Podcast
Questions and Answers
When is primary closure generally recommended for a wound?
When is primary closure generally recommended for a wound?
- When dealing with a clean wound that has been converted from a contaminated state. (correct)
- If a contaminated or infected wound is present.
- If there's a large skin defect that is too big to close easily.
- When dealing with a highly contaminated wound that might have compromised tissue viability.
In what scenario is 'second-intention healing' most likely to be pursued?
In what scenario is 'second-intention healing' most likely to be pursued?
- For a wound with extensive tissue damage where closure isn't feasible. (correct)
- For wounds that are clean and can be easily sutured.
- For wounds that are only slightly contaminated.
- When a wound has minimal tissue loss and closure is easily achievable.
Why might a surgeon opt for 'delayed primary closure' for a wound?
Why might a surgeon opt for 'delayed primary closure' for a wound?
- They assume the wound has ideal tissue viability and no edema.
- The wound is perfectly clean.
- The wound is heavily contaminated, and the surgeon doubts the viability of the tissue. (correct)
- The wound is already infected.
If a decision is made against immediate closure, what is the next critical question to address when managing a wound?
If a decision is made against immediate closure, what is the next critical question to address when managing a wound?
What role do elastic fibers in the skin play in the context of delayed primary closure?
What role do elastic fibers in the skin play in the context of delayed primary closure?
How does collagenase activity affect the tensile strength of skin during wound closure?
How does collagenase activity affect the tensile strength of skin during wound closure?
What is the 'Golden Period' in the context of wound management?
What is the 'Golden Period' in the context of wound management?
Why is achieving accurate hemostasis particularly important in primary closure?
Why is achieving accurate hemostasis particularly important in primary closure?
According to Halsted's Principles of Surgery, what's the primary purpose for careful tissue handling during wound closure:
According to Halsted's Principles of Surgery, what's the primary purpose for careful tissue handling during wound closure:
What does 'obliteration of dead space' achieve in wound closure?
What does 'obliteration of dead space' achieve in wound closure?
When preparing a wound for primary closure, why is adequate hair clipping so critical?
When preparing a wound for primary closure, why is adequate hair clipping so critical?
During the preparation of a laceration for closure, if a surgeon notices a change in skin color along the wound margins, what does this typically indicate?
During the preparation of a laceration for closure, if a surgeon notices a change in skin color along the wound margins, what does this typically indicate?
When performing sharp scalpel debridement of a wound, what's the primary goal while irrigating?
When performing sharp scalpel debridement of a wound, what's the primary goal while irrigating?
Which is the most likely outcome for the segment of skin most distant from vascular attachment?
Which is the most likely outcome for the segment of skin most distant from vascular attachment?
Why is 'Tension-free wound closure' a critical principle?
Why is 'Tension-free wound closure' a critical principle?
What is the primary purpose for placing drainage after wound closure?
What is the primary purpose for placing drainage after wound closure?
How does suture capillarity affect wound healing?
How does suture capillarity affect wound healing?
What is a key consideration when choosing a suture material?
What is a key consideration when choosing a suture material?
If a surgeon is closing a wound under moderate tension, what suture pattern might be the most appropriate?
If a surgeon is closing a wound under moderate tension, what suture pattern might be the most appropriate?
In what scenario are inverting suture patterns most valuable?
In what scenario are inverting suture patterns most valuable?
How does a Jackson-Pratt drain differ from a Penrose drain?
How does a Jackson-Pratt drain differ from a Penrose drain?
How do sweat bandages aid in wound management, especially before delayed primary closure?
How do sweat bandages aid in wound management, especially before delayed primary closure?
When performing mesh skin expansion with delayed primary closure, what is the rationale for making the initial incisions?
When performing mesh skin expansion with delayed primary closure, what is the rationale for making the initial incisions?
How does mesh skin expansion promote more effective wound drainage compared to a Penrose drain?
How does mesh skin expansion promote more effective wound drainage compared to a Penrose drain?
If a surgeon is considering a skin flap or skin graft when is plasmatic imbibition most important?
If a surgeon is considering a skin flap or skin graft when is plasmatic imbibition most important?
What is the significance of inosculation in skin grafts?
What is the significance of inosculation in skin grafts?
Fibrin exudation during the inflammatory phase leads to the formation of a fibrin seal, how quickly can it form?
Fibrin exudation during the inflammatory phase leads to the formation of a fibrin seal, how quickly can it form?
What factors might prevent a wound from sealing?
What factors might prevent a wound from sealing?
What is the recommended actions veterinarians should take for clinical decision making after a repair?
What is the recommended actions veterinarians should take for clinical decision making after a repair?
What is the likely result if a client fails to follow discharge instructions?
What is the likely result if a client fails to follow discharge instructions?
During what phase of second intention healing is it useful to use an antibacterial dressing?
During what phase of second intention healing is it useful to use an antibacterial dressing?
When you see a granulation tissue bed with the areas of wound with no granulation tissue, what does it mean?
When you see a granulation tissue bed with the areas of wound with no granulation tissue, what does it mean?
Wound care should be focused on correcting which of the following problems during the period of inflammation and debridement?
Wound care should be focused on correcting which of the following problems during the period of inflammation and debridement?
Once the wound has reached a smooth transition from wound bed to the surrounding skin, what is the wound ready to do?
Once the wound has reached a smooth transition from wound bed to the surrounding skin, what is the wound ready to do?
During which steps of contraction and epithelization is systemic antimicrobials not needed?
During which steps of contraction and epithelization is systemic antimicrobials not needed?
What is the issue with granulation tissue becoming raised above the skin margins (especially in horses)?
What is the issue with granulation tissue becoming raised above the skin margins (especially in horses)?
If an epithelial rim is not present during wound resufacing, which of the following is a likely cause?
If an epithelial rim is not present during wound resufacing, which of the following is a likely cause?
Why is it important to apply a sweat bandage?
Why is it important to apply a sweat bandage?
During the fibrosis state of wound healing, which of the following actions should NOT be done?
During the fibrosis state of wound healing, which of the following actions should NOT be done?
What is the primary distinction between primary closure and delayed primary closure in wound management?
What is the primary distinction between primary closure and delayed primary closure in wound management?
After determining that a wound is not initially suitable for primary closure, what is the MOST critical next step in the decision-making process?
After determining that a wound is not initially suitable for primary closure, what is the MOST critical next step in the decision-making process?
In the context of wound management, how do the rates of healing and cosmetic outcomes generally compare between primary closure and second-intention healing?
In the context of wound management, how do the rates of healing and cosmetic outcomes generally compare between primary closure and second-intention healing?
Which of the following best explains why aggressive treatment is recommended in the context of delayed primary closure?
Which of the following best explains why aggressive treatment is recommended in the context of delayed primary closure?
A veterinary surgeon is evaluating a laceration on a horse's limb and notes questionable tissue viability, edema and moderate skin tension. According to the guidelines, what is the MOST appropriate initial approach?
A veterinary surgeon is evaluating a laceration on a horse's limb and notes questionable tissue viability, edema and moderate skin tension. According to the guidelines, what is the MOST appropriate initial approach?
Why is it MOST important to clip hair sufficiently around a laceration before surgical preparation?
Why is it MOST important to clip hair sufficiently around a laceration before surgical preparation?
What is the BEST explanation for why the portion of skin most distant from its vascular attachment is MOST prone to necrosis after wound closure?
What is the BEST explanation for why the portion of skin most distant from its vascular attachment is MOST prone to necrosis after wound closure?
What specific aspect of Halsted's Principles is MOST directly addressed by meticulously irrigating a wound during sharp scalpel debridement?
What specific aspect of Halsted's Principles is MOST directly addressed by meticulously irrigating a wound during sharp scalpel debridement?
Which of the following suture characteristics is MOST crucial in tissues where inflammation is a primary concern?
Which of the following suture characteristics is MOST crucial in tissues where inflammation is a primary concern?
What is the MOST likely rationale for choosing monofilament sutures over multifilament sutures in a contaminated wound?
What is the MOST likely rationale for choosing monofilament sutures over multifilament sutures in a contaminated wound?
When considering suture selection in a wound under moderate tension, what suture property would be MOST important for preventing dehiscence?
When considering suture selection in a wound under moderate tension, what suture property would be MOST important for preventing dehiscence?
In what scenario would the use of inverting suture patterns be MOST beneficial?
In what scenario would the use of inverting suture patterns be MOST beneficial?
What is the PRIMARY characteristic differentiating a Jackson-Pratt drain from a Penrose drain, impacting its effectiveness in specific wound scenarios?
What is the PRIMARY characteristic differentiating a Jackson-Pratt drain from a Penrose drain, impacting its effectiveness in specific wound scenarios?
What is the BEST explanation for why sweat bandages are used to manage wounds intended for delayed primary closure?
What is the BEST explanation for why sweat bandages are used to manage wounds intended for delayed primary closure?
What is the MOST important reason for creating staggered rows when performing mesh skin expansion with delayed primary closure?
What is the MOST important reason for creating staggered rows when performing mesh skin expansion with delayed primary closure?
Why does using mesh skin expansion promote more effective wound drainage compared to using a Penrose drain?
Why does using mesh skin expansion promote more effective wound drainage compared to using a Penrose drain?
Why is plasmatic imbibition MOST critical during the initial 24-48 hours after skin flap or graft placement?
Why is plasmatic imbibition MOST critical during the initial 24-48 hours after skin flap or graft placement?
Why is the process of 'inosculation' crucial for skin flap or graft survival?
Why is the process of 'inosculation' crucial for skin flap or graft survival?
What is the PRIMARY reason to avoid hydrotherapy on fresh wounds during the initial inflammatory and debridement phase?
What is the PRIMARY reason to avoid hydrotherapy on fresh wounds during the initial inflammatory and debridement phase?
A veterinarian observes areas of a wound with no granulation tissue present. What does that finding MOST likely suggest?
A veterinarian observes areas of a wound with no granulation tissue present. What does that finding MOST likely suggest?
Why is it MOST important to prevent granulation tissue from becoming raised above the skin margins during wound healing, especially in horses?
Why is it MOST important to prevent granulation tissue from becoming raised above the skin margins during wound healing, especially in horses?
You cannot see an epithelial rim during wound resurfacing. Which of the following is the MOST likely cause?
You cannot see an epithelial rim during wound resurfacing. Which of the following is the MOST likely cause?
According to Halsted's Principles of Surgery applied to primary closure, why is gentle tissue handling considered so critical?
According to Halsted's Principles of Surgery applied to primary closure, why is gentle tissue handling considered so critical?
What is the MAIN purpose of 'obliteration of dead space' during wound closure, in accordance with Halsted's principles?
What is the MAIN purpose of 'obliteration of dead space' during wound closure, in accordance with Halsted's principles?
What is the MOST likely reason for a surgeon to change instruments and gloves during the primary closure of a wound?
What is the MOST likely reason for a surgeon to change instruments and gloves during the primary closure of a wound?
Consider the phases of complete wound healing. Place the phases in the correct order.
Consider the phases of complete wound healing. Place the phases in the correct order.
What type of suture is Cat Gut categorized as?
What type of suture is Cat Gut categorized as?
What type of suture is PDS categorized as?
What type of suture is PDS categorized as?
What type of suture is Prolene/Surgipro categorized as?
What type of suture is Prolene/Surgipro categorized as?
What type of suture is Braunamid/Supramid categorized as?
What type of suture is Braunamid/Supramid categorized as?
Which suture size has a metric size classification of 3.5?
Which suture size has a metric size classification of 3.5?
You are presented with a tension wound in need of closure. Select the MOST appropriate choice of suture.
You are presented with a tension wound in need of closure. Select the MOST appropriate choice of suture.
Match each suture pattern name to the correct 'Appositional, Evert, or Invert' ending: Cushing, Horizontal Mattress, Simple Interrupted.
Match each suture pattern name to the correct 'Appositional, Evert, or Invert' ending: Cushing, Horizontal Mattress, Simple Interrupted.
What is the timeframe that Fibrin exudation during the inflammatory phase results in a fibrin seal in?
What is the timeframe that Fibrin exudation during the inflammatory phase results in a fibrin seal in?
Which of the following are reasons that there is no seal?
Which of the following are reasons that there is no seal?
Which wound is probably NOT going to help by first intention?
Which wound is probably NOT going to help by first intention?
How do you treat a wound that is fully granulated an is ready to epithelize?
How do you treat a wound that is fully granulated an is ready to epithelize?
Wound strength increases then decreases immediately after closure. How many days is the wound at its worst strength?
Wound strength increases then decreases immediately after closure. How many days is the wound at its worst strength?
What physiological process accounts for the accelerated retraction of skin edges observed during delayed primary closure?
What physiological process accounts for the accelerated retraction of skin edges observed during delayed primary closure?
A surgeon is performing primary closure on a wound and unexpectedly encounters significant contamination after initial assessment. What is the MOST appropriate course of action?
A surgeon is performing primary closure on a wound and unexpectedly encounters significant contamination after initial assessment. What is the MOST appropriate course of action?
Which method is LEAST effective when treating an open wound that is ready to epithelize?
Which method is LEAST effective when treating an open wound that is ready to epithelize?
What consideration regarding suture material is MOST critical when closing a wound in a horse's lower limb that is predisposed to exuberant granulation tissue?
What consideration regarding suture material is MOST critical when closing a wound in a horse's lower limb that is predisposed to exuberant granulation tissue?
A horse sustains a full-thickness skin laceration on its distal limb. After initial assessment, the wound edges are moderately contaminated, and there is moderate edema. Which of the following represents the MOST strategic wound management approach?
A horse sustains a full-thickness skin laceration on its distal limb. After initial assessment, the wound edges are moderately contaminated, and there is moderate edema. Which of the following represents the MOST strategic wound management approach?
In a contaminated traumatic wound undergoing delayed primary closure, which of the following strategies is MOST effective for addressing bacterial burden before surgical closure?
In a contaminated traumatic wound undergoing delayed primary closure, which of the following strategies is MOST effective for addressing bacterial burden before surgical closure?
Following thorough debridement and lavage in preparation for delayed primary closure, what clinical sign would MOST strongly indicate that the wound environment is conducive to surgical closure?
Following thorough debridement and lavage in preparation for delayed primary closure, what clinical sign would MOST strongly indicate that the wound environment is conducive to surgical closure?
When performing mesh skin expansion of a wound on the lower limb of a horse in preparation for delayed primary closure, what is the MOST critical consideration for incision placement?
When performing mesh skin expansion of a wound on the lower limb of a horse in preparation for delayed primary closure, what is the MOST critical consideration for incision placement?
In managing a large skin defect on a horse's trunk via second-intention healing, which factor presents the GREATEST challenge to efficient wound closure?
In managing a large skin defect on a horse's trunk via second-intention healing, which factor presents the GREATEST challenge to efficient wound closure?
When presented with a heavily contaminated wound exceeding 'the golden period,' what is the MOST appropriate initial therapeutic strategy?
When presented with a heavily contaminated wound exceeding 'the golden period,' what is the MOST appropriate initial therapeutic strategy?
What is the expected effect if a wound is closed while there is both infection and avascularity?
What is the expected effect if a wound is closed while there is both infection and avascularity?
What is the purpose of making stab incisions in a wound post repair?
What is the purpose of making stab incisions in a wound post repair?
When would you want to implement the statement 'Do not put anything on this wound without contacting me first'?
When would you want to implement the statement 'Do not put anything on this wound without contacting me first'?
If granulation tissue is exuberant, which of the following is true?
If granulation tissue is exuberant, which of the following is true?
During the fibrosis stage of wound healing, which of the following techniques is NOT recommended?
During the fibrosis stage of wound healing, which of the following techniques is NOT recommended?
What is the maximum amount that contraction occurs in a wound per day?
What is the maximum amount that contraction occurs in a wound per day?
How can owners help veterinarians by providing photos?
How can owners help veterinarians by providing photos?
Why should a wound NOT be allowed to have granulation tissue become raised above the skin margin?
Why should a wound NOT be allowed to have granulation tissue become raised above the skin margin?
During the Contraction and Epithelization Steps of Wound Repair, what question should you ask yourself it you cannot see an epithelial rim?
During the Contraction and Epithelization Steps of Wound Repair, what question should you ask yourself it you cannot see an epithelial rim?
What happens to the wound immediately after closure?
What happens to the wound immediately after closure?
Flashcards
What is Primary closure?
What is Primary closure?
Immediate suture closure without any tension on the wound.
What is delayed primary closure?
What is delayed primary closure?
Done 2-5 days post-injury, includes tissue debridement and lavage also.
What is second intention healing?
What is second intention healing?
Wound heals by granulation, contraction, and epithelialization.
What is secondary closure?
What is secondary closure?
Signup and view all the flashcards
What occurs in the body due to elastin fibers in skin?
What occurs in the body due to elastin fibers in skin?
Signup and view all the flashcards
What is the result of collagenase?
What is the result of collagenase?
Signup and view all the flashcards
What is the 'Golden Period'?
What is the 'Golden Period'?
Signup and view all the flashcards
What are Halsted's Principles?
What are Halsted's Principles?
Signup and view all the flashcards
What tasks are vital for primary closure?
What tasks are vital for primary closure?
Signup and view all the flashcards
What are steps when preparing a wound?
What are steps when preparing a wound?
Signup and view all the flashcards
What are the main classifications of sutures?
What are the main classifications of sutures?
Signup and view all the flashcards
What is suture degradation behavior?
What is suture degradation behavior?
Signup and view all the flashcards
What is suture composition?
What is suture composition?
Signup and view all the flashcards
What is suture structure?
What is suture structure?
Signup and view all the flashcards
What are other characteristics of suture material?
What are other characteristics of suture material?
Signup and view all the flashcards
What are some absorbable sutures?
What are some absorbable sutures?
Signup and view all the flashcards
What are some non-absorbable sutures?
What are some non-absorbable sutures?
Signup and view all the flashcards
What are common needle point types?
What are common needle point types?
Signup and view all the flashcards
What are some key surgical knots?
What are some key surgical knots?
Signup and view all the flashcards
What are Appositional patterns?
What are Appositional patterns?
Signup and view all the flashcards
What sutures are eversion patterns?
What sutures are eversion patterns?
Signup and view all the flashcards
What are Inversion suture patterns?
What are Inversion suture patterns?
Signup and view all the flashcards
What are some tension suture patterns?
What are some tension suture patterns?
Signup and view all the flashcards
What is the purpose of Drains?
What is the purpose of Drains?
Signup and view all the flashcards
What are the key elements of a Penrose drain?
What are the key elements of a Penrose drain?
Signup and view all the flashcards
What is the main quality of a Jackson-Pratt drain?
What is the main quality of a Jackson-Pratt drain?
Signup and view all the flashcards
What is used to remove significant edema?
What is used to remove significant edema?
Signup and view all the flashcards
What are the steps of a mesh skin expansion?
What are the steps of a mesh skin expansion?
Signup and view all the flashcards
What are the benefits of mesh drainage?
What are the benefits of mesh drainage?
Signup and view all the flashcards
What decisions must be made regarding Skin viability?
What decisions must be made regarding Skin viability?
Signup and view all the flashcards
How does skin 'take'?
How does skin 'take'?
Signup and view all the flashcards
What allows optimal healing for skin?
What allows optimal healing for skin?
Signup and view all the flashcards
What occurs in the short term with proper skin closure?
What occurs in the short term with proper skin closure?
Signup and view all the flashcards
What causes no seal to occur?
What causes no seal to occur?
Signup and view all the flashcards
What is the list of steps to evaluate wounds closely post repair?
What is the list of steps to evaluate wounds closely post repair?
Signup and view all the flashcards
What decisions must be made regarding slowly gaining strength?
What decisions must be made regarding slowly gaining strength?
Signup and view all the flashcards
What actions must be taken with Prolonged support with tendon injuries?
What actions must be taken with Prolonged support with tendon injuries?
Signup and view all the flashcards
Study Notes
Wound Closure Types
- Primary closure happens with clean or clean-contaminated wounds converted to clean wounds.
- It is recommended to have immediate closure without tension.
- Delayed primary closure happens with clean-contaminated or contaminated wounds with questionable tissue viability, edema, and skin tension.
- It is recommended to perform it 2-5 days after injury, with tissue debridement and wound lavage before closure.
- Secondary closure happens with contaminated or infected wound.
- It is recommended to perform it at least 5 days after injury, and granulation tissue and epithelialized skin edges excised at the time of closure.
- Second-intention healing happens when wound tissue is unsuitable for closure, there is a large skin defect and or extensive tissue devitalization.
- It is recommended healing by granulation tissue, wound contracture, and epithelialization.
Wound Closure Decision Tree
- The first step is determining if a wound is suitable for closure.
- If yes, perform primary closure.
- If no, the next step is determining if the wound can be made suitable for closure.
- If yes, perform delayed primary closure.
- If no, perform secondary intention healing.
Primary Closure
- Primary closure can be difficult, expensive, and time consuming.
- Primary closure is not 100% successful.
- Primary closure is faster, cheaper, and more cosmetic.
Delayed Primary Healing
- When a wound is not suitable for closure initially, the goal is to transform it into one suitable for closure.
- Close the wound when the environment is suitable.
- The treatment involves topical and systemic antimicrobials.
- Wound debridement may be necessary.
- Surgical scrubs and wet-to-dry dressings can be used.
- NSAIDs may need to be administered.
Tips for Delayed Primary Closure
- Skin edges retract quickly, because of elastin fibers in the skin.
- Skin loses strength to hold suture because of collagenase.
- Treat aggressively to accomplish closure as quickly as possible, preferably in less than 24 hours.
Second Intention Healing
- Second intention healing can be expensive and time-consuming.
- It may have poor cosmetic outcomes.
- An infinite number of ways can delay wound healing due to sub-optimal wound care.
- Sometimes, there is no alternative to second intention healing.
Golden Period
- The golden period is the time after wounding in which a wound may be closed.
- The golden period is considered to be 6 hours.
- Closure should be attempted even when it is certain that at least part of the repair will fail.
Principles for Primary Closure
- Halstead's Principles of Surgery should be followed.
- Gentle tissue handling.
- Accurate hemostasis.
- Preservation of blood supply.
- Strict asepsis.
- No tension on tissues.
- Careful approximation of tissues.
- Obliteration of dead space.
Small Details for Primary Closure
- Clip hair, perform a surgical scrub, and a sharp scalpel excision, lavage.
- Change instruments and gloves mid procedure, and drape.
Clipping
- Clip hair so that skin color changes are noticeable.
- Clip to the cut edge.
- Inadequate clipping leads to skin necrosis of the segment most distant from attachment.
Procedural Steps
- Clip, clean, lavage, and debride the wound.
- Perform closure and ensure there is appropriate drainage.
Suture Classification
- Sutures are classified by degradation behavior, composition, and structure.
- Degradation behavior is absorbable vs nonabsorbable.
- Composition is natural vs synthetic.
- Structure is monofilament vs multifilament.
Suture Size
- Suture sizes are classified using:
- US Pharmacopoeia.
- European Pharmacopoeia.
- Metric Size.
- Suture Diameter Range (MM).
Other Suture Characteristics
- Flexibility
- Elasticity
- Surface characteristics or coatings
- Capillarity
- Memory
- Tensile strength
- Knot hold capacity
- Relative knot security
- Loop security
Suture Types
- Vicryl
- Absorbable
- Synthetic
- Braided multifilament
- Contains polyglactin 910
- PDS
- Absorbable
- Synthetic
- Monofilament
- Contains polydioxanone
- Monocryl
- Absorbable
- Synthetic
- Monofilament
- Contains poliglecaprone
- Cat Gut
- Absorbable
- Natural
- Multifilament
- Contains bovine GI collagen
Suture Types Cont.
- Monosof/Ethilon
- Non-absorbable
- Synthetic
- Monofilament or multifilament
- Contains nylon
- Braunamid/Supramid
- Non-absorbable
- Synthetic polymerized caprolactam
- Multifilament
- Prolene/Surgipro
- Non-absorbable
- Synthetic polyolefin plastic
- Monofilament
- Sofsilk/Silkam
- Non-absorbable
- Natural
- Braided multifilament
- Contains raw silk
Needle Types
- Taperpoint
- Tapercut
- Regular cutting
- Reverse cutting
- Spatula point
- Blunt point
Knots
- Surgeon's knot
- Square knot
- Simple knot
- Granny knot
- Half-hitch knot
Suture Patterns
- Simple Interrupted--Appositional
- Simple Continuous--Appositional
- Interrupted Intradermal/subcuticular--Appositional
- Cruciate--Appositional
- Interrupted Vertical Mattress--Appositional, slightly everting, tension
- Interrupted Horizontal Mattress--Everting, tension
- Ford Interlocking--Appositional
- Cushing--Inverting
- Connell--Inverting
- Continuous Lembert--Inverting
- Purse String--Inverting
- Near-far-far-near--Appositional/tension
- Interrupted Horizontal Mattress with Stents--Tension
- Walking Sutures--Tension relieving
- Chinese Finger Trap
Drains
- Drains help facilitate drainage.
- Remove drains as quickly as possible.
- Infection rate increases as drainage decreases.
- Drains are typically left in place for 48-72 hours.
- Types of drains are:
- Penrose: passive/capillary action, made of latex or silicone.
- Jackson Pratt: active and requires more maintenance.
Managing Tension
- Tension-relieving strategies are used when wounds have edema, even when there is no skin missing.
- Sweat bandages can remove significant edema in a very short time.
- Tension-relieving suture patterns are used.
Mesh Skin Expansion
- Mesh skin expansion involves a 1 cm incision, with 1 cm between incisions and rows, and staggered rows.
- Sutures should be placed first.
- Mesh often provides more effective drainage than a penrose drain.
- Mesh allows multiple egress sites.
- Bandage is used to keep skin in contact with underlying tissue if possible.
Skin Flaps or Skin Grafts for Wound Closure
- Plasmatic imbibition- nutrition to skin graft comes from plasma, first 24-48 hours.
- Inosculation- vascular network established between ends of cut vessels, around 48 hours.
- Blood vessels will not grow across a fluid barrier made of serum or pus.
- Skin must remain in contact with the underlying tissue bed.
- Effective drainage is essential.
Wound Closure Considerations
- Fibrin exudation during the inflammatory phase will result in a fibrin seal in < 24 hours.
- Properly aligned skin edges can epithelize in 24 hours.
- When there is no seal think: poor technique, infection, or avascularity.
- Evaluate wounds closely post repair.
- Clinical decision-making does not end with the repair.
- Change bandages daily.
- Remove sutures as necessary to provide effective drainage.
- Make additional stab incisions to promote drainage.
- Debride necrotic skin as needed.
- Some wounds are unlikely to heal by first intention.
- Wounds gain strength slowly.
- Sustain tendinous support if damaged.
- Flexor tendons require support for 4-6 months.
- Some wounds are destined to dehisce.
- Document the condition of wounds for reference.
- Never assume clients won't undo the handiwork.
Post-Op Instructions
- Owners can not resist the urge to treat wounds topically.
- Post-op discharge instructions should include: "Do not put anything on this wound without contacting me first".
Second Intention Healing Facts
- There is no medication or device that will make wounds heal any faster than the horse can do on it's own.
- Optimal conditions should not be provided by one type of bandage or wound medication.
- Medications that are beneficial in one phase may be detrimental in others.
- The therapeutic goal is to provide optimum conditions for each phase of wound healing.
- Medications such as Phenylbutazone is helpful to decrease inflammation. Maximum dose 2 mg/lb daily.
Fibrosis Days 5-14
- Wound repair begins on day 5 when fibroblast appear in the wound.
- Fibroblasts produce collagen, which is the main structural protein of granulation tissue.
- It takes at least 7 days before a granulating tissue bed is evident to the unaided eye.
- Granulation tissue should be removed immediately by sharp scalpel incision.
- Avoid using wound products containing copper sulfate.
- Every day that the granulation tissue is exuberant, there is no wound contraction or epithelization and time to healing is prolonged.
Contraction and Epithelization
- Once the wound is fully granulated with a smooth transition from wound bed to the surrounding skin, the wound is ready to be resurfaced by contraction and epithelization.
- Salient features of contraction include:
- Contraction occurs by the sliding of full-thickness skin with hair.
- The amount of contraction is determined by the amount of available skin.
- Contraction occurs at a maximum of 0.6 mm / day.
- Contraction is stopped if there is exuberant granulation tissue
- Contraction is limited by the amount of available skin
Second Intention Healing-Wound Care During Contraction and Epithelization
• Granulation tissue can not be allowed to be raised above the skin margin. • The wound bed can also dehydrate • Bandages promote exuberant granulation tissue requiring more frequent surgical debridement; in that case leave wounds uncovered -If there is no epithelium, you can treat is with is improper bandaging, inappropriate wound medications, exuberant granulation tissue. • If a bandage is used, it must be non -adherent change daily.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
