WOUND MANAGEMENT Estelle E Felarise, DVM Greene, Lewis and Associates www.greenelewis.com
Transcript
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WOUND MANAGEMENT Estelle E Felarise, DVM Greene, Lewis and
Associates www.greenelewis.com
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The Skin Is the largest organ of the body Its main functions
are to protect against the environment, bacterial invasion and to
aid in thermal regulation and prevention of water loss. One of the
most common emergencies we see in equine practice today involves
the skin.
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Wound Management: Goal To restore function and to optimize the
cosmetic appearance as expediently as possible.
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How do wounds heal? All cutaneous or skin wounds heal by two
independent processes: contraction and epithelialization.
Epithelialization is the process of skin cells proliferating and
migrating to cover the surface of cutaneous defect. Wounds heal by
producing a bed of granulation tissue and contracting from the
edges eventually covering the surface of the wound. In order for
this to occur a good blood supply and an adequate inflammatory
response are necessary.
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Wound Healing: Wounds on the trunk of the body heal differently
than the wounds on the lower limbs. Clinical observation suggest
that the rate of wound healing on the equine limb is approximately
half that of body wounds.
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Granulation tissue: Is produced in 3-4 days after the wound has
occurred. Is pink to red in color, firm, has a roughened appearance
and is found within an open wound. Is necessary for wound healing
until it becomes excessive or proud meaning that it starts to
protrude above the level of the wound edges.
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Granulation tissue cont. When the granulation tissue protrudes,
the wound edges cannot contract and therefore the healing process
is stalled. Bandaging and confinement can help decrease or prevent
excessive granulation tissue formation. The least amount of
movement a wound undergoes the faster it will heal.
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Proud Flesh or Excessive Granulation Tissue The reason for this
excessive proliferation is unknown. When compared with other
species the equine species is the only one that produces proud
flesh.
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Promotion of Granulation Tissue: The use of hydrotherapy daily
helps promote the growth of granulation tissue on wounds above the
hocks and knees Other products such as Granulex or Nitrofurasin
also help to promote the growth of granulation tissue.
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First Aid for Traumatic Wounds Preventing further injury Stop
or decrease blood loss Minimizing contamination
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Initial assessment by the owner: Call the veterinarian How long
ago did the wound occur? Location? How deep is the wound? Is there
flesh hanging? Is the horse bleeding? If so how much? Is the horse
lame? When was the last tetanus booster?
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Veterinary Initial Assessment Is the horse in pain? What is the
location of the wound? Can the wound be sutured or not and does it
need debridement? Can the wound be bandaged or left open?
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What comes next? Restraint and provide analgesia to the horse
The veterinarian will decide whether or not to: Block the area
around the wound and suture it closed Put the horse under general
anesthesia to suture the wound closed depending on horses attitude
and wound location If there is nothing to suture then he will clean
and debride the wound.
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To suture or not to suture: How long ago did the injury occur?
Location of the wound Is there enough skin to suture the wound
closed with minimal resistance? Is the skin salvageable?
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If sutured: The golden period for wound closure is 6- 8 hours.
If its within this time period and there are decent skin flaps that
have good blood supply the veterinarian may elect to suture the
wound closed.
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Before suturing: The wound is clipped and disinfected. Then the
area is block with local anesthetic. If any debridement needs to be
done it is done now. Debridement is the removal of dead and
devitalized tissue and reduces the level of bacteria in the
wound.
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Bandaging: Wounds that are sutured are usually bandaged if
possible. Bandages are usually changed every 5-10 days. The bandage
should be kept dry
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What to do with the horse? The horse should be kept confined
with the least amount of movement possible. Any amount of movement
can put unwarranted stress on the laceration and increase the
incidence of dehiscence. The horse should be put on antibiotics for
5-7 days with or without anti-inflammatories. The sutures are
removed in 10-14 days.
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The wound fell apart: If a wound is under tremendous tension or
damaged tissue is sutured together there is a good chance it will
fall apart or dehiss which usually occurs within 5-7 days after it
was sutured.
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Why suture if it will fall apart? Skin provides a good
biological bandage so even if the wound falls apart the skin has
acted as a band-aid for a few days and helped speed up the healing
process. Also if the incision falls apart usually the wound you are
left with is much smaller than the original wound. Suturing also
decreases the tendency of proud flesh to grow.
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Areas under tension: Carpus (knee) Shoulders Hocks Fetlocks
(ankles)
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If the wound is not suturable: Then the veterinarian will
sedate the horse and proceeded to Disinfect and debride the area If
it is on the lower limbs then the wound may be bandaged The bandage
should be changed every 5-10 days depending on the wound
healing.
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If the wound is left open If the wound is left open there are
number of different ointments that can be used. Picking the right
one will be up to your veterinarian and the type of wound you are
dealing with. Nitrofuracin ointment Triple antibiotic ointment
Nolvasan ointment Silver Sulfadiazine Corticosteroids
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Location of wounds: Head: Wounds on the head tend to heal very
well due to the increased blood supply. Lower limbs: We try to
close these by suturing first and then bandaging. If they dehiss
(fall apart) we then treat them as an open wound and control the
granulation tissue to aid in healing.
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Location of wounds: Trunk: These wounds tend to heal very well
But they heal more times than not by secondary intention, which
means they heal by laying down a bed granulation tissue allowing
the wound edges to contract as opposed to primary closure (suturing
the wound closed) Sutures do not hold well on some areas of the
trunk of the body because they are under constant movement.
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Complications of wounds Sequestrum is a dead piece of bone that
was damaged during the laceration or impact. It can take weeks to
identify a sequestrum on radiographs. Deep head wounds do have an
increased likely hood of forming a sequestrum due to the fact that
there is not much muscle to protect the bone. The area over the
cannon bone is also prone to sequestrums due to the lack of muscle
under the skin.
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Sequestrum
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Topical vs Systemic Antibiotics: Topical antibiotics do not
penetrate tissues well, they do however help decrease the number of
surface bacteria. Topical antibiotics can be used to supplement
systemic antibiotics (oral, IV or IM) in the treatment of heavily
contaminated wounds.
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To give or not to give? Should I give Bute or Banamine? At
therapeutic doses NSAIDs appear to have no harmful effects on wound
healing This is usually up to the veterinarian Making this decision
depends on a variety of factors: Where the laceration is located
How important is keeping the horse quiet in relation to wound
healing. Whether or not synovial structures (joints, tendons, etc)
are involved. How painful is the horse?
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Seadragon 3 year old Thoroughbred gelding Leg caught on
electric fence wire May 2007
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Seadragon.. May 11, 2007
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Seadragon. May 31, 2007
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Seadragon. September 25, 2007
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Seadragon. July 6, 2008
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Seadragon September 19, 2008
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Albi 18 month old Warmblood cross gelding Leg caught on
electric fence wire January 2008
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Albi. Jan 2008
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Albi April 2008
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Albi.October 2008
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Mini-me Yearling quarter horse filly Both hinds legs caught in
a hay rack April 2008
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Mini-me. April 15, 2008
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Mini-me. May 20, 2008
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Mini-me. July 1, 2006
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Mini-me August 19, 2008
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Mini-me.November 2008
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Marlo Weanling Thoroughbred mare Injured her leg on her stall
door. December 9, 2008
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Marlo .. December 9, 2008
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Marlo. December 31, 2008
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Marlo. January 14, 2009
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Ruby Aged quarter horse mare Injured her leg after running
through a wooden fence February 2006
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Ruby. February 18, 2006
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Ruby. February 22, 2006
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Ruby. March 06, 2006
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Ruby. March28, 2006
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Zack. January 1, 2009 12 year old Quarter Horse mare Cut head
on barn roof January 2009