Vv

1. WOUND, SINUS & FISTULA
Dr. ASTHA CHAURASIA
Department Of Veterinary Surgery & Radiology
College of Veterinary Sciences, Rampura Phul
Guru Angad Dev Veterinary and Animal Sciences University

2. • A wound is a separation or discontinuity of soft tissues caused by trauma, surgery
or noxious physical agents.
• CLASSIFICATION OF WOUND
Open or external wound
• There is discontinuity in the skin and other covering tissues to a varying depth.
• In closed or interstitial wound, only deeper tissues, barring the skin or mucous
membrane are damaged.

3. • Closed wound/internal wound
• Contusion is injury to the skin without any break in the continuity of tissue
surface. It is caused by blunt objects and the subcutaneous tissues, muscles; nerves
are damaged to a varying degree.
• According to the severity and extent of tissue damage it may be of:
• First degree with rupture of capillary vessels of the skin and subcutaneous tissue.
• Second degree with rupture of larger vessels leading to haematoma formation.
• Third degree with major damage of tissues leading to gangrene formation.

4. Open wounds
1. Incised wounds are caused by sharp cutting instruments such as knives,
scalpels, fragments of glass etc with minimum loss to tissue, edges are
regular, bleeds freely and painful.
2. Lacerated wounds are caused by tearing of tissues with torn and uneven
edges. Wounds have irregular jagged borders and loss of tissue is limited to
skin and subcutaneous tissue e.g.: barbed wire.
3. Penetrating wounds are types of deep wounds communicating with
cavities like abdomen, thorax, and joints etc. e.g.: stab wounds.
4. Perforating wound is having two opening, one of entrance and other of
exit.
5. Punctured wound are caused by sharp pointed objects like nails relatively
with a small opening. There might be presence of infection/ foreign particles
deep into the wound with inadequate opening for drainage. Ex: Stab wounds.

5. 6. Gunshot wound is produced by various forms of firearms e.g.
injuries caused by bullet.
7. Abrasions are superficial damage to the skin, generally not deeper
than the epidermis.
8. Avulsion occurs when an entire structure or part of it is forcibly
pulled away. Explosions, gunshots, and animal bites may cause
avulsions.
9. Bite wounds are caused by snake; dog or wild animals bite with
significant degree of tissue damage.
10. Virulent wounds are caused by bacteria or virus leading to
formation of pustules or vesicles e.g.: FMD, anthrax.

6. 11. Granulating wound is one in which there is a tendency to heal
within expected time.
12. Aseptic wound is surgical wound made under aseptic conditions
where chances of bacterial contamination are negligible.
13. Contaminated wound is one where there is presence of micro
organisms.
14. Infected/ septic wound: A contaminated wound may become
infected after a period of 6 -8 hours where bacterial multiplication may
occur and liberation of their toxin.

7. SYMPTOMS OF WOUND
• Localized pain and bleeding.
• Gaping of the lips of wound.
• Weakness, paralysis or a loss of function in a dependent portion.
• Febrile disturbances in severe septic wound.
• Neuritis extending along the course of the nerve involved in the wound.

8. Sinuses and Fistulae
• Sinus
• A sinus is a tubular, inflammatory tract leading from a deeper
inflammatory area, with one or more external openings upon a mucous
or cutaneous surface.
• The interior of a sinus is lined by granulation tissue. There might be
partial in-growth of surface epithelium. In chronic cases there is
thickening around the sinus tract due to fibro-connective tissue.
• “A sinus is a blind-ended tract that extends from the surface of an
organ to an underlying area or abscess cavity”

9. Etiology
1. Presence of foreign substance or dead tissue, e.g., metal or glass
pieces, infected suture material, necrotic bone, parasites, etc.
2. Infections like actinomycosis, botryomycosis, or specific lesions like
carcinoma.
3. A sinus persists when there is inadequate drainage especially when it
has a tortuous course. Constant movement of the walls of the sinus
interferes with healing process. When it develops thick connective tissue
walls and callus or epithelial lining, healing of the sinus is further
delayed.

10. Diagnosis
• Fluids injected into the sinus may show its capacity and a probe passed through
the sinus may indicate its depth and direction.
• Treatment
1. Remove the foreign body, if any, causing the condition.
2. The sinus tract is cleaned with 5% to 10% Zinc chloride lotion followed by
Tincture iodine. The use of solid or liquid caustics is indicated as it also helps
separation of necrotic tissue.
3. Drainage can be facilitated by injecting and filling the sinus with a 50% solution
of Bismuth subiodide in white petrolatum. This is better than filling the cavity with
gauze which will obstruct drainage. When there is lot of necrotic tissue, this
treatment may not be effective.

11. 4. Drainage can be provided by making a counter opening and passing
a seton dipped in antiseptic solution. The seton is changed daily.
5. Opening out the sinus. Before opening a sinus it is better to inject into
it a coloured antiseptic solution like methylene blue (1%) so that it will
be easier to identify the tract.
6. Use of antibiotics.

12. • A fistula is a an abnormal connection or tunnel that forms between two tissues,
organs, or vessels that normally do not connect. It may be caused by injury, a
destructive inflammatory or neoplastic process, or may be a congenital defect.
• Note: A fistula always leads to a natural cavity. A sinus may communicate with an
abscess cavity in connective tissues, bone, or muscle.

13. Oronasal fistula

14. 1. Congenital fistula present at birth due to some developmental
abnormality, e.g., anal fistula, rectovaginal fistula, pervious urachus, etc.
2. Acquired fistula: Those that are not congenital.
3. Complete fistula, having more than one opening.
4. Incomplete or blind fistula, having only one opening (sinus).
5. Pathologic fistula.
6. Purulent fistula.
7. Excretory fistula.
8. Secretory fistula

15. Treatment
• Congenital fistulae, excretory and secretory fistulae may require
surgical correction, depending on its location and the organ involved.
Other varieties are treated more or less on general principles of
treatment as for sinus.