing a wound in the inflammatory and debridement phase?
When should hydrotherapy be implemented during second-intention wound care?
When should hydrotherapy be implemented during second-intention wound care?
What is the MOST likely underlying reason why a practitioner observes exposed bone within a heavily granulated wound?
What is the MOST likely underlying reason why a practitioner observes exposed bone within a heavily granulated wound?
What feature of the wound, once present, eliminates the need for systemic antimicrobials?
What feature of the wound, once present, eliminates the need for systemic antimicrobials?
Why should limb edema be addressed aggressively during the inflammatory phase of second-intention wound healing?
Why should limb edema be addressed aggressively during the inflammatory phase of second-intention wound healing?
You observe areas of granulation tissue are absent in the wound bed. What is the MOST likely explanation?
You observe areas of granulation tissue are absent in the wound bed. What is the MOST likely explanation?
What is the MOST important step to prevent against exuberant granulation tissue in distal limb wounds?
What is the MOST important step to prevent against exuberant granulation tissue in distal limb wounds?
Why is it important to avoid medications containing copper sulfate on wounds undergoing contraction and epithelialization?
Why is it important to avoid medications containing copper sulfate on wounds undergoing contraction and epithelialization?
What is the therapeutic goal when managing wounds undergoing second-intention healing?
What is the therapeutic goal when managing wounds undergoing second-intention healing?
Why is daily assessment and adjustment crucial for second-intention wound healing?
Why is daily assessment and adjustment crucial for second-intention wound healing?
If a visible epithelial rim is absent, what are the possible underlying causes?
If a visible epithelial rim is absent, what are the possible underlying causes?
What information should be included in dischage instructions for an animal that requires second-intention wound healing?
What information should be included in dischage instructions for an animal that requires second-intention wound healing?
What determines when contraction ceases?
What determines when contraction ceases?
While using a sweat bandage, what is MOST important to consider in addition to edema removal?
While using a sweat bandage, what is MOST important to consider in addition to edema removal?
What should you assess before applying a topical medication?
What should you assess before applying a topical medication?
What causes a lack of available skin that diminishes contraction other than the initial injury?
What causes a lack of available skin that diminishes contraction other than the initial injury?
What factors should be considered when managing a horse with a heavily granulated wound that is difficult with bandaging?
What factors should be considered when managing a horse with a heavily granulated wound that is difficult with bandaging?
What wound medications are MOST toxic to cells causing contraction and epithelization?
What wound medications are MOST toxic to cells causing contraction and epithelization?
For what type of wound is IV Abx LEAST indicated?
For what type of wound is IV Abx LEAST indicated?
What can occur if granulation tissue is visible above the level of the exterior dermatologic margin?
What can occur if granulation tissue is visible above the level of the exterior dermatologic margin?
Why is contraction cosmetically and functionally superior when resurfacing a wound?
Why is contraction cosmetically and functionally superior when resurfacing a wound?
What should a practitioner tell a client about bandaging and exuberant granulation tissue?
What should a practitioner tell a client about bandaging and exuberant granulation tissue?
How does epithelization occur after contraction?
How does epithelization occur after contraction?
Given two wounds that are fully granulated, what can you suspect when only one is contracting and epithelializing?
Given two wounds that are fully granulated, what can you suspect when only one is contracting and epithelializing?
If you see a granulation tissue bed with areas of the wound with no granulation tissue, what should you do?
If you see a granulation tissue bed with areas of the wound with no granulation tissue, what should you do?
What is the BEST next step be when a wound is contracted, with an advancing epithelial rim?
What is the BEST next step be when a wound is contracted, with an advancing epithelial rim?
During second intention wound healing, how does skin resurface after contraction?
During second intention wound healing, how does skin resurface after contraction?
Flashcards
Second Intention Healing
Second Intention Healing
The process of healing when skin closure is not possible, resulting in a slower, less cosmetic outcome.
Primary Healing
Primary Healing
Faster, cheaper, and more cosmetic than second intention healing.
Successful Wound Management
Successful Wound Management
Requires a thorough understanding of wound healing phases and their specific needs.
Therapeutic Goal in Wound Healing
Therapeutic Goal in Wound Healing
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Daily Wound Assessment Question
Daily Wound Assessment Question
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Guiding Question
Guiding Question
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Inflammatory Phase
Inflammatory Phase
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Debridement Phase
Debridement Phase
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Proliferative Phase
Proliferative Phase
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Wound Contraction
Wound Contraction
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Epithelization
Epithelization
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Wound care variation
Wound care variation
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Treatment Timing
Treatment Timing
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Medication Timing
Medication Timing
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Bandage Adjustment
Bandage Adjustment
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Hemostasis
Hemostasis
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Prevent Trauma
Prevent Trauma
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Cleaning Wounds
Cleaning Wounds
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Fresh Tissue Hydration
Fresh Tissue Hydration
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Granulation Tissue
Granulation Tissue
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Antimicrobial Ingredients
Antimicrobial Ingredients
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Debridement
Debridement
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Dakin's solution
Dakin's solution
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IV Antibiotics
IV Antibiotics
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Tetanus Toxoid
Tetanus Toxoid
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Granulation Tissue
Granulation Tissue
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Manage Wound Edema
Manage Wound Edema
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Edema Management Methods
Edema Management Methods
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Fibrosis
Fibrosis
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Granulation Tissue Bed
Granulation Tissue Bed
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Areas lacking granulation tissue
Areas lacking granulation tissue
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Bone Sequestrum
Bone Sequestrum
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Bone Sequestrum Requirements
Bone Sequestrum Requirements
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Factors that favor exuberant granulation tissue
Factors that favor exuberant granulation tissue
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Overgranulation Management
Overgranulation Management
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Exuberant Tissue Removal
Exuberant Tissue Removal
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Second Intention Healing Without Bandage
Second Intention Healing Without Bandage
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Healing Beneath Scab
Healing Beneath Scab
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Topical Question
Topical Question
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Medication Justification
Medication Justification
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Read The Labels!
Read The Labels!
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Ingredient Research
Ingredient Research
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Marketing
Marketing
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Conditions Needed
Conditions Needed
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Wound Contraction
Wound Contraction
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When is Wound Contraction Applicable?
When is Wound Contraction Applicable?
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Contraction Resistance
Contraction Resistance
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Skin Amount Matters!
Skin Amount Matters!
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Contraction Rate
Contraction Rate
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Skin Flaps
Skin Flaps
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Early Support
Early Support
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Contraction Inhibitors
Contraction Inhibitors
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Non Adherent Layer
Non Adherent Layer
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Toxic Wounds
Toxic Wounds
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Wound Completion
Wound Completion
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Study Notes
Second Intention Healing
- Primary intention wound healing will always be faster, cheaper, and more cosmetic compared to second intention healing.
- Success in second intention healing requires knowledge of the phases of wound healing and their requirements.
- The therapeutic goal is to provide optimum conditions for each phase of wound healing.
- Daily assessments and adjustments are needed for proper healing.
- One should ask what is happening in this wound today and what can be done to make this wound progress to the next stage.
- All wounds heal by the same processes.
Inflammatory Phase
- The first phase of normal wound healing entails hemostasis.
- It is characterized by vasoconstriction, vasodilation, and increased vascular permeability
Debridement Phase
- The body uses collagenase and elastase in the debrisment phase to remove dead tissue.
Proliferative Phase
- In the proliferative phase wounds are closed.
Facts About Wound Care
- Optimal conditions cannot be provided by one type of bandage or wound medication.
- There are indications to begin treatments and indications to stop them.
- Medications that are beneficial during one phase, may be detrimental in another.
- Bandage techniques need to be adjusted as wounds progress from one stage to the next
Cleaning Wounds
- Fresh tissues imbibe water, so isotonic fluids should be used for irrigation when possible.
- Granulation tissue will not absorb water.
Common Ingredients in Antimicrobials
- Chlorhexidine
- Povidone iodine
- Silver sulfadiazine
- Nitrofurazone
- Polymixin, neomycin, bacitracin
- All antimicrobials are suitable for wounds during inflammatory and debridement phases.
- Antimicrobials are available as ointments, solutions, as well as generics.
Healing Phases
- Wound management during the inflammatory and debridement phases should focus on preventing further trauma ensuring the wound remains clean
- In the inflammatory phase the wound should be kept bandaged
- Administer Tetanus Toxoid
- Keep wounds clean.
Fibrosis
- Begins when fibroblasts appear in the wound bed on day 5.
- Requires at least 7 days to see a complete bed of granulation tissue.
- Areas without healthy granulation tissue should be evaluated for viability.
Factors Favoring Exuberant Granulation Tissue
- Bandages
- Moist environment
- Ointments
- Infection
- Infrequent bandage changes
- Motion
Second Intention Healing of Exuberant Granulation Tissue
- Remove exuberant granulation tissue immediately.
- Use sharp scalpel excision.
Second Intention Healing - Important Considerations
- Wounds will usually not become exuberant if left unbandaged and allowed to form a scab
- Contraction and epithelization will proceed underneath the scab.
- Make sure before applying any medication, what is needed from the medication.
- There are four wound medication guidelines:
- Do not use any wound medication without a specific indication.
- Know what ingredients are in the medications by reading the labels.
- Research the ingredients to find out what they actually do.
- Do not rely on marketing information.
- It is important not to treat wounds topically without veterinary guidance.
Granulation Tissue
- Granulation tissue is an impervious barrier to bacterial penetration
Things to Manage
- Manage wound edema using:
- pressure bandages
- NSAID's
- sweat bandages Restrict motion
Bone Sequestrum Requires
- Avascular bone
- Infection
Contraction and Epithelization
- Contraction and epithelization are independent but may take place simultaneously.
- Contraction is superior cosmetically and functionally.
Wound Contraction
- It is the process by which a wound diminishes in size by sliding of full thickness skin.
- Contraction does not begin until the wound bed is granulated level with the skin.
- Wound contracts until skin tension exceeds contracting force.
- The amount of contraction depends on available skin.
- Contraction occurs at approximately 0.5 mm / day.
- Proper Edema management is important to consider due to the lack of available skin other than the original injury
Things That Inhibit Contraction
- Exuberant granulation tissue
- Motion or too much tension
- Medications
After the Wound Bed is Filled Wound Must Be Resurfaced By:
- Contraction
- Epithelization
- Skin grafting
- Surgical closure
- The presence of epithelium at the wound periphery indicates the wound is ready to be resurfaced
Epithelization
- Epithelization wound is ready when the wound bed is granulated to the level of the skin.
- A non-adherent contact layer when a wound is epithelizing must be used, as well as caution with using medications that are toxic
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