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 40 characteristics can give the impression of infection, they are normal properties of these gels (Figure 8). The wound and patient should always be examined for signs of infection, such as redness, swelling, pain, purulent discharge, and fever. In the absence of such signs, the bandage change can proceed as planned. If infection is present, MWH should still be used to support WBC function, with the dressing choice adjusted, if needed, to handle a higher exudate level. Timing of Dressing Changes The clinician new to MWH may initially feel uncomfortable waiting multiple days between bandage changes. One way to handle this concern is to, using aseptic technique, unwrap the bandage and look at the dressing in the wound. Upon noting, for example, that a calcium alginate or polyurethane foam dressing is not yet saturated, or that a hydrogel is still moist, the dressing is left in place and bandage replaced. After examining dressings for a few patients, the clinician becomes familiar with the behavior of MRDs and comfortable with the longer intervals between bandage changes. Increased Cost of MWH Some clinicians may hesitate to use MRDs because the dressings themselves cost more than gauze or other dry dressings. However, the most cost effective dressing is the one that results in lowest overall cost of care. 10 The overall cost of treating a wound with MRDs is lower than with traditional wet-to-dry or dry dressings for several reasons, including faster healing time, less frequent bandage changes (and, thus, lower material and labor costs), and less need for sedation during bandage changes. 8-10 MRD = moisture-retentive dressing; MWH = moist wound healing; WBC = white blood cell FIGURE 13. Nonhealing axillary wound—that had dehisced after each of several attempts at closure—in a cat. Prior to this image, the wound had no granulation tissue and a moderately high exudate level; thus, it was bandaged with a polyurethane foam dressing. At the time of this image, the wound required additional granulation tissue and epithelialization. Because the exudate level had decreased to a moderately low level, a polyurethane foam dressing—premoistened with saline before application—was used. The wound healed without requiring surgery. FIGURE 14. Wound on the medial tarsus of a dog's limb that is producing a moderate level of exudate; granulation tissue is present but the wound requires epithelialization. Hy- drocolloid or saline-moistened polyurethane foam are appropriate dressing choices. FIGURE 15. Degloving wound—that has been lavaged and debrided—on distal limb of border collie dog; residual moisture from the lavage can be seen. Due to the wound's dry nature, a hydrogel dressing was selected.

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