Surgical Techniques and Wound Healing: Controlling Bleeding, Coagulation, and Dressings, Quizzes of Veterinary medicine

Download Surgical Techniques and Wound Healing: Controlling Bleeding, Coagulation, and Dressings and more Quizzes Veterinary medicine in PDF only on Docsity! TERM 1 What is primary hemorrhage? How is it prevented? DEFINITION 1 right after vessel disruptionPrevention: ligate vessel before transecting, gentle handling, dissect in avascular planes TERM 2 What is delayed hemorrhage? Why does it occur? DEFINITION 2 within 24 hrs of vessel disruptionDue to: hypotension, bleeding disorder, underlying dz TERM 3 When does secondary hemorrhage occur? Why? DEFINITION 3 >24 hrs later. Technical failure (slipped ligature, necrosis of vessel) TERM 4 When is the crushing/twisting of vessels indicated? DEFINITION 4 small vessel bleeding-->causes vasospasm and thromboplastin release-->thrombus formation**Tip down! Apply to END of vessel! TERM 5 What is the most secure method of controlling surgical bleeding? DEFINITION 5 Vessel ligation!Simple circumferentialDouble ligation (larger vessels): circumferential ligature + transfixation ligature distal to it (closer to cut edge)Miller's knot and modified-->lg arteries, pedicles, a lot of tissueVascular clips (not as secure as ligature!)LDS-->ligate, divide, staple instrument. NOT for lg vessels.Temporary occlusion: tourniquet, vascular clamp TERM 6 How does electrocoagulation work? DEFINITION 6 High frequency current produces heat in tissues due to the tissues impeding the current flow-->proteins are denatured and vessel lumen is sealed TERM 7 What is the most common method of energy application used to control bleeding? DEFINITION 7 monopolar electrosurgery (arteries up to 1 mm, veins 2 mm diam)current flows through patient to ground plateneed DRY fieldcan cause alternate pathway injury (thermal burns)NOT as secure as ligatures. TERM 8 What are the advantages of using bipolar electrosurgery over monopolar? DEFINITION 8 1. no ground plate and current doesn't go through patients-- >stays between tips of forceps2. can use in wet field3. greater precision-->less risk of injury to surrounding tissues4. No risk of alternate path injury TERM 9 What size vessel can an ultrasonically activated scalpel coagulate? DEFINITION 9 up to 5 mm. vibrating blade leads to friction-->heat disorganizes protein into coagulum-->coagulum seals vessel- lower temp TERM 10 What are CO2 lasers used for? DEFINITION 10 Incision, excision, tissue ablation. Good hemostasis.for vessels <0.6 mmno heat conduction-->leaves eschar/scab TERM 21 secondary closure DEFINITION 21 3rd intention healingwound closed >5 days post injurygranulation tissue may be present**used in severely infected wounds or in presence of massive tissue destruction TERM 22 How to treat puncture wound: DEFINITION 22 contamination-->deep exploration and delayed closure-- >give systemic AM TERM 23 Are abrasions very contaminated? DEFINITION 23 yes! heavily w deep penetration of debris/organisms. Clean and debride-->delayed closure (unless epidermis intact) TERM 24 avulsion treatment DEFINITION 24 vasc compromise and contaminated bites-->deep exploration-->delayed closure and systemic AM TERM 25 traumatic/physiologic degloving/shearing? DEFINITION 25 minimum contamination but still debride repeatedly.delayed or secondary closure*may need flap or graft*if traumatic: stabilize other injuries (like orthopedic) first TERM 26 does a wound need surgical repair if the epidermis is intact? DEFINITION 26 no TERM 27 venomous bite? DEFINITION 27 delayed closure or allow for 2nd intention healingmay need systemic AM TERM 28 How should burns be handled? DEFINITION 28 early and repeated debridement!reconstructive sx for deep burns (wound contraction may lead to complications)*secondary infxn is common! TERM 29 What does T.I.M.E. stand for in relation to wound bed prep? DEFINITION 29 tissueinflammation/infectionmoistureepithelial edge TERM 30 What should be used to lavage the wound after clipping and cleaning? What's the goal? DEFINITION 30 0.9% NaCl or tap water followed by sterile salineNO soap/detergent but can use chlorhex (bactericidal including pseudomonas)Goal: float away debris and loose tissue, dilute bacteria**ESP lavage w joint involvement TERM 31 If there are any severed tendons, ligaments, or major nerves in a wound, what time of closure should be planned for? DEFINITION 31 PRIMARY TERM 32 when is the optimal time for closing a wound? DEFINITION 32 good blood supplyno infxnenough skin for low tensionminimal risk under anesthclinically beneficial to closehigh likelihood of successful healing TERM 33 How are wounds classified based on contamination? DEFINITION 33 class 1- contaminated (<6 hrs old) little multiplication: GOLDEN per*just wash and debrideclass 2- colonized (6-12 hrs old). dividing but not invadingclass 3- infected: have invaded-->sepsis (>12 hrs old) TERM 34 The "T" DEFINITION 34 tissue (debridement)removing contaminated and devitalized tissue and foreign mtrl to make wound clean and "fresh"*Specific tissue rqumts:1. can aggressively excise damaged muscle2. be gentle w nerves: preserve and cleanse them3. fat-->liberally excise! good place for bacteria to grow4. fascia (avascular)- excise ragged edges (suscep to bact colonization)5. debride skin back to capillary oozing TERM 35 The "I" DEFINITION 35 Infection! CS=serous drainage + inflamm*all wounds are colonized but not all are infected*infection= more than 10^6 microbes/g tissuesteps:culturetopical and/or systemic Abtsearly closure TERM 46 what dressing for granulated bed that has begun to epithelialize and mature? DEFINITION 46 NON-ADHERENT dressing w triple abtpetroleum impreg- dressingOR hydrogels TERM 47 what kind of healing is open wound management again? DEFINITION 47 2nd intention! used for small, super contaminated, and linear wounds (on extremities)Disadv: scar, no protection, thin epith covering, prolonged healing, deformed contracture TERM 48 What's the anatomy of a bandage? (from deep to superficial) DEFINITION 48 contact layerabsorptivecompressiveadhesive TERM 49 When are adherent bandages indicated? What are the 3 types of adherent bandages? DEFINITION 49 in debridement stageex: alginate wound dressing (soft seaweed fibers)-->absorbs exudate-->forms gel covering-- >maintains moisture1. wet to dry: if necrotic tissue, foreign mtrl, viscous exudate-->will dilute and absorb it. Remove when dry. (use for 1st few days)2. dry to dry3. wet to wet TERM 50 When are non-adherent bandages indicated? What are some examples? DEFINITION 50 absorb but don't stick-->good for wounds w/o necrotic tissue or that have newly formed granulation tissue w a little exudate still.-healthy granulation tissue, serosanguineous drainage, if epith has begunExamples: adaptic, telfa, hydrogel (absorbs moisture in more wet environments), foam (if lg amt of exudate will prevent strike-through) TERM 51 when are occlusive bandages indicated? DEFINITION 51 NON-ABSORBENT. Indicated for clean NON-DRAINING PARTIAL thickness wounds.Keeps exogenous fluid and bacteria from reaching wound, but is permeable to O2.*transparent, thin, self-adhesive (films=polyurethane membranes)**maintains moist env and allows for max O2 conc-->enhanced epidermal regen***Contraindicated for chronic draining deep wounds TERM 52 What is NPWT? DEFINITION 52 neg pressure wound therapy=an advanced wound intervention. Combine suction device w/ primary dressing (foam or gauze)-- >use vacuum pump to collect exudate in sealed canister*indicated for lg open contaminated wound, skin avulsion, degloving, dehiscence, chronic wound, prevent preop seroma, bolster skin graft, compartment syndrome**granulation tissue appears earlier and is smoother***can cause bleeding, grow into foam pores, impair wound contraction if used too long. NOT for malignant tissue or osteomyelitis TERM 53 What is wound VAC therapy? DEFINITION 53 vacuum assisted closure- an adv wound treatment.removes fluid, improves circ, enhances granulation tissue formation, incr bacterial clearance, faster wound closure TERM 54 what is hyperbaric O2 therapy? DEFINITION 54 incr atm pressure drives O2 into wound bed (not the same as topical O2). speeds up healing.patient is entirely enclosed in pressurized chamberprotocol: 90 min/day x 20-60 days TERM 55 What are some tension relieving techniques? DEFINITION 55 (orient suture line parallel to tension lines)1. walking sutures- bites in wound surface (fascia of body wall) are made closer to center of wound than the bites in the dermis-->distributes tension2. stent sutures: vert mattress through tubing (esp for areas with a lot of movement)3. relaxing incision: if tissue doesn't move easily but has good blood supply, can make a parallel incision and leave it unsutured (like for roof of mouth)4. punctate relaxing incisions: made next to closed degloving injury TERM 56 When does a wound need a drain? DEFINITION 56 incompletely debridedmassively contaminatedquestionable viability of tissuedead space present TERM 57 3 types of drains DEFINITION 57 1. Passive/penrose: relies on gravity but assoc w 90% pos culture- don't exit thru incision or dorsally-anchor at bottom w suture passed through it2. Active/jackson pratt: fenestrated, has suction source, keep closed, only 20% pos culture, less painful. place w chinese finger trap*both need bandages; remove in 3-5 days (for lg wounds, septic abd)3. TLS wound evac: for <100 cc fluid. attach vacutainer TERM 58 The "E" DEFINITION 58 Epithelial edge: deciding if wound should be closed based on contamination, time of injury, tissue damage, location, patient's condition, etc. TERM 59 How should a fresh traumatic or surgical wound be closed? DEFINITION 59 primary closure (1st intention) TERM 60 How should a severely contaminated wound be closed? DEFINITION 60 delayed primary closure (1st intention at 3-5 days since injury but no granulation tissue yet)