1. Wound Healing/ Bandaging
VTDRG pp. ____________ CTVT pp

2. Wound Formation
Wounds are created when an insult disrupts the ____________ of the tissue.
These wounds can either be created purposefully (______ incision) or incidental (___________injury).
The process of wound healing begins ________________ after the insult
Wounds are ______________ based on whether they are surgically created or are traumatic, and their level of contamination

3. Wound Classification
__________________________

4. Clean Wounds Are made under _____________ conditions Are non-traumatic
Are _________________, operative wounds that do not enter a hollow ___________ like the GI or urinary tract.

5. Clean-Contaminated Wounds…
…are a ______wound into which a hollow viscus is entered without significant ____________________.
GI, urogenital, or respiratory tract are examples of a hollow viscus.
…are _____________ occurring wounds with ____________ contamination.
…are a ______________ wound with a minor break in _____________technique.

6. Contaminated Wounds… …are open, _________________ wounds
…are surgical wounds with a __________ break in sterile technique
Are a surgical wound into ____________________ areas such as the colon or inflamed/contaminated skin.

7. Dirty and Infected Wounds…
…are any old, traumatic wound
…are an _____________ wound or perforated viscera
…are a wound with a high ______________ count

8. Phases of Wound Healing
__________________________

9. Inflammatory Phase Phase begins ___________________ after injury.
_________ will fill the wound and clean the wound surface.
Blood vessels _______________ to slow down any hemorrhaging
__________ form to help stabilize the wound edge

10. Debridement Phase
This phase begins approximately ___ hours after injury.
The ________________ of white blood cells, dead tissue and fluid collect on the wound
These exudates are commonly associated with wounds

11. Lag Phase
Lag Phase
During the first 3-5 days, wound strength is minimal
________________________ phase + ____________________________phase = “Lag Phase”

12. Repair/Proliferative Phase
____-____days after injury the repair phase usually begins
This phase continues as ____________________ tissue is formed

13. Maturation Phase
______-______days following injury and begins when ______________ is adequately deposited to help form a scar.
This process may take __________ to ________ to complete

14. Factors that affect wound healing
Host factors
Things that often can delay wound healing
______________

15. Factors that affect wound healing
Foreign material in a wound: Not always a ___________________!
These factors can interfere with normal wound healing
Surgical implants
Drains
Suture

16. Factors that affect wound healing
Contamination: Tissue becomes infected if the bacteria multiply to a critical number of organisms. The presence of infection will ______________ stop the repair phase
With proper wound care, many complications can be avoided.
Medications:
______________ delay all phases of wound healing.

17. Factors that affect wound healing
Blood supply to wound
Amount of movement allowed
Both can be affected by a bandage

18. Factors that affect wound healing
Blood supply: Important for wound healing because it is responsible for supplying _________ and metabolic _______________ (a substance upon which a enzyme acts) to the cells
Do not use overly-___________ bandages; they can compromise the wound’s blood supply

19. Wound Management

20. ***In order to protect the patient and yourself, _________ should be worn when managing wounds.
It is a good idea to respect the wound from the start since we do not know if any multi drug resistant organisms are present***

21. Immediate Wound Care
Cover wound with a clean dry bandage to prevent contamination. (If appropriate)
Water-soluble ointment may be applied to keep the wound moist and reduce contamination when clipping hair around wound.
Once the patient is stabilized and other life threatening injuries have been addressed the wound can be prepared for treatment

22. Wound Treatment
In order to obtain quality cleaning, __________ and pain relief is generally warranted
Chlorhexidine scrub is used to complete a “dirty” prep of the area before a __________ prep is done. It is important to make sure that the chlorhexidine does not enter the wound as scrubs cause irritation, toxicity, and pain
____________ is not recommended in management of open wounds
Sterile gloves and drape material can definitely reduce new contamination and create a cleaner work environment

23. Wound Lavage Why is it done? How is it done?
Remove ____________ and loose particles
Reduce ______________
How is it done?
Flush with large volumes of _____________________ crystalloids
No added antibiotics, soaps, detergents or antiseptics.
Mechanical action of the lavage

24. Lavaging the Wound
Using a warm, sterile, isotonic solution is preferred for any wound.
LRS or 0.9% Sodium Chloride are both commonly used and are easily available.
Tap water should not be used unless the wound is excessively dirty.
Tap water can be cytotoxic to fibroblasts due to additives that make it safe for drinking.

25. Lavaging the Wound
Lavage pressure is the goal for successful removal of debris without destroying healthy tissue.
Recommended lavage pressure is between psi.
18g needle and a 35cc syringe are recommended to achieve ideal pressure.
A 3 way stop-cock may also be used
Copious lavage may also be achieved with a bulb syringe and bowl.
“The solution to pollution is dilution.” This sums up the reason for copious lavage.

26. Initial Evaluation of the Wound
The wound should be _____________ to determine the extent of damage
A sterile _______________ can be used to gently probe where visualization may be compromised.
The results are then used to decide the best way to cover the wound and facilitate healing.

27. Wound Debridement
Removes ____________, devitalized, or _______________ tissue.
Removes foreign material
Methods:
SX excision of affected tissue “en bloc”
Means that you remove the entire wound via sx incision.
Enzymatic debridement (trypsin products
Hypertonic solutions like honey or sugar. (these are mentioned on pg. 980 in your book.)
Medicinal ___________ ingest debris and liquefy necrotic tissue.

28. En bloc Wound Debridement

29. Types of Wound Healing
Wound healing and wound ________ go hand in hand.
_____________ (first) Intention healing = surgical apposition of edges with suture or staples
_____________ Intention = healing via the formation of granulation tissue and epithelialization.
Recommended for wounds older than 6-8 hrs.
Takes a longer time to complete healing
Extra cost to manage the fragile wound (epithelialization)
_____________ Intention healing = __________ closure.
Wounds older than 6-8 hrs., infected, or necrotic wounds
Wound allowed to form healthy granulation tissue and THEN is closed by apposition or surgical excision. (Primary closure).

30. Wound Closure
The method of closure depends on the __________________ of the wound.

31. Types of Wound Closure ___________________ Closure
___________________ Primary Closure

32. Primary Wound Closure Healing by ____________ intention
Suturing or grafting a wound
Fresh, clean, sharply incised wounds
Should have minimal contamination
Plenty of surrounding tissue to close
Should be done within ____ hours from incident.
(____________ granulation tissue can form.)

33. Primary Wound Closure

34. Delayed Primary Wound Closure
Allows any local contamination or infection to be controlled prior to closure
Wound can be closed ___-___ days after injury, before ______________________ appears in the wound.
_______________ contamination
_______________ trauma
May require some cleansing and debridement

35. Secondary Wound Closure
Healing by contraction and epithelialization
________________, contaminated, traumatized wound
Cleansing and debridement are ___________.
Closure may be difficult
Not always a desirable method of closure.
Also known as “_________ intention wound healing”.

36. Factors Determining Method of Closure/Healing
_______ since injury
Degree of contamination
Amount of _______________ damage
Thoroughness of debrideent
Blood supply to the wound
Patient’s ________________
Closure without tension or dead space
________________ of the wound

37. Wounds that Require Special Management
Abrasions
Lacerations
Burns
Punctures
Degloving Injuries
Decubitus Ulcers

38. Abrasions
_______________ wounds that heal well by reepithelialization.
Maintaining a ____________ environment will speed this process.
Not recommended to let this type of wound “________________”.
Takes longer to heal than a moist environment.

39. Lacerations Have sharply incised edges with ___________ tissue trauma.
Can be superficial (_________)
Can be deep (_______________, _____________.)
<12 hours after injury
Minimal debridement, lavage, primary closure
>12 hours after injury
___________ debridement, primary closure

40. Burns
Classified by how _______ into the tissue, and how large the affected area is.
First, second, third and fourth degrees
Animals with extensive burns are critically ill and need intensive care to survive.
Severe burns often require skin ______________.

41. Puncture/Bite wounds
Challenging to asess if injury goes __________ than visibility allows
Management includes _______________, lavage, and debridement.
___________ may be placed if there is extensive dead space.
Helps prevent formation of seroma/hematoma.

42. Degloving Wounds
Defined by a large section of skin torn off the underlying tissue in a “glove” like fashion.
Abrasion of ____________ or exposure of ___________ are common
Take _________ to __________ of wound care.
Tend to be highly contaminated (dragging injuries or falling/jumping from moving vehicle.
Require aggressive wound _____________ and debridement, as well as possible skin grafting.

43. Decubitus Ulcers/Pressure Sores
Develop over bony proiminences caused by compression during long periods of ___________________.
Recumbent, ______________, obese, or _________ breed dogs are most prone.
Soft bedding and/or frequent turning are the best prevention.
If these wounds are advanced, reconstructive SX may be required.

44. Now that we know how to care for the wound…
Let’s talk about how to BANDAGE it!!!

45. Bandaging

46. Bandaging: Purpose _________________
To prevent simple fractures from becoming more complicated
Protection from licking, scratching, biting, and other forms of self ___________________.
From _________________________
Holding wound dressings and cold compresses in place
Immobilizes the wound and promotes ____________.

47. Bandaging: Purpose ____________________ To improve mobility
To reduce pain and swelling
Extra support for internal fixation of fractures

48. Bandaging: Purpose ____________________:
Compression bandages are a useful first aid measure to help arrest ________________.
Post-operatively, bandaging is useful to prevent excess ___________; therefore reducing or preventing _____________.

49. Bandaging: Purpose _______________________...
…of a fractured limb to prevent further trauma to damaged soft tissue
…of limb to aid speedy recovery of open wounds if near a joint, or where excessive ______________ is undesirable.
…of limb, if fracture repair is complicated or near a joint, requiring complete ____________.
…if ____________ fracture repair is not sufficient and extra support in the form of a bandage is needed.
…following _______________ procedures; after dislocated hips have been ______________.

50. Bandaging: purpose _____________/_____________
To hold ____ _______________ in place
To keep limb extended for fluid lines, and other such procedures
When necessary, secure tail bandage to base of tail.
To tape _________ together above dog’s head for ______ or ________bandage.

51. Bandaging for Wound Healing
Promotion of wound healing by:
Protecting the wound from additional trauma and contamination.
Preventing wound from _______________.
Preventing ________________ and seroma formation.
_________________ the wound to prevent cellular and capillary disruption.
Minimize post-op ______________ around incision
Absorbs wound ____________ and lifts away foreign material and loose tissue as bandage is removed.
Keeping the wound warm.

52. Leaving a wound open to “dry out” and form a scab is never indicated

53. Important Points to Remember
The bandage the purpose for which it was intended.
The bandage must be applied ____________, but not so tightly that _____________ is impaired.
It must be as comfortable as possible for the patient.
It must look _______________ to the owner. (Take pride in its appearance.)

54. Bandaging Layers
_____________________ Layer

55. Primary Layer of Bandaging
Is the _________ layer.
Is in direct contact with the _______ or wound.
Even _________ wounds should have a sterile primary layer.
Telfa Pads
Gauze squares

56. Functions of Primary Layer
_____________________
Deliver _____________________
Transmit _____________________ to second layer
__________ wound

57. Types of Primary Layers
___________________
Dry to dry
Wet to dry
Wet to wet
Semiocclusive
Occlusive

58. Primary Layer - Adherent
An _______________ primary layer promotes debridement in the inflammatory stage
Uses a wide __________ material (sterile gauze), allowing tissue to become incorporated into the bandage. This tissue is then ____________ with bandage changes.
Not highly recommended due to unselective ___________________ and damage during the proliferative (repair) phase of wound healing.
___________________ to remove
Must be changed ______________.

59. Types of ADHERENT Primary Layers
Dry to dry
Used when __________, necrotic tissue is evident
Absorbs ___________, necrotic tissue and foreign material
Debris adheres to dry, sterile gauze and is removed with bandage change.
Wet to dry
Used for wounds with dry or semi-dry exudates
Gauze is soaked in _________ or chlorhexidine and applied wet.
Loosens material from wound by ___________________
As it dries, exudate is pulled into material and away from the wound.
Bacteria proliferation and strike-through = disadvantages with wet to dry primary layer.

60. Adherent Primary Layers - Continued
Wet to wet
Used on wounds with large amounts of ____________ and _________________.
Material covering the wound is kept moist, sometimes by ______________ of fluid into the bandage.
Absorbs fluid easily
Can be used to ________ wounds, increasing capillary action and _______________ of wound
Removed ______(less painful)
Disadvantage: Little wound debridement because of _______________ adhesion to necrotic tissue

61. Non-adherent Primary Layers
Moist wound care is the most important management principle.
A non-adherent bandage is usually a fine, mesh, ____________ material. This layer promotes moisture regeneration and epithelialization with __________ disruption of granulation bed.
Moist wound care enhances _____________ debridement within the wound by drawing the exudate from the wound and allowing wound to bathe in cytokine-rich material.
Involves the use of non-adherent ____________ bandage layer to keep the wound surface moist.
Moist wound care results in less _________________ and less disruption during healing.
Either _________________ or _____________

62. Primary, Non-adherent SEMIOCCLUSIVE layers
Allows ________ and _________ to move through the dressing.
Keeps wound moist yet draws exudate and debris from the wound
Indicated for moderate to copious ____________
Must be changed frequently (q __-__ d), depending on _______________ production.

63. Non-adherent, semiocclusive Primary Layer
Examples are found on pg: 980 in CTVT, and include:
Hydrogel
Hydrocolloid
Hydrophilic
Polyurethane films
Hydrophilic colloids

64. Occlusive - Primary, non-adherent layer
Impermeable to ___________________
Allows some _____ transfer
Indicated for ______________ exudate
Promotes ___________________________
Changed infrequently (q __-__ d)
Can be used as a protective layer for new epithelium, preventing _______________ and abrasion of fragile tissue
Some products adhere to skin (hydrophilic or non-hydrophilic)

65. Secondary Bandage Layers
Covers the ____________ layer, and supports the wound
Purpose is to be able to ___________ and _________ fluids from the wound.
Materials used in this layer include:
Cast padding or rolled cotton
Should not be applied with excessive _______________, but should be snug enough to keep primary layer in.

66. Secondary Layer Examples
Roll Cotton
Cast Padding

67. Tertiary Bandage Layer
This is the _______________ layer that holds the bandage in place.
Usually consists of _______ layers made up of:
Cling/Kling gauze
Vet Wrap or Elastikon
Cling/Kling gauze
Vet Wrap

68. Tertiary Layer Should be ______-____________ to allow air flow
_________-____________= outer layer becomes wet, allowing moisture and bacteria to wick to the rest of the bandage.
MUST BE CHANGED _________________________
_____________________= contraindicated as it traps excess moisture leading to tissue maceration.

69. Technician Note
The middle _____toes of any bandaged limb should always be exposed to allow assessment of _______, _________, and ____________.

70. Bandage Types
__________________________

71. Robert Jones Badage
Used for _________________ immobilization of fractures __________ to the elbow or stifle before surgery
Must extend one joint ________ and ____________ the structure you wish to ________________.
___________, bulky bandage that provides __________ stabilization

72. Robert Jones Procedure
A large amount of rolled cotton is applied to the forelimb reaching ____________ the elbow
Rolled cotton is then compressed with _________________.
________________ tape may be used at the bottom of bandage to secure Vet Wrap to patient and prevent ____________.

73. Robert Jones Bandage
Notice that the toes are still visible at the bottom of the bandage.

74. Robert Jones - Note
If applied correctly, the bandage should have a nice “_______” or “______” when thumped with the index finger.

75. Modified Robert Jones Very common bandage in small animal medicine
May be applied to __________or __________
Numerous indications
Protect _____________or wound
Provide support (______________)
Prevent / reduce ______________

76. Modified Robert Jones - Tips
Always work ________to ____________ on limb
Maintain constant _____________
Use _____% overlap technique
Place limb in _______________ position when wrapping
Avoid _________________
Make sure the _______ toes are visible at all times!

77. Modified Robert Jones Procedure
Tape __________are placed on the ___________ aspects of the limb.
A tongue depressor is placed between them to prevent adherence of the stirrups to each another
Roll cotton is placed around the limb, covering the tape. (Cast padding may also be used if a thicker bandage is needed.)
Elastic gauze is then tightly wrapped over cotton to compress it. After this, the tape from the stirrups are ________________ up over the gauze
Protective, non-occlusive tape, like Vet Wrap is then applied over the entire bandage and forms the outer layer.

78. Modified Robert Jones Pt. 1

79. Modified Robert Jones Pt.1

80. Modified Robert Jones Pt. 2
Notice that the non-occusive tape may again be applied to the distal portion to prevent slipping.

81. Abdominal or Chest Bandage
Must be applied ___________ but not so much that it restricts or puts pressure on chest or abdomen.
Applied in the _____ layers as previously described

82. Specialized Bandages
May be needed on extremities that are difficult to bandage. (_______, ______, etc…)
Make sure that bandage is secure enough to prevent slipping, but not so tight as to cause swelling/lack of _____________

83. Splints Caudal or “__________” splints
Are used to support __________ portion of front limbs
Not appropriate for injuries above _________.
Limb should be well-padded to avoid pressure sores
Always place on ___________ aspect of limb

84. Caudal “Spoon” Splints

85. Lateral Hind-limb Splints
Are applied to the ____________ aspect of the _______ limb.
Are not appropriate for injuries above the _________.
Should be well padded to avoid pressure sores.

86. Lateral Splints

87. Casts
Used to stabilize fractures distal to __________ or ____________.
Immobilization of limbs to prevent ____________ or ____________ rupture.
Must extend one joint above and below structure being stabilized.

88. Casts

89. After-care for Bandages, Casts and Splints
Monitor patient _________ if hospitalized
Make sure patient is not chafing or rubbing at bandaged area. (____________may be necessary)
Exercise should be restricted to short leash-walks
Protect bandage when walking outside with plastic bag, or old fluid bag that has holes cut in top and a lace placed for tying. (_______ min. maximum)
Monitor _____________ if out-patient
Client education is critical if out-patient
Checking toes for: ____________, _______________, ____________ or foul _______________ from area

90. The End!!!