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Shearing/Degloving Wounds 909

Shearing/Degloving Wounds Bonus Material Client Education
Sheet
Online
VetBooks.ir Diseases and Disorders
BASIC INFORMATION
degree of circulatory compromise, blood loss,
and presence of necrotic tissue/infection. • Bacterial culture and susceptibility of infected
wounds to select the most appropriate
Definition antibiotic
Traumatic soft-tissue injury commonly associ- Etiology and Pathophysiology
ated with the limbs and tail • Wounds are the result of the transfer and Advanced or Confirmatory Testing
absorption of energy by the body; severity As indicated by the severity and type of
Epidemiology depends on the type of trauma and surface trauma
SPECIES, AGE, SEX area(s) absorbing it.
Dogs and cats, any age, either sex • Lacerations are the result of contact with a TREATMENT
sharp, bladelike object (e.g., glass, metal) or
RISK FACTORS impact against a hard-edged surface such as Treatment Overview
Roaming; areas with high automobile traffic a curb. Bite wounds may create an irregular Treatment goals:
(vehicular trauma is the primary cause) laceration as a result of the cutting and • Provide hemodynamic stability before anes-
tearing of tissues. thesia; other injuries (e.g., pneumothorax,
Clinical Presentation • Crushing wounds are the result of compres- diaphragmatic hernia) may exist.
DISEASE FORMS/SUBTYPES sion, either from impact with a heavy object • Assess severity of soft-tissue and orthopedic
Any of the following is possible: laceration, or contact with a mechanical device or from injury.
contusion, crushing, shearing, penetration, a powerful bite. • Assess wound for tissue viability.
perforation, avulsion, thermal injury, bite • Cutaneous surfaces may be stripped or • Provide definitive wound care and closure
wound avulsed from the extremity, damaging the if indicated.
circulation to the traumatized skin segment • Prevent or manage infection.
HISTORY, CHIEF COMPLAINT (typically from vehicular or bite trauma). • Stabilize local fractures or joint instability.
• An open wound, bleeding, or swelling of • Shearing wounds are the result of tangential
the injured area impact with a hard surface, dragging of a Acute General Treatment
• Necrotic tissue body region on a hard road surface, or • Consider sedation, pain medication, muz-
• Absence or avulsion of tissue and underlying entrapment of an extremity beneath the zling, or placing an Elizabethan collar to
tissues: exposure of bone tire of a moving vehicle. reduce the risk of being bitten.
• Purulent discharge • Accurate assessment of tissue circulation • Cover open wounds with a sterile dressing.
• Lameness in association with limb injury at the time of injury can be incomplete. • Initiate systemic antibiotic therapy: empirical
• The patient may display pain by vocaliza- Progressive loss of circulation can result in therapy for broad aerobic coverage (e.g.,
tion, guarding the injured area, or defensive vascular stasis and necrosis that may not be cefazolin 22 mg/kg IV q 90 minutes peri-
posturing. evident for 4 or more days after the initial operatively), then based on bacterial culture
injury. and sensitivity
PHYSICAL EXAM FINDINGS • General anesthesia is preferable for definitive
• Open wounds DIAGNOSIS wound care because manipulation of the
○ Skin laceration affected area can be painful.
○ Partial or complete loss of skin and Diagnostic Overview ○ Regional nerve blocks can be used for
underlying tissues The diagnosis is made from the history and patient comfort.
○ Avulsion or partial detachment of skin physical exam findings, although the full extent • Liberally remove fur from around the
segments of bony lesions and other internal injuries may circumference of a shearing wound.
○ Necrotic tissue be appreciated only with radiographs and/or • Povidone iodine or chlorhexidine surgi-
○ Exposure of tendons, ligaments, bones, ultrasound. cal scrub is used for preparing the skin,
and joints alternated with swabbing the area with
○ Varied development of granulation tissue Differential Diagnosis sterile-saline–impregnated sponges.
in older wounds • Vehicular trauma • Aseptically drape the wound.
• Evidence of hemorrhage • Bite wounds • Explore the wound and remove nonviable
• Intact skin with the presence of contusion • Penetrating/perforating objects (gunshot, tissue and foreign debris; perform copious
(ecchymosis/bruising) impalement) lavage of the wound with sterile saline to
• Local swelling due to edema, hematoma • Sharp objects remove contaminants.
formation • Thermal injuries, including contact burns ○ Chlorhexidine solution (1 : 40 dilu-
• Condition and viability of the digital and (muffler/engine contact) tion) or povidone iodine solution (1 : 9
metacarpal/metatarsal pads; severity of tissue dilution) may be added to the sterile
trauma Initial Database saline.
• Evidence of underlying orthopedic injury • CBC, serum biochemistry profile, urinalysis: • Gentle pressure lavage is useful to remove
○ Fracture provides baseline; various abnormalities; can contaminants, using a fluid bag and pressure
○ Joint instability associated with soft-tissue suggest concomitant injury (e.g., azotemia cuff or a 35-mL syringe and 18-gauge needle
trauma and bone loss due to urinary rupture from vehicular (moderate pressure only).
○ Partial, tangential loss of bone and trauma) • In the absence of infection and necrotic tissue
cartilage • Radiographs (two orthogonal views) of (creating a surgically clean wound)
• Pain with manipulation of the affected the injured area to rule out orthopedic ○ Skin borders can be approximated with
limb(s) trauma sutures.
• The overall health status of the animal • Thoracic radiographs to rule out diaphrag- ○ Partial closure or delayed primary closure
depends on a variety of factors, including matic hernia, lung contusions, pneumotho- if substantial incisional tension and/or
body region(s) involved, extent of trauma, rax, and fractured ribs from vehicular trauma unresolved edema
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