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54 Cards in this Set
- Front
- Back
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wound contamination
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bacteria not replicating within the wound
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wound colonization
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replicating bacteria without trauma to animal. May be beneficial by reducing adherence of pathogenic bacteria to wound bed
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wound infection
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bacteria replicating and causing trauma to animal
10^5 bacteria/ gram of tissue |
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wound infection development is dependent on:
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1.dose of bacteria
2.virulence of the bacteria 3.host resistance 4.amount of necrotic tissue(debride necrotic tissue) |
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chronic wound infection
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fragile granulation tissue
weak collagen in diorganized patterns reduced wound contraction |
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What should be considered in any wound that fails to heal despite providing the best possible wound healing environment
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foreign body
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covert wound infection
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-loss of granulation tissue
-change in the character of granulation tissue -edematous -pale gray or deep maroon in color -tissue that is more friable |
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Foreign material in a wound reduces the volume of bacteria necessary for infection to what
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10^4/g tissue
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what concentration of chlorexidine is ok for cleaning wounds
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generally less than .05%. general rule is to use the lowest possible concentration to reduce celluar toxicity
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Hydrogen peroxide
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only use to remove necrotic tissue
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acetic acid (vinegar)
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-poss.action against pseudomonas sp. and other aerobic gram negative bac.
-rec. 15min/day soak or compress -may help with odor -should be stopped once infection is under control |
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Dakin's solution
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.5% bleach solution
-only use for chemical debridement of necrotic tissue |
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summary of cleaning agents
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antispetics are useful to clean the very surface of a wound or the area surrounding a wound
-becuase of celluar toxicity, they are probably not the best choice for wound cleaning and should not be used in clean wounds |
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topical antibiotics
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effective in reducing bacterail numbers in burn patients
-avoid commonly used systemic antibiotics -use for 2 weeks or less -use an approapriate anitbiotc culture/sensitivity |
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silver
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.5% silver nitrate
-burn patients -cream needs to removed and replaced daily -study:collagenase better than silver -study:silver in horses less garanulation tissue |
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nitrofurazone
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study showed that it sig. reduces healing rate
-not recommended |
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triple antibiotic
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synergistic action
-more recent studies have shown that a moist wound-healing environment may be as beneficial as triple antibiotic in reducing bacterial numbers and more beneficial in stimulating wound healing |
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constant clens
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wound cleanser
-non toxic -contains polysorbate 20 -non-irritating -isotonic and pH-balanced -risen off with saline |
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methods of debridement
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1.autolytic
2.enzymatic 3.mechanical 4.sharp |
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autolytic debridement
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breakdown of nectroic tissue by WBC
-achieved under occlusive dressing -won't work well in dirty wounds or dry wounds |
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enzymatic debridement
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topical application of proteolytic substances
-expensive -like amped up autolytic debridement |
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mechanical debridement
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physical force
-wet to dry dressing -wound irrigation -gauze manipulation |
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sharp debridment
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scalpel
laser |
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dead space
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it is important to minimize the dead space by suturing, using passive drains, or active drains
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moist wound healing
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occlusion provides constant thermal regulation
fine balance bt drying out and maceration of peri-wound tissue |
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wet gauze dressing
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tends to dry out
-amount of moisture retention dependent upon many factors: secondary dressing, amount of solution, type of gauze, freq. of dressing change, and must be moistend up to 6 times a day |
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hypertonic saline dressing-curasalt
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pre moistened
-designed for infected or heavily exudating wounds only -works by non selective debridement -must change dressing at least every 3 days to prevent dilution of saline |
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antimicrobial dressing:
kerlix, AMD |
polyhexamethylene biguanide (PHMB)(similar to chlorhexidine)
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PHMB dressing changes
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-surgical incisions every 5 days
-in necrotic wounds at least every 3 days to prevent dilution of the PHMB -premoisten in dry wounds/cover |
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Hydregel wound dressings (curafil)
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medical grade gel that is intended to promote moist wound healing
-composed of water, glycerin,polymer -use on dry to moist wounds with cavities -first and second-degree burns -cuts -abrasions -minor irriations of the skin |
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hydregel dressing changes
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up to 5 days
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calcium alginate dressing (curasorb)
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-soft, nonwoven fabric pads composed of sodium and calcium alginate, a derivative of seaweed
-interacts with sodium in wound -absorb up 20 times its weight in exudate -used for moderate to heavily draining wounds |
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calcium alginate dressing applications
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-wounds where granulation tissue needs to be stimulated
-dehisced surgical wound -abrasions -lacerations -skin tears -pressure ulcers -other external wounds with moderate to heavy exudate |
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calcium alginate dressing changes
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up to 5-7 days
-cover with plastic in dry wounds |
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topical dressing:collagen
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-final wound strenght determined by the character and quality of collagen
-hydropilic moist wound environment -powders, gels, and sponges |
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topical dressing:maltrodextrans
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--polysaccharide powders from plant starches
-inhibit growth of some bacteria -provide nutrition -granulation stage of wound healing |
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replacement tissue dressing
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-provide a framework over which other cells migrate
-stimulate to form the tissue that is desired -procine smeall intestinal sub-mucosa |
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acell extracellular matrix scaffold
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-porcine bladder
-provides structural and functional proteins -influence how cells attach, express their genes, and eventulally differentiate -studies:affect the type of cells recruited -not rejected by the host unlike other xenographic transplants, -tissue types invading: urinary tract, dura matter, esophagus, musculotendinous tissues, and blood vessels -possible antimicrobial activity |
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Equine amnion dressing
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-studies: reduces wound retraction and granulation tissue formation, and improves epithelializtion
-used in skin grafting as a non adherent dressing -drawback is the availability and the amount of time necessary for preparation |
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cytokines in wounds
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chemotactic effects, mitogenic effects, and activating effects, which simulate production of the extracellular matrix components
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platelet derived growth factor
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decreasing wound-healing times by acting as a chemotactic agent and mitogen for fibroblasts, smooth muscle cells and inflammatory cells
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transforming growth factor beta
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chemotactic agent for fibroblasts and macrophages, smooth muscle cells and osteoblasts
-inhibitory effect on endothelial cells, various epithelial cell types and lymphocytes |
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transforming growth factor alpha
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potent angiogensis factor
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growth factor summary
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growth factor soup vs purified growth factors
-present in wound exudate during moist wound healing -greatest benefit in the granulating and epithelialization stages of wound healing and will be used with other synthetic dressings |
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platelet rich plasma in wound healing
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commercail
autologous growth factors fibrin scaffold |
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hyperbaric oxygen TX
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wound healing: granulation tissue formation, epitheliaization, wound infection
-expense -availabilty -mixed reports |
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semi occulsive foam dressing hydrasorb
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semi occlusive
use on mildly exudative wounds -minimized exuberant granulation tissue |
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ventral midline surgical approach
layers |
skin
subcutaneous linea alba - holding layer peritoneum |
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paramedian surgical approach
layers |
skin
subcutanous external rectus sheath: holding layer -rectus abdominus muscle -internal rectus sheath -peritoneum -used in cattle for abomasum pexy |
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flank surgical approach
layers |
skin
-subcutaneous -external abdomimal olique fascia and muscle:holding layer -internal abdominal oblique muscle -transverse abdominus muscle -peritoneum -most common in food animals: r for exploration l for c section |
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ventral lateral surgical approach
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skin
-subcutaneous -external abdominal oblique fascia and muscle/ external rectus sheath: holding layer -internal abdominal oblique muscle/recuts abdominus muscle -transverse abdominus muscle/interna rectus sheath -peritoneum -good acess to uterus in cattle |
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paracostal surgical approach
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-skin
-subcutaneous -externalabdominal oblique fascia and muscle:holding layer -internalabdominal obique muscle transverse abdominus muscle -peritoneum |
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in body wall closure where should your largest sutures go
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holding layer
small in subcutaneous to close dead space big enough in skin to hold, small enough to be cosmetic |
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bowel healing stages
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initially edges are sealed by a serofibrinous coagulum
granulation tissue is laid down begining at 24-48 hours by 14 days replaced by fibrous tissue new vessels emerge by 72 hours, originating from the arterial plexi form all layers except the mucosa hypervasculation by 7 days vascular response diminishes after 14 days in the aligned layers |
