Treatment Options for Wounds in Small Animals

what is surgical wound debridement

remove biofilm and devitalised tissue

what is mechanical wound debridement

-irrigation

-wet to dry dressing

-negative pressure wound therapy

what is autolytic wound debridement

-body's own enzymes beneath a dressing to liquefy tissues

-hydrocolloids, hydrogels, honey, foam, etc

what is enzymatic wound debridement

prescribed topical agent that chemical liquifies necrotic tissues with enzymes

what is biological wound debridement

-maggots

-luilia sericata (green bottle fly)

surgical wound debridement steps

-remove devitalised (necrotic, infected) tissue

-scrape outer surface of granulation (chronic granulation)

-preserve vital structures

what is chronic granulation tissue

wound gets stuck at this stage so need to scrape the outer surface of granulation tissue away -> then can go onto heal

how do you lavage debride a wound

• lactated ringers (hartmanns)

• 0.9% saline can be used

• fluid at body temp

why is hartmanns used for debridement

• ideal pH and compatible with tissue

how much fluid should be used for lavage debridement on new wounds

high volume

what syringe and needle is used for lavage debridement

-20-35ml syringe

-18G needle=7-8 psi

when should wet to dry debridement dressing be changed

-change every 24 hours

when can wet to dry debridement be used

-used on chronic granulation

Can then manage the healthy granulation bed after this

why do we debride wounds

Remove particulate matter and lower bact load

Getting the wound into a healthier state for wound closure or dressing

what do we have to be careful of when debriding wounds

we are trying to push out and move away, not push things into the wound

how do you apply wet to dry dressing

• Take sterile swabs and soak in isotonic crystalloid solution (hartmanns)

• Wring them out so arent dripping wet

• Place directly onto wound

• Place dry swabs on top

• Conforming layer

• Vet wrap/ bandage layer

how often are wet to dry dressing changed

Changed every 24hrs

how does topical negative wound therapy work

• when turned on, pump gently reduces air pressure beneath dressing, drawing off exudate and reducing oedema in surrounding tissue

why topical negative pressure wound therapy

-reduces bacterial colonisation

-promotes granulation tissue development

-increases rate of cell mitosis

-spurs migration of epithelial cells within wound

what else is needed for topical negative pressure wound therapy

waterproof airtight coating around outside

honey for debridement

-antibacterial

-healing stimulating

-debriding

-anti inflam

-odour reducing

-reduction in wound pain

-osomotic effect

how does honey have healing stimulating properties

r•eduction in wound size, healing time, complete healing, stimulation of granulation tissue and epithelialisation

how does honey debride wounds

•Low pH (approx. 3.7)

•Osmotic effect

•Both help draw up fluid from the wound area → debride at same time

how does honey have antimicrobial agents

• Hydrogen peroxide (due to glucose oxidase)

• Anti-oxidant (due to flavonoids)

• High sugar content (so gives osmotic effect)

• Acidic (pH 3.2 - 4.5)

• Methylglyoxal (Manuka honey)

  • It’s potency as an antimicrobial can be measured by the Unique Manuka Factor® (UMF®)

  • +15 will ensure potent antimicrobial properties over and above those of standard honey

can regular/ table honey be used

• Might not be sterile (e.g., Clostridium)

• High sugar content (osmotic effect)

• Acidic (pH 3.2 - 4.5)

• The production process might have an adverse effect the activities of

  • Hydrogen peroxide (glucose oxidase)

  • Anti-oxidant (flavonoids)

• so may grow other bacts

how long is topical negative pressure wound therapy left in for

Left insitu for 48-72hrs before needing to be change

what does a higher methylglyoxal amount in manuka honey mean

higher its unique manuka factor

So has higher antimicrobial factor

what is biological debridement

using maggots

speed to effect of debridement methods (fastest to slowest)

-scraping with scalpel

-maggots

-negative pressure wound therapy or wet to dry dressing

-flushing with hartmanns

-amorphous hydrogel or honey or foam dressing

expense of debridement treatment (most expensive to least)

-negative pressure wound therapy

-maggots

-amorphous hydrogel or honey or foam dressing

-flushing with hartmanns or wet to dry dressing

-scraping with scalpel

what are the best methods of debridement

• scraping with scalpel blade

• wet to dry dressing

what are the negatives of using maggots to debride

Don’t recognise healthy from unhealthy tissue

Can go off the wound

Not nice to look at