Case workshop: Complex wounds and complications of wound healing

Describe the wound - 'badger bite' - and what are your next steps

- sloughing

- necrotic

- old wound

- create a healthy granulation tissue bed - through surgical debridement under GA

- irrigate the wound

- this wound has been closed using suture, but over time devitalised skin has revealed itself. you should remove the sutures

- wet to dry dressing - means of debriding.

what is the skin like in bite wounds

Necrotic skin doesn’t reveal itself for a few days with bite wounds

May only see the punctures and so want to close the wound but this wasn’t the right decsision -> necrotic skin has revealed itself

describe this wound, its factors and next steps

poor blood supply→ cannot graft

skin wont epithelialise over exposed periosteum

bone shows granulation tissue growth

faraging to promote granulation over exposed bone can be used

wet- dry dressing - secure

what is faraging

 

Drill into exposed periosteum

Releases cytokines that promote granulation tissue

 

There isnt much you can do with wounds where periosteum is exposed without faraging

after faraging what can be done to this wound

Wet to dry dressing on awkward to dress place eg the chin

Loops of suture place around the wound

Use the loops to tie on wet to dry dressing itself

 

how old is this wound

7-10 days

what do you think of this granulation tissue

more red and shiny

should bleed if healthy

this is too pale

how often do you change wet-dry dressings

every day - with heavy sedation or anaesthesia - pain

what are the disadvantages of wet to dry

Needs changing every 24 hours, but is cheap

Saline inexpensive too

Stressfull for the dog, painful

Often require sedation, maybe ga

how are you going to promote epitheliasation after granulation has occurred

free skin graft

• This would need holding in place and being dressed, don’t want fluid to lift it off, need contact between the graft and wound bed

• Need it to take

pinch or punch

heal by second intention - not cosmetically ideal

subdermal (random) single pedicle advancement flap

what would your concerns be for this flap?

long flap, long pull - tension - highest = furthest point from start of flap

wound breakdown = jaw

blood supply - base needs to be wider than the tip to maximise supply

if theres a little breakdown - you could leave to heal by 2nd intention, but not large scale

describe this wound

granulation tissue

epithelial tissue

sloughing

lots of movement

not good blood supply

not granulating over foreign body

infected

what is this main reason for the chronic non-healing wound

• Periosteal elevation

• Soft tissue swelling

• bone fragment - acting as a foreign body

  • debride thoroughly

  • flush

describe this wound

dehisence

inflammation

infection

lots of tension - conversion from circular wound to linear - not loose skin

high movement area

owner complience?

describe this wound and your steps to managing it

heal by secondary intention

clean granulation tissue and epithelialisation

right wound - slightly over granulated

some part of wound has broken down but is healthy