Wound Management

Front 1

method of wounding

Back 1

abrasion, avulsion, incision, laceration, puncture, crush
need to know cause diff wound have diff healing process.

Front 2

type of wound

Back 2

open and closed
open= skin open
close- skin close

Front 3

Duration of wound

Back 3

6-8 hr golden period for wound care, ideal to clean and close wound

DEGREE OF CONTAM best way to evaluate closure

Front 4

Primary wound closure

Back 4

clean or clean contam wound
wound closure soon after infliction in golden period (6-8hr)
closure under good condition
minimal contam
through debridement and lavage

Front 5

premature closure consequence

Back 5

wound dehiscence
rather clean initally and close after

Front 6

Clean wound closure

Back 6

primary closure

Front 7

clean- contam wound

Back 7

primary (careful not to spill GI content)

Front 8

contam wound (6-8 hr)

Back 8

primary closure over drain
delayed primary closure

Front 9

infected wound (old wound infected)

Back 9

skin, muscle and superfical wound- open wound for drainage and debridement, management then delayed primary closure or healed by 2nd intension)

Front 10

Open wound management

Back 10

allow repeated debridement and optimal drainage
more time consuming and costly due to ongoing bandaging
may require follow up surgery if contraction problems develop (close too tight affect physiologically)
large contam or infected wound with extensive tissue damage
have to bandage open wound cause hospital bug

Front 11

Clipping

Back 11

if sedate to manage wound, fill wound with KY jelly, prevent wound from foreign material and help decrease re-contam esp if managed open
CLIP WIDE, wounds get bigger before smaller

Front 12

aseptic skin prep

Back 12

pocidine iodine
chlorhexidine
AVOID ANTISEPTIC IN WOUND CAUSE INHIBIT HEALING cause destroy membrane
use solution DIFFERNT from scrubbing soution, LESS BUBBLY EFFECT, NEED DILUTE

Front 13

Wound lavage

Back 13

removes debris from wound (flush dead stuff out of wound)
dilute bacteria load
assist in debridement

Front 14

Principle of lavage

Back 14

1 liter per small wound, moderate pressure
ISOTONIC SOLUTION
can add antibiotic or DILUTE antiseptic and STILL can damage tissue

Front 15

most often use isotonic solution to lavage

Back 15

LRS, least cytotoxic and isotonic but NOT antimicrobial(disadvantage), expensive to use than tab water, use tab water when there is nothing better,

Front 16

Hydrogen peroxide

Back 16

DO NOT WORK WELL
converts to H2O and Oxygen by tissue catalases, foaming action remove dirt and debris
DOESN"T KILL BACTERIA AS WELL
KILL SPORE on contam skin
INJURES CELL essential for healing

Front 17

Culture

Back 17

collect swab for bacterial culture and sensitivity of infected wounds

Front 18

Systemic antibiotics

Back 18

indicated
admin as soon as possible (after wounding before debridement)
multimodal antimicrobial (gram + and -) before culture and sensitivty come back
send home with 7 days at least to prevent antimicrobial resistant

Front 19

Debridement

Back 19

Surgical
enzymatic
biosurgical
mechanical
DO NOT DEBRIDE UNTIL SURE IT"S DEAD. is not sure, leave it

Front 20

Enzymatic debridement

Back 20

break down necrotic tissue
liquify using proteolytic enzyme liquified biofilm
DO NOT DAMAGE LIVING TISSUE
poor anesthetic risk

Front 21

Biosurgical debridement

Back 21

larvae eat necrotic tissue not healthy tissue
STERILE and bred for surgery
leave on for 48 hr
indicated: tissue very infected, necrotic, chronic

Front 22

Wet to dry bandage

Back 22

Primary layer: wet 4X4 placed on area to be debrided, follow by dry 4X4, a lot get stuck so when take off, mechanically rip off tissue stucked
secondary layer: absorbant padded material for comfort of animal, cotton paddling, enough to prevent strike thru, can incoporate splint
tertiary layer: roll gauze+ tape, vet wrap or other dressing holder

Front 23

Dry to sry debridement

Back 23

rip off LIVE tissue, not used often

Front 24

Goals of debridement

Back 24

remove devitalized tissue
remove Foreign debris
maintain hemostasis
abundant lavage with physiologic solution
drain dead space
minimize further tissue damage

Front 25

En Bloc debridement

Back 25

excision of the wound and surrounding tissue
infected wound w/o systemic infection
remove nonessential tissue
on trunk and porx limb, not distal limb, not enough skin

Front 26

Bandaging

Back 26

bandage wound for protection till further debridement
limit swelling and hemorrhage
prevent further trauma
prevent further contam
absorb exudate
prevent wound desiccation
aid in mechanical debridement of wound

Front 27

General principle of bandage

Back 27

sufficient padding- protect dog skin and deeper structure
apply evenly and snug
aviod traumatizing newly formed granulation tissue or epu
3 layers- primary, secondary, tertiary

Front 28

Primary layer (contact layer)

Back 28

direct contact with wound
medicated (frequently not)
occlusive: fluid does not pass thru or semi or non occlusive
may be adherant (gauge) or non adherant (telfa pads)

Front 29

Triple antibiotic:
Bacitracicn, neosporin, polymixin- B ointment

Back 29

Zn/ bacitracin enhance re-epi
broad spectrum antibacterial
poorly absorbed
ineffective against pseudmonas

Front 30

Topical antibiotics

Back 30

only effective if COMBINE WITH DEBRIDEMENT
ointment based occlude wound
powder based incite foreign body rxn
canno used debridement bandage

Front 31

Silver sulfadiazine

Back 31

1% water miscible cream
broad spectrum antibactieral
AGAINST PSEUDOMONAS so tx of choice in BURN PT (prone to pseudomonas)
enhance re-epi, penetrate eschar and necrotic tissue (goodcause we don't debride non necrotic tissue)

Front 32

Honey

Back 32

enhance debridement
redeuce edema and infalm
promote granulation and re- epi
increase colagen maturaiton
prevent bacterial growth (don't kill)
need medicinal honey
smell bad

Front 33

Sugar

Back 33

mix with exudate, act as hypertoni, not as anti- inflam as honey

Front 34

Adherent vs. non- adherent

Back 34

wet to dry- aid in debridement, remove healthy granulation tissue and prevent epi
dry to dry- rarely use

Front 35

non- adherance

Back 35

vasline impregnated- prevent epi
telpha
surgical wound or protect grnulation tissue or early epi

Front 36

Silver sulfadiazine

Back 36

1% water miscible cream
broad spectrum antibactieral
AGAINST PSEUDOMONAS so tx of choice in BURN PT (prone to pseudomonas)
enhance re-epi, penetrate eschar and necrotic tissue (goodcause we don't debride non necrotic tissue)

Front 37

Honey

Back 37

enhance debridement
redeuce edema and infalm
promote granulation and re- epi
increase colagen maturaiton
prevent bacterial growth (don't kill)
need medicinal honey
smell bad

Front 38

Sugar

Back 38

mix with exudate, act as hypertoni, not as anti- inflam as honey

Front 39

Adherent vs. non- adherent

Back 39

wet to dry- aid in debridement, remove healthy granulation tissue and prevent epi
dry to dry- rarely use

Front 40

non- adherance

Back 40

vasline impregnated- prevent epi
telpha
surgical wound or protect grnulation tissue or early epi

Front 41

occlusive vs. non occlusive

Back 41

semi- occlusive- petroleum, vaseline
polyurethane foam
non- occlusive= telpha, release, wet to dry, dry to dry
occlusive- medicianl ointment, robert jones bandage

Front 42

intermediate layer

Back 42

cast padding or roll cotton
absord tissue exudate
pads the wound to prevent additional trauma
supports limb

Front 43

Tertiary or outer layer

Back 43

holds primary (telfa) and secondary (rolled cotton) layer in place
provide pressure to decrease swelling and immobilize area
gauze and vet wrap, can be too tight so careful

Front 44

banadage application

Back 44

direction: toe to proximal so push excess fluid up leg rather than trap in toe
tertiary later, gauze ends a little before cotton so don't strangulate

Front 45

Bandage care

Back 45

gauze and vet wrap ca be too tight, monitor toe for swelling and animal excess discomfort
monitor VERY CLOSELY FOR DYSPENA if head or neck bandage
keep clean and dry or decrease wound healing
monitor for soiling, displacment, or foul smell- need to be changed immediately

Front 46

Delayed primary closure

Back 46

wound closure 2-5 days after infliction
open wound management til tissue healthy
allow staged debridement
contam wound

Front 47

secondary closure (not secondary healing)

Back 47

close 5 or more days after injury
wound formed a healthy granulation bed
used when wound contracture may cause complication
complete closure may require drain

Front 48

indications for drain

Back 48

abscess or other fluid accumulation
tissue of questionable viability and cannot be excised
foreign materials in wound
massive contam inevitable
destroy dead space and prevent accumulation of blood, exudate, serum or air
huge open area, can't close it, use drain

Front 49

passive drain

Back 49

drain by gravity, pressure differential, overflow of capillary action
penrose drain, tubular drain, fenestration

Front 50

penrose drain

Back 50

soft, latex tubing not fenestrated, fluid move along tubing, cappilary action outside of drain to drain fluid so not fenestrated

Front 51

tubular drain

Back 51

noncollasping
rubber or plastic
may be fenestrated
passive if no suction attach to tube

Front 52

active drain

Back 52

vaccum applied to a rigid, fenestrated tubular drain with no external air vent
exudate collect in vacuum
keeps wound and dressing dry
decrease drainage time and eliminate need for irrigation

Front 53

drain placement

Back 53

at lowest location in wound cause need gravity
need to tack drain to skin at exit so drain don't get suck back
DO NOT EXIT DRAIN IN SUTURE LINE

Front 54

drain management

Back 54

keep drain cover with sterile, absorbant bandage to see character and amt of exudate
remove drain once drainage decrease: 3-6 days

Front 55

E- collar

Back 55

any tube stick out of dog, have e- collar