Large Ani. Sx- Integument 1

wilsbach's version from 2015-11-04 19:40

definitions + wound management

Question Answer
what is an abrasion?A wound which does not extend through the dermis
what is a laceration?Tearing without extreme loss of tissue (Classic example - barbed wire cut)
what is an incision?Results from a cut by a sharp instrument or scalpel
what is an avulsion?A tearing wound in which is a considerable loss of tissue
what is a contusion?No break in the skin but deeper damage (Classic example - kick with considerable muscle damage and no break in the skin)
what is a puncture wound?A wound that is produced by a sharp pointed instrument that produces a small external opening, causes internal damage and usually has a poor drainage (Classic example - nail in the foot)
how do you Control Hemorrhage?Pressure to Arteries, Pressure to Wound, Ligate, Reduce Clotting Time (not very effective)
in what situation is it more important to clean a wound?Minimal importance in old wounds, but important in fresh wounds.
how do you Prevent contamination of the depths of the wound during initial cleansing?Apply sterile K - Y jelly in wound, or pack with sterile dressing
when you Explore Depth of wound, you should esp. be looking out for what 3 things?Foreign Bodies, Fractures, Vital Structures
what are some things you should discuss with the owner when you are going to treat a wound?Complications, Treatment Desired, Management (Techniques, cost, risk, complications, success rate, time)
CQ: what looks better- Following successful repair of full thickness wounds, do pinch or skin grafts look better?skin grafts look better
CQ: should most upper body wounds be bandaged?no
CQ: Tetanus antitoxin and toxoid should NOT be given at the same time. (T/F)?F- they SHOULD be
CQ: (T/F) Lower leg wounds usually respond best if they are not bandagedF
If you see a horse with this posture, what do you suspect? head and neck extended ... early case of tetanus
are horses or cows more suseptible to tetanus?Horses are quite susceptible to tetanus - all horses with wounds should have their vaccination status evaluated and appropriate steps taken to maximize protection. (Sheep and goats are moderately susceptible, Cattle and swine are not nearly as susceptible)
how many units of tetanus antitoxin provides immediate protection?1500
how do you give Tetanus toxoid?two injections given one month apart is routine and provides very good immunity
how do you give tetanus anti-toxin?one injection of 1500 units
can you combine tetanus toxoid and anti-toxin? details?yes! Tetanus antitoxin and toxoid can be given at the same time to provide immediate as well as long-term immunity. The injections should be given in different muscles and be given with different syringes. Also, The combined use of antitoxin and toxoid is many times used when the vaccination history is unknown.
how are horse's protected/boostered against tetanus (since they are extra sensitive)?In horses it is routine to booster the immunity by giving a yearly toxoid injection. Tetanus toxoid is effective in all species but is he infrequently used in animals other than horses
which method do you use to PREVENT the tetanus?use of tetanus toxoid
CQ: (T/F) tetanus Is easily managed with the use of tetanus antitoxin, antibiotics and sedativesFalse-- this IS the suggested regimen but it is not very successful (so the easily part is false)
CQ: (T/F) tetanus Is best managed by the use of tetanus antitoxinno, management with the toxoid
when should you be cautious about using tetanus anttoxin?Caution must be used when giving tetanus antitoxin to older horses--> Serum hepatitis (Theiler's Disease) sometimes occurs secondary to tetanus antitoxin administration (low chance of happening but discuss with owner.) Some veterinarians give only tetanus toxoid to older horses (even those that have never had a previous injection of toxoid) hoping that immunity will develop rapidly sp to protect the animal (Recent research implicates a specific virus (Pegivirus) contaminant in tetanus antitoxin as a suspected cause of Theiler's disease.)

Open wound management + sx management of wounds

Question Answer
bandages are primarily used where? why use bandages?Legs primarily, purpose is to Keep Clean, Reduce Irritation, Reduce Motion. They often reduce healing time as well.
when are bandages esp. important to use?Exposed bone, vital Structures
(long notes) Parenteral antibiotics are often indicated in what situations? (2)(1) Indicated in severe flesh wounds for three or four days to control cellulitis (2) Indicated in wounds involving synovial structures until joint capsules and/or tendon sheaths are closed
(long notes) Most upper extremity and body wounds respond quite well to what kinda treatment?respond quite well if they are cleaned frequently and no topical medications are applied
( long notes) Ointments for use on lower legs....(3)(1) Furacin has been commonly used - delays epithelialization (2) Silvadene and neosporin are suggested (3) Medications to control excessive granulation tissue are many times necessary
Upper leg wounds and body wounds are difficult to bandage and bandages are of limited value unless...unless bones, nerves or vessels are exposed
what are some of the major benefits to sx closure of a wound?Surgical closure of wounds many times markedly reduces healing time. The total cost of wound management may be reduced by initial surgical closure even though the -initial- expense is much greater.
how old should a wound be to be considered for primary surgical closure? are there exceptions?the wound should be less than 10 hours old to be considered for primary surgical closure exceptions are wounds that involve the head or the perineum
how should degree of contamination affect your choice to provide 1* sx closure of wound?All of the foreign material must be removed prior to closure
how might location of wound determine if you want to do a 1* sx closure?Must be in an area where movement of the wound edges is minimal or can be minimized with bandages, splints or casts.
you must make sure there is enough remaining tissue for a 1* wound closure, otherwise you risk--too much tension, dehiscence
what are some secondary factors to consider for 1* sx wound closure?Prognosis for healing without surgery, Temperament of the animal, Wishes of the owner, Available facilities
explain Primary Closure TechniquePreoperative parenteral antibiotics, Thorough cleansing and debridement of the wound, Acceptable surgical techniques to close the wound, Consider the use of drains. Be sure to Minimize tension with stay sutures, splints, casts, bandages and or restricted motion
what would make you want to do delayed primary closure?Must have all the criteria for primary closure except that the wound may be heavily contaminated and a number of hours old
what is the technique for delayed primary closure?Initially the wound is thoroughly cleansed and debrided. The animal is given parenteral antibiotics. The wound is medicated and bandaged in a sterile manner for approximately 3 days. After three days the wound is carefully debrided and closed as in primary closure
WHY do you want to wait 3d for delayed 1* closure?bc if wait 3 days the acute inflammatory stage will be done then
when is facilitated wound contraction indicated? what is the aim of this technique?This technique is indicated if there is inadequate tissue to close the wound without excessive tension. Basic aim is to minimize the size of the area that must closed by epithelialization
what is the technique used for facilitated wound contraction?The wound is initially cleaned and debrided. Monofilament suture material and a tapered needle are used to place intradermal sutures in a continuous horizontal mattress pattern. The tension on the suture is increased each day to stretch the skin

Skin Grafting 1

Question Answer
what is the primary indication for skin grafting?primarily for lower leg wounds: To increase speed of wound epithelialization when---- (1) Defects cannot be closed by conventional suturing techniques (2) Wounds are in areas where healing by wound contraction is minimal
what are are autographs or autogenous grafts (synonymous terms)?In this technique tissue is moved from a donor site to a recipient site on the same animal
what are Allografts or homografts?grafts transferred between genetically different animals of the same species
what are Xenografts or heterografts?transferred between animals of different species
there can be full thickness grafts, or there can be split thickness- what are some kinds of split thickness grafts?thin, intermediate or thick
what is the pro of the thicker graft? pro of the thinner graft?Thinner the Graft –Better the Take. Thicker the Graft –Better Appearance (Generally the better the appearance the less likely the graft is to take (be successful) )
Cosmetic appearance - listed from best to worst full thickness, thick- partial thickness, thin- partial thickness. Then Pinch, punch, and tunnel
endency to take - listed worst to bestfull thickness, thick- partial thickness, thin- partial thickness. Then Pinch, punch, and tunnel
which grafts require there to be Healthy Granulation Tissue which is Not Infected? Which grafts can get away with some degree of infection present (granulation bed must still be healthy though)NO INFECTION: Mesh, Full Thickness, Split Thickness. INFECTION: Pinch, punch tunnel
prior to grafting, you need what to develop? How can you accomplish this promptly?Routine daily wound care is indicated to minimize the time it takes for the animal to produce healthy granulation tissue (prior to grafting)
what are two places that are good donor sites?The pectoral region, The ventral abdomen
which grafts need to be done under general anesthesia?Split thickness grafts, Mesh grafts, Tunnel and strip grafts - modifications of the split thickness graft, Full thickness grafts (NOT pinch or punch!!!)
explain the pinch graft techniqueThis involves harvesting a very small segment of skin (Suggest the use of iris forceps and a Bard Parker blade to harvest the graphs)- Remove as small a segment of skin as possible. At the recipient site make small pockets in the granulation tissue by inserting a number 15 Bard Parker blade very superficially and parallel to the surface of the granulation tissue bed. The donor skin is placed in the depths of the small pocket. The wound is bandaged with a non stick dressing. Consider leaving the bandage in place for up to seven days to avoid removing the grafts when the bandage is changed! Usually takes 2 to 3 weeks to determine if the grafts have taken
how long might it take to determine if a pinch graft has taken?2-3wk
what can you do to help avoid removing the pinch grafts along with the bandage when it is to be changed?Consider leaving the bandage in place for up to seven days
what is the normal donor site for punch grafts?The pectoral region is the normal donor site
technique for performing a punch biopsy?The pectoral region is the normal donor site. Donor skin can be removed as a full thickness segment of skin and then cut with a biopsy punch or it can be harvested directly with a biopsy punch--> With either method all the subcutaneous tissue is removed from the graft. A 6 mm biopsy punch is usually used to cut the donor grafts and a 4 mm punch to produce the recipient sites in granulation tissue. The recipient sites are routinely prepared first and sterile cotton swabs are placed in them to control hemorrhage. Following placement of the grafts a nonstick bandage is applied and if necessary splints or casts used to control motion
how do you make sure the donor punch biopsy segments will fit well/snugly into the recipient pinch biopsy holes?A 6 mm biopsy punch is usually used to cut the donor grafts and a 4 mm punch to produce the recipient sites in granulation tissue

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