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Cattle make ________ granulation tissue than horses.
less [cows don't get proud flesh, like horses do]
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What are the steps in wound management? (4)
- control hemorrhage, if present
- remove contamination/ foreign material
- surgical repair when appropriate
- external coaptation to prevent further injury
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How can you assess the amount of blood loss?
HR and MM color
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What is the "golden period"?
time period when debridement will allow primary closure to proceed; severe tissue trauma or massive contamination will negate golden period
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What is a major concern with anesthesia and head wounds/ head trauma?
neurogenic pulmonary edema
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NEVER close a _________ type of wound.
puncture
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What is a concern when there is bone showing through a wound?
development of a sequestrum [curette cortical surface of denuded bone]
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How can you handle puncture wounds? (4)
- probe in the wound and take a radiograph- assess extent of wound
- inject/ pressurize synovial cavity suspected of involvment
- NEVER suture
- be aggressive with antibiotics
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What are the concerns with deep lacerations? (2)
- contamination not easy to assess
- involvement of vital structures, which may be difficult to assess
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What is a major concern/ sequela of degloving injuries?
- proud flesh
- total degloving has very very poor prognosis
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The presence of foreign material reduces the ____________ necessary for __________.
bacterial numbers; infection to occur
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What is a challenge of wound debridement in large animals?
don't have a layer of fascia we can completely remove; usually cannot surgically debride/ resect all contaminated tissue (use a drain!)
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____________ areas are more resistant to infection than other body areas.
Head and urogenital region
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Wound infection is most common in _________ and __________; it is rare in __________.
puncture wounds; sutured wounds; lacerations left unsustured
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Damage to _________ is not a big deal in horses! Do not suture.
extensor tendons
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What type of antibiotics should you give when dealing with a wound?
- broad spectrum injectable (procaine penicillin IM, gentocin IV)
- not oral because they don't reach tissue levels by the time of closure
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If you pressurize a synovial cavity and it IS involved in a wound, you should... (3)
- lavage joint or tendon sheath with at least 1L of sterile isotonic fluid
- inject aminoglycoside into synovial cavity
- aggressive antibiotics (regional limb perfusion?)
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What are concerns with closure versus no closure of a wound?
- greatly increased chance of sepsis if you close a contaminated woundÂ
- don't close very small wounds or very deep wounds
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What is the maximum amount of time you should leave a penrose drain in?
72 hours if you get this question on boards (but realistically, 3-5 days)
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What are challenges of approximation of wound edges in equine patients? (3)
- tension is always a concern (except head wounds)
- undermine skin aggressively
- release incisions/ meshing skin (watch blood supply,place more aggressively on parent skin than on flap with questionable blood supply, decreases tension and acts as drainage to decrease seroma/ infection)
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How should you suture wounds when it is appropriate to do so?
- vertical mattress tension sutures
- don't over evert skin edges, don't make sutures too tight
- may use tie-over stentor quill sutures
- usually just closing skin, especially on distal limbs
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What type of suture should you use to close skin?
- polypropylene best, can use nylon
- BUT use absorbable if location that will be difficult to remove suture
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When and why is external coaptation necessary? (4)
- tension relief
- decreased movement to prevent proud flesh
- stability for extensor tendon lacerations
- minimizes excessive swelling
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What are advantages of bandages? (3)
- provide pressure to decrease swelling, control hemorrhage, support closure
- wick exudate away from wound
- keep wounds clean
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If you are placing a bandage cast, it is important to...
incorporate the foot in the fiberglass cast OR "tape the bejeezus out of the foot"
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With heel bulb laceration, ALWAYS check for...
DIP joint involvement!
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How do you handle proud flesh in distal limb lacerations and second intention healing?
frequent surgical removal of proud flesh, pressure wraps, and steroid ointment (Panalog)
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