1887

Trauma and wound management

image of Trauma and wound management
GBP
Online Access: GBP25.00 + VAT
BSAVA Library Pass Buy a pass

Abstract

This chapter focuses on initial treatment and assessment of the unstable trauma patient, initial assessment of the stable trauma patient, further assessment and management and decision-making in wound management. : Abdominal rupture and hernia management; Bladder rupture repair.

Loading full text...

Full text loading...

/content/chapter/10.22233/9781910443149.chap4_10

Figures

Image of 4.10.1
4.10.1 Lateral and dorsoventral radiographs of the thorax of a 4-year-old cat with tachypnoea 24 hours after a road traffic accident. A small volume of pleural fluid is present, most evident caudoventrally. Air bronchograms extend into the cranial lung lobes indicating consolidation – essentially an alveolar infiltrate that can reflect pulmonary haemorrhage (such as contusion due to trauma) or pulmonary oedema, neoplasia or pneumonia. Some subcutaneous gas is evident over the cranial thorax. The diaphragmatic line appears to be intact. No skeletal injuries are evident. There is consolidation of the right and left cranial lung lobes, and small volumes of pleural fluid bilaterally. A large pocket of subcutaneous gas is superimposed over the right scapula. Suspected pulmonary contusions and pleural effusion secondary to trauma were diagnosed. Treatment included oxygen therapy, cage rest and analgesia (methadone in this case). (Courtesy of Langford Veterinary Services, University of Bristol)
Image of 4.10.2
4.10.2 This actively necrotic wound with purulent discharge should be treated as an open wound. The initial goal is debridement. A dressing (gauze squares or other absorbent material) is applied and allowed to dry out, so that dead tissue will be removed when the inner layer of the dressing is changed.
Image of 4.10.3
4.10.3 Debridement using a saline jet. Purulent discharge, tissue debris and other contaminants are removed by high-pressure saline jets, created in this case by fenestrating the lid of a saline bottle with a 22 G needle. Alternatively, a syringe can be filled with saline which is then injected through a 22 G needle.
Image of 4.10.4
4.10.4 Sharp surgical debridement. This is reserved for cases where it is obvious which tissues will survive and which are necrotic. Debridement should be performed with scissors or a scalpel, the aim being to sharply cut back necrotic or infected tissue until healthy, bleeding tissue is reached. Scraping is not appropriate, as it damages otherwise healthy tissue.
Image of 4.10.5
4.10.5 A tie-over dressing for an effusive wound (shown here on a dog but a similar approach is used for a cat). Sutures of 3.5 metric (0 USP) polypropylene are placed in the skin surrounding the wound. Nylon tape is passed through these anchoring sutures and tied over an absorbent dressing to hold it in place. The dressing is changed every 12–24 hours, depending on how quickly strikethrough of wound exudate is noticed on the exterior.
Image of 4.10.6
4.10.6 This wound has been treated with a tie-over wet-to-dry dressing. The wound has passed its inflammatory phase and is now less effusive; it is thus ready for a less aggressive form of wound management, such as a non-adherent dressing using honey or paraffin gauze.
Image of 4.10.7
4.10.7 A polyurethane foam dressing has been stapled to the wound edges to hold it in place (shown here on a dog). This is appropriate for granulating wounds with a small amount of discharge, where the main aim is to keep the wound moist while preventing environmental contamination and self-trauma. This type of dressing need only be changed every 72 hours.
Image of Kitten with abdominal wall rupture (arrows) and herniated bowel identified by ultrasonography. This otherwise healthy kitten presented for evaluation of a traumatic abdominal rupture. There was no evidence of damage to the abdominal viscera but it was considered an emergency due to the large amount of viscera present within the hernia and an inability to reduce it, suggesting a very small rupture.
Kitten with abdominal wall rupture (arrows) and herniated bowel identified by ultrasonography. This otherwise healthy kitten presented for evaluation of a traumatic abdominal rupture. There was no evidence of damage to the abdominal viscera but it was considered an emergency due to the large amount of viscera present within the hernia and an inability to reduce it, suggesting a very small rupture. Kitten with abdominal wall rupture (arrows) and herniated bowel identified by ultrasonography. This otherwise healthy kitten presented for evaluation of a traumatic abdominal rupture. There was no evidence of damage to the abdominal viscera but it was considered an emergency due to the large amount of viscera present within the hernia and an inability to reduce it, suggesting a very small rupture.
Image of Large dorsal hernia (arrowed) following rupture of the left cranial abdominal wall viewed from within the abdomen. (The patient’s head is to the left.) This hernia could only be properly evaluated with an exploratory laparotomy, followed by dissection dorsally between the ventral skin incision and the body wall, revealing its true extent.
Large dorsal hernia (arrowed) following rupture of the left cranial abdominal wall viewed from within the abdomen. (The patient’s head is to the left.) This hernia could only be properly evaluated with an exploratory laparotomy, followed by dissection dorsally between the ventral skin incision and the body wall, revealing its true extent. Large dorsal hernia (arrowed) following rupture of the left cranial abdominal wall viewed from within the abdomen. (The patient’s head is to the left.) This hernia could only be properly evaluated with an exploratory laparotomy, followed by dissection dorsally between the ventral skin incision and the body wall, revealing its true extent.
Image of Untitled
Image of Untitled
Image of Untitled
Image of Kitten being prepared for hernia repair. A jugular catheter (optional; usually performed in specialist centres only) has been inserted to allow fluid administration intraoperatively due to the kitten’s small size; alternatively, the intraosseous route (using the trochanteric fossa of the proximal femur) can be used if cephalic vein cannulation is not possible.
Kitten being prepared for hernia repair. A jugular catheter (optional; usually performed in specialist centres only) has been inserted to allow fluid administration intraoperatively due to the kitten’s small size; alternatively, the intraosseous route (using the trochanteric fossa of the proximal femur) can be used if cephalic vein cannulation is not possible. Kitten being prepared for hernia repair. A jugular catheter (optional; usually performed in specialist centres only) has been inserted to allow fluid administration intraoperatively due to the kitten’s small size; alternatively, the intraosseous route (using the trochanteric fossa of the proximal femur) can be used if cephalic vein cannulation is not possible.
Image of The right (at top) linea alba is being retracted using atraumatic Babcock forceps. DeBakey forceps are being used to manipulate the delicate muscle of the rupture in the abdominal wall and a ribbon (malleable) retractor is being used to gently retract the viscera. (The kitten’s head is to the right.)
The right (at top) linea alba is being retracted using atraumatic Babcock forceps. DeBakey forceps are being used to manipulate the delicate muscle of the rupture in the abdominal wall and a ribbon (malleable) retractor is being used to gently retract the viscera. (The kitten’s head is to the right.) The right (at top) linea alba is being retracted using atraumatic Babcock forceps. DeBakey forceps are being used to manipulate the delicate muscle of the rupture in the abdominal wall and a ribbon (malleable) retractor is being used to gently retract the viscera. (The kitten’s head is to the right.)
Image of Rupture closed with single interrupted sutures.
Rupture closed with single interrupted sutures. Rupture closed with single interrupted sutures.
Image of Large dorsal hernia. The linea alba incision is dorsal and the surgeon has slipped their fingers down along the outside of the abdominal wall and in through the traumatic defect in the body wall. This rupture should be repaired in layers. The internal layer (transversus abdominus muscle) should be sutured to the ventral muscles of the spine without impinging on the retroperitoneal structures such as the ureter. The internal and external abdominal oblique muscles should be sutured to the lateral epaxial (spinal) muscles and the lumbar fascia.
Large dorsal hernia. The linea alba incision is dorsal and the surgeon has slipped their fingers down along the outside of the abdominal wall and in through the traumatic defect in the body wall. This rupture should be repaired in layers. The internal layer (transversus abdominus muscle) should be sutured to the ventral muscles of the spine without impinging on the retroperitoneal structures such as the ureter. The internal and external abdominal oblique muscles should be sutured to the lateral epaxial (spinal) muscles and the lumbar fascia. Large dorsal hernia. The linea alba incision is dorsal and the surgeon has slipped their fingers down along the outside of the abdominal wall and in through the traumatic defect in the body wall. This rupture should be repaired in layers. The internal layer (transversus abdominus muscle) should be sutured to the ventral muscles of the spine without impinging on the retroperitoneal structures such as the ureter. The internal and external abdominal oblique muscles should be sutured to the lateral epaxial (spinal) muscles and the lumbar fascia.
Image of Basic surgical kit. A = towel clamps; B = Brown–Adson thumb forceps; C = needle-holders; D = No. 3 scalpel handle; E = No. 15 scalpel blade; F = No. 10 scalpel blade; G = mosquito forceps; H = Metzenbaum scissors; I = Mayo scissors; J = Blunt–sharp suture scissors; K = gauze surgical swabs.
Basic surgical kit. A = towel clamps; B = Brown–Adson thumb forceps; C = needle-holders; D = No. 3 scalpel handle; E = No. 15 scalpel blade; F = No. 10 scalpel blade; G = mosquito forceps; H = Metzenbaum scissors; I = Mayo scissors; J = Blunt–sharp suture scissors; K = gauze surgical swabs. Basic surgical kit. A = towel clamps; B = Brown–Adson thumb forceps; C = needle-holders; D = No. 3 scalpel handle; E = No. 15 scalpel blade; F = No. 10 scalpel blade; G = mosquito forceps; H = Metzenbaum scissors; I = Mayo scissors; J = Blunt–sharp suture scissors; K = gauze surgical swabs.
Image of Rupture of the bladder in a cat with feline idiopathic cystitis. The blue catheter is a cystostomy tube that had been placed following the original episode of obstruction, before bladder rupture occurred (the cystostomy tube did not prevent rupture in this case, due to its occlusion). The three stay sutures are visible. The apex of the bladder is towards the top of the photograph and the rupture has occurred on the ventral aspect of the bladder. Debris within the bladder is consistent with urinary crystal formation, and fibrinous inflammation of the bladder mucosa.
Rupture of the bladder in a cat with feline idiopathic cystitis. The blue catheter is a cystostomy tube that had been placed following the original episode of obstruction, before bladder rupture occurred (the cystostomy tube did not prevent rupture in this case, due to its occlusion). The three stay sutures are visible. The apex of the bladder is towards the top of the photograph and the rupture has occurred on the ventral aspect of the bladder. Debris within the bladder is consistent with urinary crystal formation, and fibrinous inflammation of the bladder mucosa. Rupture of the bladder in a cat with feline idiopathic cystitis. The blue catheter is a cystostomy tube that had been placed following the original episode of obstruction, before bladder rupture occurred (the cystostomy tube did not prevent rupture in this case, due to its occlusion). The three stay sutures are visible. The apex of the bladder is towards the top of the photograph and the rupture has occurred on the ventral aspect of the bladder. Debris within the bladder is consistent with urinary crystal formation, and fibrinous inflammation of the bladder mucosa.
Image of Untitled
Image of The mucosa everts when the bladder wall is excised Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The mucosa everts when the bladder wall is excised Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The mucosa everts when the bladder wall is excised Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Incorrect way to hold bladder for suturing. Grasping the cut edge directly across the everted mucosa would cause it to evert again once the sutures were placed and tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Incorrect way to hold bladder for suturing. Grasping the cut edge directly across the everted mucosa would cause it to evert again once the sutures were placed and tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Incorrect way to hold bladder for suturing. Grasping the cut edge directly across the everted mucosa would cause it to evert again once the sutures were placed and tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of The cut edge should therefore be grasped at right angles. The forceps are then rotated to ensure that mucosal eversion is reduced, prior to placing the sutures, so that there is no eversion of mucosa when the suture is tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
The cut edge should therefore be grasped at right angles. The forceps are then rotated to ensure that mucosal eversion is reduced, prior to placing the sutures, so that there is no eversion of mucosa when the suture is tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. The cut edge should therefore be grasped at right angles. The forceps are then rotated to ensure that mucosal eversion is reduced, prior to placing the sutures, so that there is no eversion of mucosa when the suture is tightened Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Untitled
Image of Untitled
Image of Untitled

More like this

/content/chapter/10.22233/9781910443149.chap4_10
dcterms_title,dcterms_description
-contentType:Journal
5
5
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error