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The importance of adopting best-practice wound management techniques

“In all phases, we aim to protect the healing wound by decreasing factors that delay healing.”

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The subject of wound care is a broad one that encompasses the most superficial of skin dermatitis cases to severe deep tissue damage.

General wound management principles include recognizing and treating two phases of healing: The inflammatory phase, with a focus on debridement and decontamination, and the proliferative phase, using wound care techniques that optimize the epithelial migration and the formation of healthy granulation tissue, according to Teri Weronko, DVM, clinical instructor at Ross University Veterinary Clinic in St. Kitts, West Indies.

“In all phases, we aim to protect the healing wound by decreasing factors that delay healing,” said Dr. Weronko. “This may include movement, necrosis, infection, caustic substances, and wound tension, to name a few.”

At the start

Approaches to wound care depend on where the wound originates and its severity, according to Jeffrey Werber, DVM, with Century Veterinary Group in Los Angeles.

For example, simple superficial wounds often can be treated by cleaning them with mild soap and water, dabbing them dry, and applying an antibacterial spray, cream, or ointment. However, deeper, more severe wounds require a veterinary exam, as the animal could be suffering internal damage, as well.

“I’m in no rush to close bite or dirty wounds (those that have been contaminated with external factors such as mud, rust, metallic, or plant debris) that could cause larger infections,” said Dr. Werber. “If I anticipate infection, I wait a few days until the wound has been cleaned and inspected thoroughly, and I put the pet on antibiotics, etc., before putting in a drain and closing the wound.”

If the wound is gaping or has a large exposed area with a hanging or missing patch of skin, Werber will cover the exposed area or temporarily tack the skin flap to protect the exposed area.

There are key points for dealing with any wound, no matter its size, said Mandy L. Wallace, DVM, MS, DACVS-SA, assistant professor, small animal surgery at the University of Georgia.

“First, examine the patient thoroughly to determine whether they are stable,” said Dr. Wallace. “Many of these patients have just experienced significant trauma, whether that is being hit by a car or being in a dog fight. Failing to triage the patient early in the examination could cause a patient to decompensate quickly.”

Second, if the patient is stable and the veterinarian believes it’s appropriate, heavy sedation or even general anesthesia can be helpful for initial wound management, as it allows doctors to carefully evaluate all wounds without worrying about causing additional pain to the patient, she added.

“Third, clip a wide area around the wounds to ensure you don’t miss any additional damage and to allow thorough evaluation of all wounds,” Wallace said. “Having a small sterile pack with a drape, a few hemostats, a needle driver, thumb forceps, and a scalpel handle available is an efficient way to ensure you have everything you need at once for wound evaluation.”

Vets should not be afraid use a scalpel blade to connect two puncture wounds to allow better evaluation of a pocket that may have been created during the trauma, as one can always close that wound later, and it will allow better visualization to remove debris within the wound pocket, Wallace said.

One of the most important points of wound management is performing a thorough lavage with sterile saline or LRS, she added, as this is a veterinarian’s best opportunity to thoroughly clean the wounds and prevent infection.

“After the lavage is complete, a sterile wet to dry bandage can be applied,” Wallace said. “I would not recommend closing contaminated wounds like dog bite wounds on the day they occur, as that can trap bacteria within the closed wound and lead to infection. Clean lacerations that come in soon after the trauma has occurred may be able to be closed that day after lavage has
been performed.”

New trends emerge

In the past several years, veterinary medicine has seen an increase in the availability of products used in human medicine to improve wound management.

“Twenty years ago, we applied moist antibacterial dressings from beginning to end,” said Weronko. “Today, new enzymatic cleansers and autolytic dressings are used in the inflammatory phase to help to debride and decontaminate wounds more effectively. As the wound becomes cleaner and moves into the proliferative phase, other dressings are available that provide a moist environment that encourage epithelial migration and healing.”

One of the most important points of wound management is performing a thorough lavage with sterile saline or LRS, as this is a veterinarian’s best opportunity to thoroughly clean the wounds and help prevent infection.

The University of Wisconsin recently released a study that advocates for veterinarians to open a cavity to check for internal bleeding in cases of penetrating wounds, such as deep bite or stab wounds. The thought is that, although not evident on a radiograph, internal damage equally as severe to the intestine or an organ could be present and is best determined by sight inspection.

“There are other, less aggressive ways to check for blood loss, such as an abdominal tap, an ultrasound, or a scope (if available), or monitoring for signs of a progressing anemia,” Werber said. “As the field continues to evolve, we’ve learned there are some practices, such as using hydrogen peroxide for wound cleaning and disinfecting, that are less effective than originally thought. On the other hand, there also are some newer products, such as liquid bandages, as well as new surgical options, that are becoming increasingly popular.”

Another significant change from the past few years is the increased incidence of multidrug-resistant bacteria in wounds. Some veterinarians are using such substances as honey, sugar, or silver-based dressings that can be effective against these bacteria even when antibiotics are not, according to Wallace.

“These are developing both from infections obtained from the environment as well as from hospitals,” she said. “Always wear sterile gloves when changing bandages or dealing with these wounds once they are in your practice. This way, we can limit the potential of introducing bacteria into the wound.”

Additionally, Wallace said, establishing a dedicated area within the practice for changing bandages on wounds containing multidrug-resistant bacteria helps prevent spreading it within a practice.

Another subject of recent interest is using platelet-rich plasma (PRP) created from the dog’s own blood using one of several PRP systems that concentrate the platelets present within the whole blood into the plasma.

“The concept behind using PRP is that it contains growth factors and cytokines that may increase healing potential within the wound,” Wallace said. “While several studies have been performed evaluating the effect of PRP on skin wound healing, the majority have been performed in surgically created wounds and have had some variability in the results obtained. More studies are necessary in evaluating the effect of PRP on traumatic wounds and infected wounds before we can say if this option really does promote wound healing.”

Wound care

In recent years, veterinary medicine has seen an increase in the availability of products used in human medicine to improve would management.

When caring for a wound that is already present, less is more in applying anything topical, Werber said.

“Sprays that are water-based are generally better to use, as alcohol-based products may sting an open wound,” he said. “Although alcohol is helpful and often used when prepping for surgery, but it can damage open, exposed tissue. Of course, it’s essential to prevent the dog from licking, scratching, and rubbing the wound, which can cause further irritation.”

Caring for wounds from cat bites generally are more apt to cause severe infection than bites from dogs.

“I treat a patient more aggressively if I know that a cat delivered the bite,” Werber said.

He added that when owners limit the likelihood of their dogs developing wounds, they can minimize complications and infection.

“Many owners don’t realize that dogs often inflict wounds on themselves for multiple reasons, the main reason being allergies,” he said. “For dogs, scratching is the No. 1 sign of allergic skin disease. If left untreated, the scratching can lead to open wounds that can become infected. Apoquel can help ensure their dog doesn’t cause a self-inflicted wound from excessive rubbing or scratching.”

Many surgical interventions have been developed to cover large-scale wounds that cannot heal on their own and have seen great success, such as skin grafts and wound flap advancement, Weronko said.

“The old myth involving letting ‘pets keep their own wounds clean’ has often been recognized as negatively impacting wound healing,” she said. “Our ability to handle and heal major wounds, which previously would have been life threatening, has increased exponentially by using proper wound care management on  all species.”

 

One thought on “The importance of adopting best-practice wound management techniques

  1. Tell me please. What is your
    opinion to Plasma Vet medicine? Does US veterinary medicine use commercial sources of nonthermal plasma?
    Sincerely, Natalia

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