1. by Dr. Nimer Khraim DVMS, MVSc
Wounds by
Dr. Nimer Khraim
DVMS, MVSc

2. Wounds Close wound Contusion wound
In this wound the skin is damage but remain unbroken
In contusion mostly CT may be damaged

3. Wounds Abrasion wound:
these wound result from scraping or friction applied to the skin
Surgically interpretation is unnecessary

4. Wounds The contusion classified in to three type
Contusion of the first degree
Characterized by rupture of capillary vessels in the skin and S\C tissue and formation of ecchymosis

5. Wounds Contusion of the second degree
Characterized by rupture of large blood vessels and production of hematoma

6. Wounds Contusion of the third degree
In these contusion there is considerable destruction of tissue which may undergo gangrene

7. Wounds Treatment of contusion Cold water irrigation
Astringent application
Iodine application
Massage
Application of compression bandage

8. Wounds Open wound Incision (incised wound)
Caused by sharp object, the tissue are clearly divided and bruising of margin is minimal
Deep incision may sever m. tendon blood v. and nerves
They usually companied by h.

9. Wounds Laceration They produce by blunt objects that tears the tissue
Some laceration produce skin flab or S\C pocket

10. Wounds
Punctures
Its cause by sharp of blunt object and are usually deep but have no significant opening
Tetanus has been associated with these type of wound

11. Wounds Penetrating wound These wound communicate with body cavity
They may cause internal infarction such as general peritonitis or empyemia

12. Wounds
May associated with sever internal injuries such as penetration of intestine, rupture of blood v. etc. ,
if penetrating wound is suspected exploratory labrotomy or thoracotomy should be performed

13. Wounds Bite wound It’s the most serous injuries
because they may provide multiple source of infection like S\C tissue, muscle and deep structure may inoculated with bacteria or virus from the saliva of biting animal

14. Wounds Classification of wound according to degree of contamination
0-6 hrs. minimal contamination
6-12 hrs. signifiant contamination
12-more gross contamination

15. Wounds Treatment of wound
Its necessary to remove all F.B and devitalization tissue from the wound
Debridement of an open wound should be done as soon as possible in the course of the treatment
It may required the use of spinal or local analgesia or G.A

16. Wounds Step of wound Debridement
Clipping the hair in all area around the wound
Thorough wash with soap and water
Strong soap and detergent are best used only on the surrounding of the wound and not in the center of the wound

17. Wounds
The wound is gently washed with the saline sterile solution S.S.S
Make a thorough examination of the wounded tissue
Extension of the margin of the wounded skin may required particularly in the case of destructive injuries

18. Wounds
Area of the skin that are badly damage or that have no capillary oozing from the margin are excised
Any facia in the wound should be excised because Its normally and particularly susceptible to colonization by bacteria

19. Wounds
Area of m. that are a vascular, pale friable badly damage or heavily contaminated should be excised
Nerve, major v. and tendon should be cleaned as well as possible and preserved unless they are necrotized

20. Wounds
F.B such as hair, organic material and debris should be removed when ever it seen
Further removal of the bacterial colonies should be done by thorough lavage of the wound by SSS or ringer solution
the addition of antiseptics and antibiotic to this solution can used
also you can use povidone iodine (1 part to 9 part of SSS)

21. Wounds Management of wound infection
When wound accumulate a poket of exudates the first step of treatment is the remove of the suture and open the wound completely to provide a drainage in to the abscess
Then the wound is debrided

22. Wounds
Closing the wound can be done only if the Debridement is perfect with application of drainage

23. Wounds
Drain
May used prophylactically or therapeutically to prevent accumulation of blood, pus, serum or air in a fresh wound
Or to drain fluid that have already accumulated

24. Wounds A drain tube may be soft or pliable or rigid.
The purpose of the drain is to keep a channel through with blood, pus, serum or natural body fluid can escape

25. Wounds Wound healing Inflammatory stage
The immediate response to injuries is vasoconstriction of the small v. in the area of the wound

26. Wound Healing
Actually vascular occlusion occur at the point of the trauma tending to control h.
This response last 5-10 min. and is follow by active vasodilatation
Soon after injuries leukocyte in the local vasculature become sticky and adhere to the endothelium

27. Wound Healing
The predominant cell is PolyMorphonuclear Cell PMNc

28. Wound Healing The repair stage
The repair process begin almost immediately after wounding and continue as rapidly as necrotic tissue, blood clot and other debris are removed from the wound
The PMN is important in the wound healing if sepsis is present

29. Wound Healing
In absence of infection however wound repair proceeds normally in the complete absence of PMNc

30. Wound Healing Fibroblastic Stage (modern theory)
Wound fibroblast are derived from local mesenchymal cells particularly that associate with blood v. adventasia

31. Wound Healing
Shortly after injuries undifferentiated cells begin to change to migratory fibroblast
After the fibroblast inter the wound they secret protein polysaccharides and various glyco-protein that make the ground sub.
The fibroblast stage last 2-4 weeks depending on the wound

32. Wound Healing Epithelization stage
Epithelization, proliferation and migration are the first signs of repair and occur before any C.T has been formed in the wound
The initial stage and response of cells near the wound is mobilization and then epithelial cells enlarge and begin to migrate down and a cross the wound

33. Wound Healing Contraction stage
The size of full thickness of the wound is diminished and is characterized by central movement of the whole thickness of the surrounding skin

34. Wound Healing Factor affecting wound healing Hypoproteinemia
If serum protein conc. Is below 2gm\100ml this will inhabit the healing process

35. Factor affecting wound healing
Anemia and blood loss
The healing wound depend on microcirculation to supply the oxygen and other nutrient
therefore any thing that interfere with microcirculation it will cause inhabit in wound healing as in case of anemia due to blood loss

36. Factor affecting wound healing
Oxygen
Its require for normal wound healing, so any decrease in oxygen level will delay healing

37. Factor affecting wound healing
Temperature
It was reported that the wound heala faster at an environmental temp. of 30c than room temp.

38. Factor affecting wound healing
Uremia
It will decrease wound healing because they will change enzymes system and cellular metabolization which lead to decrease of healing process

39. Factor affecting wound healing
Anti-inflammatory drugs
Cortisone and its derivatives decrease the rate of protein synthesis
High dose of corticosteroid limit capillary budding, inhabit fibroblast proliferation and decrease the rate of Epithelization

40. Factor affecting wound healing
Vit. And minerals
Vit. A,C,E
Minerals Zink

41. Factor affecting wound healing
Radiation and cytotoxic drugs
They cause inhabit in deviation of local fibroblast and epithelial cells which lead to delay or prevention of wound healing

42. Factor affecting wound healing
Dehydration and edema

43. Factor affecting wound healing
Infection
Infected wound had decreased fibroblastic activity
Bacteria change wound PH which may affect on healing process

44. Factor affecting wound healing
Antiseptic
It may destroy bacteria but they also injure body cells
Any solution that is not isotonic can injure cell

45. Factor that influence the establishment of wound infection

46. Factor that influence the establishment of wound infection
Pathogenic and virulence of microrganism
Size of bacterium inoculums
Presence of F.B

47. Factor that influence the establishment of wound infection
Blood supply to the site
General health of animal

48. Factor that influence the establishment of wound infection
Poor management in the inatial handling of the wound which include:
In adequet Debridement
Poor hemostasis
Rough handling of tissue

49. Factor that influence the establishment of wound infection
Improper use of drainage
Poor using of dressing and bandages
Incorrect using of supportive antimicrobial therapy

50. The purpose of bandaging the wound

51. The purpose of bandaging the wound
To minimize edema and hematoma formation
To decrease the dead space
To protect against additional contamination and trauma

52. The purpose of bandaging the wound
To absorb drainage
To minimize excessive motion

53. Complication of the wound

54. Complication of the wound
Hemorrhage and traumatic anemia
Result from loss of large amount of blood
When h. is severe acute anemia will develop
The animal being will collapse and grasping respiration

55. Complication of the wound
running down of pulse
pal m.m
death may occur rapidly from cerebral ischemia

56. Complication of the wound
Syncope
characterized By sudden stoppage of heart action
the patient appear to be dead
the cause may severe h., reflex action as may occur in severe operation

57. Complication of the wound
Shock
in this case the function of the heart and respiration is continued and the patient un-conscious

58. Complication of the wound
Traumatic Neuralagia
may occur at the time of the wound which extend along the n. course or may occur during healing process

59. Complication of the wound
Traumatic Emphysema
this is due to infiltration of cellular T. by air
it’s a common complication of puncture wound of resp. tract

60. Complication of the wound
Venous Thrombosis
it’s the result of phlebitis which appear in the vain that has been opened or contused at the site of the wound

61. Complication of the wound
Traumatic Fever
its happen due to absorption of toxin from the wound caused by presence of bacteria

62. Complication of the wound
Septicaemia and Pyemia
this complication now very little to happen because of antibiotic administration and the uses of aseptic tech.

63. Complication of the wound
Gangrene
this due to the invasion the wound by anaerobic organism and its associated by deep wound