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UNIQUE THERAPIES FOR DIFFICULT WOUNDS | Application 1. Lavage & Debridement: See Wound Preparation. 2. Application: Acetic acid is applied directly onto the wound or soaked into the primary bandage layer prior to application. 3. Bandaging: After acetic acid has been applied to ÌhiÊ ÜoÕn`]Ê }>ÕâiÊ oÀÊ >Ê non>`hiÀinÌÊ `ÀiÃÃin}Ê iÃÊ added. By using an absorptive secondary layer, the acetic acid becomes the base of a wet-to-dry ban- dage and provides antibacterial effects topically. Alternatively, using a nonadherent or occlusive secondary layer helps keep the acetic acid on the wound for prolongation of antibacterial effects but does not mechanically debride it. The remainder of the dressing continues as it would for a standard modified Robert Jones bandage. Disadvantages Common canine and feline ear cleansers contain- ing acetic acid are frequently used. However, their concentrations may vary, which affects efficacy. They also lack broad-spectrum efficacy and have a narrow safety margin compared to commonly used solutions, ÃÕVhÊ>ÃÊVhloÀhiÝi`iniÊ>n`Ê«oÛi`oniÊio`ini°8 However, VhloÀhiÝi`iniÊV>nÊLiÊiÀÀiÌ>Ìin}Ê>n`Ê«oÛi`oniÊio`iniÊiÃÊ inactive in organic material and can cause sensitivity/ allergy issues in some patients, providing a place for both acetic acid and Dakin’s solution (see below) in wound therapy. DILUTED SODIUM HYPOCHLORITE SOLUTION 0.5% When initially discovered, sodium hypochlorite’s com- position was unknown, but its bleaching and dis- infecting properties were noted. A diluted sodium hÞ«oVhloÀiÌiÊÃolÕÌionÊ >kin½ÃÊÃolÕÌion®Ê>ÌÊä°x¯ÊVon- centration has: UÊ i}hÊ}iÀmiVi`>lÊ>VÌiÛiÌÞ MAKING DAKIN’S SOLUTION (0.5%) 5IF JOHSFEJFOUT SFRVJSFE UP NBLF %BLJO T TPMVUJPO JODMVEF UBQ XBUFS CBLJOH TPEB BOE IPVTFIPME CMFBDI #PJM DVQT PS UÊ oÊiÀÀiÌ>Ìin}ÊVonÌ>min>nÌÃ°Ê At this concentration, it may be applied continuously voÀÊ>ÊÇÊ`>ÞÃÊÜiÌhoÕÌÊ iÀÀiÌ>Ìion°12 Studies have shown Ìh>ÌÊ>Êmo`ivii`Ê >kin½ÃÊÃolÕÌion]Êä°äÓx¯]ÊiÃÊÌhiÀ>«iÕÌi- cally as efficacious as a fluid dressing. At this concentra- tion, the solution preserves its bactericidal properties and is not detrimental to wound healing.13 concentration, the solution is effective against gram positive and negative bacteria, fungi, and viruses.8 Application 1. Lavage & Debridement: See Wound Preparation. 2. Application: Similar to vinegar, Dakin’s solution may be applied directly onto the wound or soaked into the primary bandage layer. 3. Bandaging: The remainder of the dressing is applied as you would to create a wet-to-dry bandage. 4. Length of Application: Application of Dakin’s solu- ÌionÊiÃÊ ÀiVommin`i`ÊvoÀÊ ÇÊ`>ÞÃÊoÀÊ liÃÃ°Ê ÌÊ iÃÊivvi- cacious against bacteria, but will not debride the wound, encourage macrophages, relieve edema, or provide anti-inflammatory properties. Disadvantages Similar to vinegar, disadvantages of Dakin’s solu- tion are its limited spectrum of efficacy and narrow Ã>viÌÞÊm>À}inÊÜhinÊ Vom«>Ài`Ê ÌoÊ VhloÀhiÝi`iniÊ >n`Ê povidone iodine.8 MAGGOT THERAPY In the early 1800s, it was accidentally discovered that maggots prevented infection and accelerated wound healing in soldiers with battle injuries. They were intentionally introduced into wound management ÃhoÀÌlÞÊ>vÌiÀÆÊhoÜiÛiÀ]ÊiÌÊÜ>Ãn½ÌÊÕnÌilÊÀiVinÌÊÞi>ÀÃÊÌh>ÌÊ their popularity increased in human medicine due to increasing antimicrobial resistance.11,15 Maggot therapy refers to the application of disinfected fly l>ÀÛ>iÊÌoÊ>ÊÜoÕn`ÆÊëiViviV>llÞ]ÊÌhiÊVommonÊ}ÀiinÊLoÌÌliÊ fly, Lucilia sericata. Common applications include:££]£È]£Ç UÊ iLÀi`iminÌÊovÊniVÀoÌiVÊÌiÃÃÕi UÊ nviVÌionÊ VonÌÀolÊ miVÀoLi>lÊkillin}ÊEÊ>nÌivÕn}>lÊ activity) PVODFT PG UBQ XBUFS JO B DMFBO QBO XJUI UIF MJE PO GPS NJOVUFT 3FNPWF UIF QBO GSPN IFBU 6TJOH B TUFSJMF NFBTVSJOH TQPPO BEE ½ UFBTQPPO PG CBLJOH TPEB BOE PVODFT PS N- PG CMFBDI 1MBDF UIF TPMVUJPO JO B TUFSJMF KBS DMPTF UIF MJE UJHIUMZ BOE DPWFS UIF FOUJSF KBS JO BMVNJOVN GPJM UP QSPUFDU JT GSPN MJHIU 5ISPX BXBZ BOZ VOVTFE QPSUJPO IPVST BGUFS PQFOJOH 6OPQFOFE KBST DBO CF TUPSFE BU SPPN UFNQFSBUVSF GPS NPOUI BGUFS QSFQBSBUJPO UÊ-ÌimÕl>ÌionÊovÊ}À>nÕl>ÌionÊÌiÃÃÕi° Although little is known about specific advantages and disadvantages of maggots in veterinary wound m>n>}iminÌ]ÊinvoÀm>ÌionÊiÃÊiÝÌÀ>«ol>Ìi`ÊvÀomÊhÕm>nÊ Ài«oÀÌÃÉÀiÃi>ÀVh°Ê nÊ >``iÌion]Ê iÝ«iÀiinVi`Ê «À>VÌiÌio- ners report that maggot therapy is beneficial and safe.£È Application 1. Obtaining maggots: Medical maggots are easily accessible and can be obtained from distributers in the U.S., such as Monarch Labs (monarchlabs.com). 2. Application: The number of maggots needed for ÌÀi>ÌminÌÊÛ>ÀiiÃÊL>Ãi`ÊonÊÜoÕn`ÊÃiâiÊ>n`Ê>moÕnÌÊ of necrotic tissue. 3. Bandaging: A porous bandage should be placed to July/August 2011 Today’s Veterinary Practice 15 Ê ÌÊ>Êä°Óx¯Ê