1887

Management of open wounds

image of Management of open wounds
GBP
Online Access: GBP25.00 + VAT
BSAVA Library Pass Buy a pass

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. : Open wound management of a chronic shear injury; Management of an acute road traffic shear injury

Loading full text...

Full text loading...

/content/chapter/10.22233/9781905319558.chap4

Figures

Image of 4.1
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.
Image of 4.2
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.
Image of 4.3
4.3 Wound packed with sterile saline-soaked swabs (sponges).
Image of 4.4
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)
Image of 4.5
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.
Image of 4.6
4.6 Wound edges debrided until haemorrhage occurs.
Image of 4.7
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.
Image of 4.10
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.
Image of 4.11
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. An adherent dressing (dry-to-dry in this case as the wound was so wet) was applied and changed every 12 hours. After 24 hours, the foot was no longer swollen and was much less painful. The infection had resolved and exudate levels were manageable.
Image of 4.12
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.
Image of 4.13
4.13 Hydrogel is available as an amorphous gel or a preformed sheet with a membrane backing.
Image of 4.14
4.14 Modified Robert Jones bandage. Cotton wool inner layer. Conforming bandage is placed to compress the cotton wool as firmly and evenly as possible. Cohesive dressing is placed over the bandage. 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.
Image of 4.15
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.
Image of 4.17
4.17 Example of a wound record sheet.
Image of Wound on presentation.
Wound on presentation. Wound on presentation.
Image of Removal of adherent dressing.
Removal of adherent dressing. Removal of adherent dressing.
Image of 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. Exudate is already reduced, granulation tissue looks more normal (i.e. granular) and skin edges are smooth and dry.
Image of 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. Removal of hydrocolloid dressing. There is characteristic yellowish liquefied colloid material where exudate has been absorbed. Skin edges are beginning to epithelialize.
Image of Healthy granulation tissue prior to grafting.
Healthy granulation tissue prior to grafting. Healthy granulation tissue prior to grafting.
Image of Free skin graft in place.
Free skin graft in place. Free skin graft in place.
Image of 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. 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.
Image of Wound on presentation.
Wound on presentation. Wound on presentation.
Image of 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. The wound was filled with sterile aqueous gel and the skin around the wound and along the thorax and neck was clipped.
Image of 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. Using a scalpel blade and forceps, fascial layers were picked up and carefully cut away from the underlying fresh fascial planes.
Image of Wound following lavage and debridement.
Wound following lavage and debridement. Wound following lavage and debridement.
Image of Bandaged wound.
Bandaged wound. Bandaged wound.
Image of 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. 48 hours after surgery the bandage and drains were removed and the dog was discharged.
Image of 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. Wound appearance at 10 days when the dog returned for suture removal. The dog was sound.

More like this

/content/chapter/10.22233/9781905319558.chap4
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