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University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Dr Amy Plummer Large.

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Presentation on theme: "University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Dr Amy Plummer Large."— Presentation transcript:

1 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Dr Amy Plummer Large Animal Emergency and Critical Care University of Tennessee College of Veterinary Medicine

2 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Overview Emergency lacerations Blood loss Joint involvement Penetrating wounds Care of lacerations

3 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Emergency Lacerations When to call your veterinarian –Blood loss –Laceration/wound over a joint What to do while you wait –Pressure bandage –Clean? –Keep horse quiet

4 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Emergency Lacerations Blood loss –Can cause death, although rare –Arterial blood loss blood usually pulsating –Quantitate blood loss Drops/sec Visualize pool of blood –More concern if bleeding does not stop with pressure

5 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Emergency Lacerations Common sites –Distal extremities –Neck lacerations

6 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood Loss Apply pressure –Manual with hand (cleanliness) –Pressure bandage Minimal padding and vet wrap –Do not remove first bandage, apply another bandage over the first –Minimize movement of the horse

7 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood Loss

8 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood loss Amount of blood –20% of blood volume (approximately 9-10 liters or 2 gallons) before life threatening –Clinical signs Respiratory distress High heart rate Weakness

9 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood Loss Visualize the bleeding vessel –Hold vessel off –Tie vessel if easily done

10 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood Loss Once the vet arrives –Ligate vessel –Sterile bandage –If significant bloodloss: Referral for IV fluids and/or blood transfusion

11 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Blood Loss Majority controlled by pressure and/or ligation Rare to need blood transfusion Keep wound as clean as possible Bandage best on leg wounds

12 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations with Joint Involvement VERY important to determine if joint is involved If laceration is NEAR a joint, consider it an emergency

13 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Anatomy

14 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Anatomy

15 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint Involvement Emergency veterinary care Keep horse quiet and in clean environment Clean? Bandage?

16 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint Involvement Veterinary Care –Determine structures involved –Radiographs? –Lavage of joint/tendon sheath –Antibiotics (IV, regional, intra- articular) –Phenylbutazone

17 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint Involvement Radiographs for foreign bodies

18 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint Involvement Determining if joint is affected

19 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint Involvement Prognosis –No joint affected –Joint contamination vs infection Multiple levels of care Monitor for lameness –Acute non-weight bearing lameness

20 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Joint/Tendon Sheath Involvement Antibiotics –Systemic –Intra-articular –Regional limb perfusion

21 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Observe horse carefully to find Look for matted hair, swelling Often result of wire, fences or gates but can be from tree limbs ect.

22 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds If object is in place, LEAVE in place, unless unable to do so Prevent hemorrhage/bleeding Help veterinarian know direction, depth of the penetration

23 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds LEAVE object in place

24 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Puncture wounds on limbs or upper body Tetanus status Monitor for swelling, gas production

25 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Can be more significant that what meets the eye

26 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Wounds to the sole of the foot

27 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Radiographs

28 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds After radiographs, veterinarian will remove object

29 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Wounds to sole Sole vs Frog

30 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Frog –Navicular bursa –Coffin Joint Treatment depends on structures involved

31 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Penetrating Wounds Wounds to sole and frog Dr Gray will present more this afternoon with Non- Weight Bearing Lameness

32 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Primary closure, Delayed primary closure –Sutures –Staples Seconday closure –Lavage and debridement first, then closure after granulation tissue Second intention healing –Unable to suture, allow to heal on its own

33 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Primary closure –Clean, fresh wound –Adequate skin –No synovial structure involvement Before closing –Lavage –Debride area

34 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Debridement –Remove layer of compromised tissue, decrease bacteria

35 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Lavage of area –Wash away contamination and decrease bacteria –Solution?

36 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations

37 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Primary closure

38 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations

39 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations

40 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Primary Closure- Complications –Infection –Dehisence Delayed primary closure- allows more debridement –Lavage –Wet-to-dry bandaging

41 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Secondary closure –After bed of granulation tissue present –Often when there is an infected joint or tendon sheath –Delay closure until infection under control

42 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Laceration Second intention healing –No closure of wound –Depend on Contraction and Epithelialization –Best for upper body wounds, not as good for limbs –Sometimes there is no alternative

43 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Second intention

44 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Second intention healing

45 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Second intention healing

46 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations

47 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Treatments –Bandaging of limbs Important technique Keeps clean and dry –Lavage Depends on wound –Topical medications Depends on wound Numerous available products- discuss with your veterinarian

48 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Care of Lacerations Bandaging

49 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Lacerations and Penetrating Wounds Blood loss –Pressure to stop bleeding Lacerations near joints –Know the anatomy –Treat as emergencies Discuss care of a specific laceration with your veterinarian

50 University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Questions?


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