Today's Veterinary Practice

JUL-AUG 2015

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com MoisT Wound Healing: THe neW sTandard of care Peer reviewed 34 OPEN WOUND MANAGEMENT Open wound management includes covering the wound with an appropriate dressing and bandage; it does not mean the wound is left open to the environment. The goal of open wound management is to work synergistically with the cells, providing the best environment possible to support the body's wound healing process. In some cases, open wound management may be continued until the wound closes on its own (second intention healing); this is appropriate when: • Healing is progressing well • Reconstructive surgery is not needed to prevent contracture or scarring that might inhibit mobility or be cosmetically unacceptable • The patient tolerates bandaging. Wet-to-Dry Bandages Wet-to-dry bandages involve placing saline-soaked gauze pads on the wound, then removing them after the bandages have dried and adhered to the wound. Although once a traditional choice in human and veterinary medicine, wet-to-dry bandages are no longer the standard of care because they compromise wound healing in many ways (Table 1). 1,7-11 Moist Wound Healing Moist wound healing (MWH) is now the standard of care. 1,4,7,9,11 Moist—not soaking wet or dry— wound healing techniques can be achieved with MRDs, and numerous studies confrm the benefts of MRDs compared with traditional wet-to-dry or dry dressings (Table 1). 4-6,9,12 Choice of MRD is based on the specifc needs of the wound at that point in time (eg, debridement, granulation, epithelialization) and amount of exudate the wound is likely to produce: • During the infammatory/debridement phase, the chosen MRD should support selective autolytic debridement by WBCs and function of cytokines that signal the repair phase, as well as be able to absorb the exudate generated by that debridement. • During the repair phase of healing, the chosen MRD should support function of growth factors and fibroblasts, endothelial cells, and epithelial cells responsible for granulation, epithelialization, and contraction, while either removing exudate or adding moisture back to the wound, if needed. 4,5,9,12 Occurrence of Infection A common concern raised about MRDs is whether they favor bacteria. Studies demonstrate that rates of infection with plain MRDs are no greater than, or signifcantly less than, rates of infection with traditional wet-to-dry or dry dressings. 5,9,13 Reasons that MRDs do not increase infection rates include: • WBCs and their bacteria-fighting proteases function best in a moist environment. • Less desiccated tissue, which serves as a medium for bacteria, is present. • The occlusive or semi-occlusive nature of MRDs decreases oxygen tension and pH, conditions that attract WBCs, stimulate angiogenesis and collagen formation, and inhibit bacteria. • MRDs better protect against exogenous bacteria because they are more occlusive than gauze and do not need to be changed as often as wet-to-dry or dry dressings. 5,9,13 MRDs impregnated with antimicrobial substances, such as honey, silver, or zinc, may be benefcial in infected wounds. 4,7,14 Types of MRDs Many MRDs are available (Table 2). In my experience, the clinician can manage most companion TablE 1. Wet-to-Dry Versus Moisture-Retentive Dressings WET-TO-DRY BANDAGES MOISTURE-RETENTIVE DRESSINGS • Macerate (overhydrate); then desiccate wound bed, compromising function of cells involved in wound healing • When removed, much-needed cells and tissue, such as WBCs, granulation tissue, and new epithelium, along with necrotic tissue, are pulled off (nonselective mechanical debridement) • WBCs migrate into the open-weave dressing • Environmental bacteria can penetrate gauze • Cause discomfort when worn and when removed • Remnants of gauze fber remain in the wound, resulting in infammation • Increase costs for total wound care • Allow healing to progress 24 hours a day because wound does not dry out • Remove excess exudate • Maintain contact between wound fuid and wound, allowing patient to beneft from normal balance of prohealing factors during each healing phase • Promote optimal function of cells and proteases, which orchestrate healing • Stimulate faster healing with lower infection rates • Require less frequent bandage changes and are more comfortable during, and in between, bandage changes • Eliminate disadvantages of wet-to-dry bandages • Decrease costs for total wound care

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