Originally published in the October 2014 issue of Veterinary Practice News
In the opinion of Sam Franklin, MS, DVM, Ph.D., Dipl. ACVS, wound healing is all about the phases of an injury.
Dr. Franklin, an assistant professor of small animal orthopedic surgery at the University of Georgia College of Veterinary Medicine and a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, emphasized that effective management of wounds “really requires just three general things.”
To start with, it requires that a veterinarian know the healing phases. Each phase is “well defined and well described” in textbooks and articles, he said, and any practitioner interested in managing wounds can and should learn them.
“There are only four or five phases—depending upon the source consulted—and so learning about them is very feasible,” Franklin added.
Additionally, a practitioner should be capable of evaluating a wound and accurately determining what stage of healing it’s in, he said.
Finally, “As the wound progresses to the next step of healing, the practitioner then adjusts to the next set of treatments or bandages that are appropriate for that phase,” Franklin said.
Forget the goop. That’s the advice from Randy Lynn, DVM, MS, Dipl. ACVP.
“Just about every veterinary clinic has a tub of some sort of goop they like to put in a wound,” said Dr. Lynn, manager of technical services at Merck Animal Health. “While that makes you feel good about smearing it in the wound, many of those products actually interfere with the cellular process.”
Lynn said that cells drive the healing process and that petroleum jelly products or products containing petrolatum, while popular with many practitioners, are not good for cells.
“It’s the cells in the area of the wound that actually conduct the healing,” he said. “Anything that we can do to help those cells do their job is going to facilitate proper wound healing.”
He prefers basic measures such as maintaining a clean environment around the wound, removing all foreign debris, proper cleaning of the wound, using an appropriate dressing to keep a wound from drying out, and providing a dressing that removes tissue fluids. He also advised steering clear of cleaners that damage cells.
Some who are heavily involved with wound care caution that one of the biggest problems in the field is marketing hype and consumers who buy into it.
Georgie Hollis, BSc, founder of the Veterinary Wound Library and secretary of the U.K.-based Veterinary Wound Healing Association, believes the practice of wound healing has become murky, especially with pet owners who buy into commercials instead of making more visits to their veterinarian’s office.
“Some of the best wound specialists are sadly not courted by the companies as they rely less on products than addressing the needs of the wound as the physiology progresses,” Hollis said. “The search for the one product to fix all wounds will go on, but the companies behind them can dodge regulation to allow animal owners to believe it is a possibility.”
Just the Basics
There is no shortage of basic sources on wound care. The Merck Veterinary Manual offers these step-by-step recommendations:
- Wound lavage: to wash away both visible and microscopic debris.
- Debridement: It may be done in layers or as one complete section of tissue. “Tissues that have questionable viability or are associated with essential structures such as neurovascular bundles should be treated conservatively,” the manual states.
- Wound closure: Although primary closure is considered the simplest method of wound management, it should be used only in ideal situations to avoid complications.
- Open wound management: Some wounds cannot or should not be closed, including those in which the loss of skin makes closure impossible or those too grossly infected to close.
The manual also addresses sugar dressings, which it notes have been used as an inexpensive wound dressing for more than three centuries, and another long-time favorite, honey dressings—though the manual notes the honey must be unpasteurized.
“Manuka honey may be the best option for wound care,” the manual states.
“The contact layer wound dressings should be soaked in honey before application,” it adds. “The bandage may be changed daily or more frequently as needed.”
One relatively new technique that improves the wound-healing process that Franklin likes is negative pressure therapy.
“Negative pressure wound therapy has been demonstrated to have some benefits in hastening granulation tissue formation in comparison to traditional open wound management techniques,” Franklin said.
Negative pressure therapy is in its infancy in veterinary medicine. Effusive wounds and skin defects are among ailments the therapy may be used to treat.
The therapy’s effectiveness was noted in the study “Negative Pressure Wound Therapy: Experience in 45 Dogs,” which was published this year by Kathryn A. Pitt, BS, DVM, MS, and Bryden J. Stanley, BVMS, MVetSc, Dipl. ACVS.
In the ACVS study, most of the wounds, which were largely traumatic in origin, were closed surgically after negative pressure therapy and were healed by 14 days.
“NPWT [Negative Pressure Wound Therapy] is applicable to a wide variety of canine wounds, is well tolerated, allows for several days between dressing changes, and can be used to optimize the wound bed for surgical closure or second intention healing,” the authors note in their conclusion.
The Michigan State University department of small animal clinical sciences conducted a 2011 study of the effects of NPWT on the healing of open wounds in dogs. The researchers noted that granulation tissue appeared significantly earlier, and was smoother and less exuberant in NPWT wounds, compared with standard wound dressings.
However, the study noted that prolonged use of the therapy “impaired wound contraction and epithelialization.”