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1 Wound management, bandaging Dr. Csébi, Péter SZIE ÁOTK Surgical Dep Wound types laceration, contusion (bruise), penetrating, bite, shearing, burn etc. Wound types by the degree of contamination Clean Clean-contaminated contaminated Contaminated Dirty Grading by time: Grade 1 : Mild contamination, fresh wound in the first 6 hours ( golden period ) Grade 2: Moderate contamination, 6-12 hours Grade 3: Severe contamination, after 12 hours Wound healing 1
2 Before we do any wound treatment: Use sterile gloves (MRSA, MRSI)! First stabilise the patient s vital functions in traumatic cases! Iv. catheter, fluid resuctitation, analgesia, oxygen etc. First aid: (0. Muzzle the dog!) I. Stop the bleeding! Pressure bandage Arterial compression proximally II. Keep the wound moist with saline soaked sponges III. Cover the wound with sterile bandage material or at least with any kind of clean dressing to prevent further contamination Wound treatment step-by-step: 1. Clip the hair Clipping with wide margines Prevent the wound from fur contamination! Cover the wound with saline soaked sponge or K-Y jelly before clipping 2. Wound lavage Lavage the wound with copious amount of sterile fluid! Use: Saline, Ringer or Lactated-Ringer Do not use!: Antiseptics (Betadine, Hydrogen-peroxyd peroxyd, alcohol etc.) These are toxic for the cells! 2
3 3. Disinfection around the wound Betadine or Clorhexidine on the normal skin surface 4. Debridement Necrotic tissue must be removed! Proper anaesthesia is necessary. Must be done as an aseptic surgical procedure! Surgical Autolytic Enzymatic Larvae 5. Wound closure or bandaging? Grade 1: primary closure Grade 2, 3: delayed closure after initial open wound management or second intention wound healing Delayed primary closure (2-5 days later) Secondary closure (closure with complete excision of the healthy granulation tissue) Drain Primary closure is contraindicated with rare exceptions in case of: Penetrating wound Bite wound Large contused wound Penrose-drain Closed-suctionsuction drain 3
4 Most common microbes in wounds: Staphylococci- and Pseudomonas-sp sp. Microbiological examination is recommended! AB treatment should be based on culture and sensitivity results! Inproper use of ABs result in multiresistant bacterias!! Bandaging Why?: Immobilisation Protection Decrease pain, oedema, bleeding Facilitate wound cleaning Decrease dead spaces Bandaging Layers: Contact layer (sterile gauze or others) Intermediate absorbing layer (cotton, absorbing pads) Outer layer Dry wound management Dry-to-dry Cleaning up Wet-to-dry Cleaning up Contact layers Moist wound management Calcium-alginate, Foam Cleaning up with heavy exsudate Hydrogel or hydrocolloid Clean granulation tissue, dry wound Alginate Alginate + Foam 4
5 Hydrocolloid, Hydrogel Other special contact layers Silver impregnated dressing Iodine impregnated dressing Paraffin or other cream impregnated dressings Activated charcaol impregnated dressing Manuka honey impregnated dressing Topical wound treatment: Triple antibiotic cream: Bacitracin, Neomycin, Polymixin B to prevent an infection; not effective against Pseudomonas sp. Silver-sulphadiazine cream: antiseptic effect with wide spectrum. Recommended on burns and decubital ulcers. Nitrifurazon (Furacin): antiseptic effect with wide spectrum. Recommended on exsudative wounds. Sugar: hyperosmotic, good efficacy on heavily exsudative, septic wounds during the cleaning up. After initial wound management 1 cm thick sugar layer should be powdered on the the wound surface. The wound should be lavaged and resugarised in every 4 hours to keep it s antibacterial effect. Aloe Vera: burns, Pseudomonas infections. Creams to help epithelisation 5
6 Manuka honey - metilglioxal Complications of bandaging Pressure sores Infection, Maceration, Swelling - necrosis Modified Robert-Jones bandage Bandage has to be checked and changed regularly to prevent complications! 6
7 7
8 Tie-over bandage Pressure-reliefrelief bandage Special bandages Thank you for your attention! Furher readings: Fossum: Small Animal Surgery Textbook, Swaim: Wound Management, An Issue of Veterinary Clinics: Small Animal Practice, BSAVA Manual of Canine and Feline Wound Management and Reconstruction, Swaim: Small Animal Bandaging, casting and splinting techniques, Web: Veterinary wound management society Veterinary wound healing association 8
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