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Management of open wounds
/content/chapter/10.22233/9781905319558.chap4
Management of open wounds
- Author: Davina Anderson
- From: BSAVA Manual of Canine and Feline Wound Management and Reconstruction
- Item: Chapter 4, pp 37 - 53
- DOI: 10.22233/9781905319558.4
- Copyright: Copyright © 2017 British Small Animal Veterinary Association
- Publication Date: March 2009
Abstract
Open wound management in small animals is a common event in veterinary practice. It is economically significant and can cause considerable distress and pain to the animal. The aim of wound management is to provide conditions that allow for optimal wound healing or to prepare the wound for definitive closure by reconstructive techniques. However, every wound is unique and this problem is reflected in the paucity of published studies analysing the effectiveness of wound dressing products in the management of small animal wounds. Wounds must be properly evaluated at the first presentation in order to plan a treatment protocol and to give the owner an indication of the expected duration of treatment and ultimately the prognosis. This chapter considers how to manage open wounds and how to use dressings and bandages to optimize the healing process. The following topics are addressed: Principles of wound management; Wound lavage; Wound debridement; Systemic treatments; Bandages and dressings; Topical medications; Primary (contact) layer wound dressings; Bandaging; and Wound management strategy and planning. This chapter also includes case examples focusing on Open wound management of a chronic shear injury prior to skin grafting; and Management of an acute road traffic shear injury. Case examples: Open wound management of a chronic shear injury; Management of an acute road traffic shear injury
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Figures
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4.1
Wound lavage is best carried out using sterile isotonic fluids. A bag of intravenous fluids is attached to a three-way tap via the giving line. The fluids are drawn into a 20 ml syringe and the wound is lavaged with an 18 gauge needle. The fluids should not be re-used for another case; it is important to keep all items used for wound management dedicated to one case only. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2009 British Small Animal Veterinary Association
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4.1
Wound lavage is best carried out using sterile isotonic fluids. A bag of intravenous fluids is attached to a three-way tap via the giving line. The fluids are drawn into a 20 ml syringe and the wound is lavaged with an 18 gauge needle. The fluids should not be re-used for another case; it is important to keep all items used for wound management dedicated to one case only. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.2
Wound lavage carried out with a 20 ml syringe and hypodermic needle. The spray is at an appropriate pressure to dislodge debris and necrotic material without driving them further into the tissues. © 2009 British Small Animal Veterinary Association
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4.2
Wound lavage carried out with a 20 ml syringe and hypodermic needle. The spray is at an appropriate pressure to dislodge debris and necrotic material without driving them further into the tissues.
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4.3
Wound packed with sterile saline-soaked swabs (sponges). © 2009 British Small Animal Veterinary Association
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4.3
Wound packed with sterile saline-soaked swabs (sponges).
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4.4
Surgical instrumentation suitable for wound debridement. Left to right: Debakey thumb forceps; Adson–Brown thumb forceps; fine-toothed Adson thumb forceps; Debakey needle-holder; scalpel handle with No.15 blade; skin hook; short Metzenbaum scissors. (Courtesy of L Hopley) © 2009 British Small Animal Veterinary Association
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4.4
Surgical instrumentation suitable for wound debridement. Left to right: Debakey thumb forceps; Adson–Brown thumb forceps; fine-toothed Adson thumb forceps; Debakey needle-holder; scalpel handle with No.15 blade; skin hook; short Metzenbaum scissors. (Courtesy of L Hopley)
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4.5
Layered debridement is used to remove contaminated or necrotic material in a wound, gradually in layers, until clean tissue is reached. Instruments and gloves should be changed after each layer so as to convert the contaminated wound into a clean wound as far as possible. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2009 British Small Animal Veterinary Association
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4.5
Layered debridement is used to remove contaminated or necrotic material in a wound, gradually in layers, until clean tissue is reached. Instruments and gloves should be changed after each layer so as to convert the contaminated wound into a clean wound as far as possible. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.6
Wound edges debrided until haemorrhage occurs. © 2009 British Small Animal Veterinary Association
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4.6
Wound edges debrided until haemorrhage occurs.
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4.7
En-bloc debridement involves closing a contaminated wound so as to seal the dirty surface off from the surgical procedure. The wound is then removed in one piece, leaving only sterile tissue exposed for primary closure. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2009 British Small Animal Veterinary Association
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4.7
En-bloc debridement involves closing a contaminated wound so as to seal the dirty surface off from the surgical procedure. The wound is then removed in one piece, leaving only sterile tissue exposed for primary closure. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.10
These larvae have been used to treat a wound infected with MRSA. Three days after application the wound is healthy and no longer infected. The skin surrounding the wound is protected by an adherent hydrocolloid and the maggots will be flushed out of the wound using sterile saline. © 2009 British Small Animal Veterinary Association
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4.10
These larvae have been used to treat a wound infected with MRSA. Three days after application the wound is healthy and no longer infected. The skin surrounding the wound is protected by an adherent hydrocolloid and the maggots will be flushed out of the wound using sterile saline.
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4.11
A chronic shearing injury was presented with a soaked bandage that had been in place for several days. The granulation tissue was foul-smelling and the foot was painful and very swollen. (a) An adherent dressing (dry-to-dry in this case as the wound was so wet) was applied and changed every 12 hours. (b) After 24 hours, the foot was no longer swollen and was much less painful. The infection had resolved and exudate levels were manageable. © 2009 British Small Animal Veterinary Association
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4.11
A chronic shearing injury was presented with a soaked bandage that had been in place for several days. The granulation tissue was foul-smelling and the foot was painful and very swollen. (a) An adherent dressing (dry-to-dry in this case as the wound was so wet) was applied and changed every 12 hours. (b) After 24 hours, the foot was no longer swollen and was much less painful. The infection had resolved and exudate levels were manageable.
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4.12
Foam dressing in place at presentation of the case shown in
Figure 4.11
. Prior to removal, heavy absorption of exudate by the foam is seen as a dark stain under the membrane outer surface. © 2009 British Small Animal Veterinary Association
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4.12
Foam dressing in place at presentation of the case shown in
Figure 4.11
. Prior to removal, heavy absorption of exudate by the foam is seen as a dark stain under the membrane outer surface.
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4.13
Hydrogel is available as an amorphous gel or a preformed sheet with a membrane backing. © 2009 British Small Animal Veterinary Association
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4.13
Hydrogel is available as an amorphous gel or a preformed sheet with a membrane backing.
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4.14
Modified Robert Jones bandage. (a) Cotton wool inner layer. (b,c) Conforming bandage is placed to compress the cotton wool as firmly and evenly as possible. (d,e) Cohesive dressing is placed over the bandage. (f) End-on-view showing bandage layers and the exposed middle toes. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2009 British Small Animal Veterinary Association
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4.14
Modified Robert Jones bandage. (a) Cotton wool inner layer. (b,c) Conforming bandage is placed to compress the cotton wool as firmly and evenly as possible. (d,e) Cohesive dressing is placed over the bandage. (f) End-on-view showing bandage layers and the exposed middle toes. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.15
A tie-over dressing can be used to dress a wound in an area that is difficult to bandage. Tapes are secured to the skin surrounding the wound, using large loops of stay suture. The tie-over tapes can be undone to change the dressing and then looped together again when the fresh dressing is reapplied. © 2009 British Small Animal Veterinary Association
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4.15
A tie-over dressing can be used to dress a wound in an area that is difficult to bandage. Tapes are secured to the skin surrounding the wound, using large loops of stay suture. The tie-over tapes can be undone to change the dressing and then looped together again when the fresh dressing is reapplied.
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4.17
Example of a wound record sheet. © 2009 British Small Animal Veterinary Association
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4.17
Example of a wound record sheet.
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Wound on presentation.
Wound on presentation. © 2009 British Small Animal Veterinary Association
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Wound on presentation.
Wound on presentation.
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Removal of adherent dressing.
Removal of adherent dressing. © 2009 British Small Animal Veterinary Association
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Removal of adherent dressing.
Removal of adherent dressing.
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Exudate is already reduced, granulation tissue looks more normal (i.e. granular) and skin edges are smooth and dry.
Exudate is already reduced, granulation tissue looks more normal (i.e. granular) and skin edges are smooth and dry. © 2009 British Small Animal Veterinary Association
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Exudate is already reduced, granulation tissue looks more normal (i.e. granular) and skin edges are smooth and dry.
Exudate is already reduced, granulation tissue looks more normal (i.e. granular) and skin edges are smooth and dry.
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Removal of hydrocolloid dressing. There is characteristic yellowish liquefied colloid material where exudate has been absorbed. Skin edges are beginning to epithelialize.
Removal of hydrocolloid dressing. There is characteristic yellowish liquefied colloid material where exudate has been absorbed. Skin edges are beginning to epithelialize. © 2009 British Small Animal Veterinary Association
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Removal of hydrocolloid dressing. There is characteristic yellowish liquefied colloid material where exudate has been absorbed. Skin edges are beginning to epithelialize.
Removal of hydrocolloid dressing. There is characteristic yellowish liquefied colloid material where exudate has been absorbed. Skin edges are beginning to epithelialize.
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Healthy granulation tissue prior to grafting.
Healthy granulation tissue prior to grafting. © 2009 British Small Animal Veterinary Association
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Healthy granulation tissue prior to grafting.
Healthy granulation tissue prior to grafting.
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Free skin graft in place.
Free skin graft in place. © 2009 British Small Animal Veterinary Association
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Free skin graft in place.
Free skin graft in place.
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Foot with fur fully grown back 6 months later. Because the graft was harvested from the side of the body, the hair has grown back longer than the rest of the hair on the foot.
Foot with fur fully grown back 6 months later. Because the graft was harvested from the side of the body, the hair has grown back longer than the rest of the hair on the foot. © 2009 British Small Animal Veterinary Association
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Foot with fur fully grown back 6 months later. Because the graft was harvested from the side of the body, the hair has grown back longer than the rest of the hair on the foot.
Foot with fur fully grown back 6 months later. Because the graft was harvested from the side of the body, the hair has grown back longer than the rest of the hair on the foot.
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Wound on presentation.
Wound on presentation. © 2009 British Small Animal Veterinary Association
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Wound on presentation.
Wound on presentation.
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The wound was filled with sterile aqueous gel and the skin around the wound and along the thorax and neck was clipped.
The wound was filled with sterile aqueous gel and the skin around the wound and along the thorax and neck was clipped. © 2009 British Small Animal Veterinary Association
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The wound was filled with sterile aqueous gel and the skin around the wound and along the thorax and neck was clipped.
The wound was filled with sterile aqueous gel and the skin around the wound and along the thorax and neck was clipped.
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Using a scalpel blade and forceps, fascial layers were picked up and carefully cut away from the underlying fresh fascial planes.
Using a scalpel blade and forceps, fascial layers were picked up and carefully cut away from the underlying fresh fascial planes. © 2009 British Small Animal Veterinary Association
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Using a scalpel blade and forceps, fascial layers were picked up and carefully cut away from the underlying fresh fascial planes.
Using a scalpel blade and forceps, fascial layers were picked up and carefully cut away from the underlying fresh fascial planes.
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Wound following lavage and debridement.
Wound following lavage and debridement. © 2009 British Small Animal Veterinary Association
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Wound following lavage and debridement.
Wound following lavage and debridement.
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Bandaged wound.
Bandaged wound. © 2009 British Small Animal Veterinary Association
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Bandaged wound.
Bandaged wound.
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48 hours after surgery the bandage and drains were removed and the dog was discharged.
48 hours after surgery the bandage and drains were removed and the dog was discharged. © 2009 British Small Animal Veterinary Association
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48 hours after surgery the bandage and drains were removed and the dog was discharged.
48 hours after surgery the bandage and drains were removed and the dog was discharged.
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Wound appearance at 10 days when the dog returned for suture removal. The dog was sound.
Wound appearance at 10 days when the dog returned for suture removal. The dog was sound. © 2009 British Small Animal Veterinary Association
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Wound appearance at 10 days when the dog returned for suture removal. The dog was sound.
Wound appearance at 10 days when the dog returned for suture removal. The dog was sound.