Small Animal Wounds

where does a wound often get stuck

at granulating

how do you describe the stage a wound is at

Describe the stage of wound healing  by the colour

what colour is necrotic

back

what colour is sloughy

yellow

what colour is granulating

red

what colour is epithelialisation

light pink

at sloughing

dry out as overly wet

at granulating and epithelialising

add dressing with moisture as dry

recent trauma presents as

-between granulating and sloughing

-following haemostasis observations will move to left. as inflam ensues, WBCs become active and slough and exudate increase as result. as proliferation begins, wound progresses towards right again

-if deteriorating, wound will stay towards left

-improving wounds should progress to right

options with healthy granulation bed

-secondary intention healing

-tertiary intention healing

-bring in new epithelium with pinch/punch graft or free skin graft

key to wound healing

healthy granulation bed

where does epithelisation come from

 epithelium

what is the main aim in chronic wound

• get to state of healthy granulation bed in chronic wound

• Bc then have options

what must be done to necrotic tissue

debride to remove it

what happens to the wound at epithelialisation

wound contracts and gets smaller

what has happened here

Has been undermined and placed over

So will heal quicker than leaving for secondary intention

The costs might be less

why might we choose not to dress wounds

can be costly and means lots of trips to vet so stress

what are pinch/ punch grafts and why

• use tool

• Take subcut fat off it and place into granulation tissue

• Bringing more epithelium-> epithelisation is quicker bc epithelium edge is bigger

pinch/punch grafts indications

Indications:

- granulating wounds

- small wounds

- contaminated wounds or low grade infection

- wounds over areas not requiring durability

- irregular contour

-Bed pockets: 2-4 mm deep, 5-7 mm apart with scalpel blade

- Pockets for punch: 1-2 cm apart, 4mm bx punch

- change first bandage 3-4 days post-op

why make small holes in free skin grafts

Holes to drain excess fluid out

pinch/punch grafts advantages

- quick, easy
- take easy and reliable
- less invasive
- easy wound drainage
- irregular surface

pinch/punch grafts disadvantages

Disadvantages:

- XS bleeding may float graft out or delay revascularization

- poor cosmetic appearance

- remainder of recipient bed covered with neoepithelium from keratinocyte proliferation and migration -> delicate epithelium

wound care product selection

-topical therapy

-continually reassess patient and wound

-remain up to date with products so informed decisions made

wound dressings that absorb moisture

-alginates

-specialty absorptives

-gauze

-foams

-hydrocolloids

-wound fillers

-honey

wound dressings that maintain existing moisture levels

-composites

-transparent films

-biologicals

-collagen dressing

-contact layers

wound dressings that add moisture

-sheet hydrogels

-amorphous hydrogels

criteria for product selection of wound dressings

-frequency of change

-ease or difficulty of dressing change procedure

-availability of products

-cost of products

-requirement for hospitalisation

-requirement for topical antimicrobial agent

what are the most likely reasons for things to go wrong when dressing wounds

-frequency of change

-requirement for hospitalisation

foam dressings

-absorbent, sponge like polymer dressings (hydrophilic polyurethane)

-provide thermal insulation

-help create moist wound environment

-allow gas exchange

-impermeable to bacteria and water

can be adhesive

Rely from moisture coming from the wound and trap it

Can evaporate but is delayed

So remains moist

foam dressings suitable for

-all types of exuding wounds but NOT DRY

-some have moisture sensitive film backing with variable permeability dependent on level of exudate

foam dressings vary in ability to absorb exudate

-some suitable only for lightly to moderately exudating wounds

-others have greater fluid handling capacity and suitable for heavily exuding wounds

foam dressings under compression bandaging

-fluid handling capacity of foam reduced

-takes same volume as dressing but when compressed then less

If not allowed to evaporate -> become a wet wound

why do you need to make sure the foam dressing is on the right way round

otherwise wont work

what can saturated foam dressings cause

cause maceration of healthy skin

bc is over moist

now prone to infection

hydrogel dressings

-made up of water in polymer to maintain moist wound base

-available in amorphous or sheet formulations

-take shape of wound

-secondary, non absorbent dressing needed

hydrogel dressings used for

donate liquid to dry wound

when to avoid hydrogel dressings

in presence of infection and heavily exuding wounds

what phase best to use amorphous gels on

granulating and epithelialising

provide moisture in controlled manner

-use with foam dressing

what do you need to work out with hydrogel

Will say how much is in the tube

Eg 15g= 15ml

So need to work out how much of it you need to get the foam dressing to work efficiently

hydrocolloid paste

manage dermal wounds with light drainage

hydrocolloid gel

-used on partial and full thickness wounds

-fills dry wound cavities

-promotes autolytic debridement

clingfilm as dressing

-water vapour impermeable

-very likely to macerate

but Best way to know if things are working is to have a look b

silver ions dressing

--exudating wounds

-infectious wound

-proportional release

silver nitrates swab ointment

-easy application

-cauterise infected tissue

silver sulfadiazine cream

-serious burns

-infected wound

silver zirconium phosphate sheet like crystals

-early wound management

-kills bacteria

why use silver

has broad spectrum of antimicrobial activity

honey

-antibacterial

-healing stimulating properties (reduce wound size, healing time, complete healing, stim of granulation tissue, epithelialisation)

-debriding effect

-anti inflam effect

-odour reducing

-reduction in wound pain

honey has good debridement properties because

-low pH

-osmotic effect

-help draw up fluid from wound area

honey has antimicrobial properties due to

-hydrogen peroxide (glucose oxidase)

-anti oxidants

-high sugar content (osmotic)

-acidic (pH 3.2-4.5)

how does honey debride

Pulls fluid towards the honey -> helps debride

what is methylgloxal in manuka honey

-potency as antimicrobial can be measured by unique manuka factor

-+15 ensures potent antimicrobial properties over and above those of standard honey

• High conc of methylglyoxal= better antimicrobial effect

tie over dressing

A dressing placed over a skin graft and tied on by sutures that have been left long enough for that purpose

 put dressings over the top and use the loops to tie in the dressing

what can be placed over tie over dressing

nappy

• is absorbent layer