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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com MoisT Wound Healing: THe neW sTandard of care Peer reviewed 38 selected for the replacement bandage. Indeed, the dressing selected at the beginning of wound management is likely to be different from the dressing selected later in wound healing because exudate level and needs of the wound change over time. • During the inflammatory phase of healing, when exudate production is highest, a properly chosen MRD is typically changed every 2 to 3 days. • As granulation tissue forms, a less absorptive dressing is usually appropriate, and the interval between bandage changes may be increased up to 7 days. • A bandage change should always be performed if strike-through or soiling occurs, regardless of the time since the dressing was placed. MAKING THE CHANGE TO MWH The use of MRDs and MWH requires some adjustments for clinicians more familiar with dry or wet-to-dry dressings. Qualities of Gel Many MRDs combine with wound fuid to form a gel, and it is normal for this gel to have a slight odor, yellowish tinge, and slimy feel. While these FIGURE 9. Degloving wound on the distal limb of a small-breed dog: This fresh wound with extensive damage is expected to be highly exudative, making calcium alginate an appropriate choice (A). Granulation tissue is forming, but the wound still has a moderately high exudate level; therefore, a polyurethane foam dressing is appropriate (B ). A B FIGURE 10. A 5-year-old border collie was hit by a car and sustained a degloving wound of the distal left hindlimb with exposed bone and tendon. Granulation tissue was forming with the use of MWH techniques. Polyurethane foam was selected due to the expectation of a moderately high exudate level and need for additional granulation and epithelialization. FIGURE 11. Patient from Figure 10: The polyurethane foam dressing was pressed onto the wound to create an imprint, then cut around the imprint so that the dressing would ft in the wound bed and not overlap skin. FIGURE 12. Patient from Figure 10: Six days and 2 bandage changes after the previous images ( Figure 10 and 11) were taken, the wound had a healthy granulation bed and epithelialization was underway. A skin graft was then performed.