Today's Veterinary Practice

NOV-DEC 2013

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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HElPful TIPs for MANAgINg WouNds | healing tissue from further damage, such as self-mutilation, hospital organisms, and the outside environment. STeP-bY-STeP: CreATING AN ACTIve CLOSeD DrAIN A butterfly catheter can be converted into an active closed drain by (figure 4):10 1. Cutting off the syringe adaptor 2. fenestrating the end of the tube with a needle 3. Passing the fenestrated end into the wound. 4. Attaching the butterfly needle to a blood collection tube, which provides the vacuum for suction. Figure 4. Butterfly catheter providing active drainage after removal of a salivary gland that resulted in an excessive amount of dead space. STeP-bY-STeP: PLACING A PeNrOSe DrAIN Penrose drains are commonly placed incorrectly or in inappropriate places (figure 5). To correctly place the drain: 1. Chose the most ventral aspect of the wound for drain placement. 2. Place the proximal end of the drain in the most dorsal aspect of the wound, not outside the wound or skin. 3. We prefer to insert a monofilament nonabsorbable suture blindly through the skin, which exits from the dorsal aspect of the wound. 4. Place a mattress suture through the proximal aspect of the drain; the suture then exits the wound back through the skin where the suture is tied, securing the drain in place in the most proximal aspect of the wound (figure 6). removal is made easier by using a different color of suture to secure the drain than the color used to close the wound. 5. Place the drain in as much of the wound as possible; then create a stab incision that allows the drain to exit the wound ventrally (figure 7). 6. Monitor drains daily and remove them once drainage decreases or changes to a more serosanguineous appearance. However, do not leave drains in place for more than 3 to 5 days. tvpjournal.com Topical Agents Topical agents can be a double-edged sword: use of the correct agents at the right time is essential to healing, but application of incorrect agents at the wrong time can be detrimental to healing. • In general, topical agents, especially antimicrobial agents that have broad spectrum activity, are useful early in the course of wound management. • Other topical agents, such as honey or sugar, are best used during the inflammatory or early repair phases. Honey is a unique agent in that it has antibacterial activity, reduces edema and inflammation, and enhances granulation tissue and epithelialization. Sugar has a hyperosmotic effect, creating an antibacterial environment within wounds. Types of bandages After application of a topical agent, a contact layer must cover the wound. The type of layer and frequency of bandage changes will depend on the expected amount of exudate. Regardless, any open wound should have its bandage changed every 24 hours at a minimum. A b Figure 5. Improper placement of penrose drains: In A (dog), note the entrance and exit points, placement in an area where fecal matter can contaminate the wound, and lack of covering. In B (cat), note the entrance and exit points, longitudinal drain placement, and lack of covering. 6 7 Figure 6. Proper placement of drain (dog's head) prior to being covered; note the single exit site of the drain. A single suture at the most proximal aspect is securing the drain in place; another suture is securing the exit point of the drain. Figure 7. Proper placement of a drain (dog's neck) prior to being covered; note the single exit site of the drain (ventrally) and the new wound created for the drain's exit. Not clearly visible is the most proximal aspect of the drain, which is buried and tacked to the skin at the most dorsal aspect of the wound. November/December 2013 Today's Veterinary Practice 35

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