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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tvpjournal.com | July/August 2015 | TodAy's VeTerinAry PrAcTice MoisT Wound HeAling: THe neW sTAndArd of cAre Peer reviewed 37 underlying MRD cannot absorb and retain all of the wound's exudate. Bandaging the Wound After placement of the MRD, bandage the wound in the standard fashion with: • Cast padding: To keep the dressing in contact with the wound, absorb excess moisture, and provide protection • Conforming gauze roll: To stabilize the cast padding • Outer layer: Surgical tape or a cohesive (self- adherent) wrap, to provide pressure appropriate to the injury and keep inner layers clean. 15 CHANGING THE MRD The frequency of bandage changes depends on: 1. Amount of exudate produced 2. How well the exudate is being addressed by the MRD. The dressing should be changed before it becomes oversaturated or dries out. • Lift gel out if coherent (Figure 8), or gently lavage the gel out if not. • If the MRD has dried out and is stuck to the wound, inject sterile saline at the dressing/wound interface to release the dressing and avoid a wet-to-dry effect. Adherence of the dressing may signal that the chosen dressing was: 1. Too absorptive for the given exudate level 2. Left in place too long. In either case, a different dressing should be TablE 4. Guidelines for Dressing Selection Based on Exudate Level & Wound Needs EXUDATE LEVEL Wound Requires DEBRIDEMENT OR GRANULATION Wound Requires EPITHELIALIZATION & CONTRACTION* High Calcium alginate Not applicable; high exudate very unlikely at this phase Moderately high Polyurethane foam Polyurethane foam Moderate Hydrocolloid Hydrocolloid Saline-moistened polyurethane foam† Moderately low Hydrocolloid Saline-moistened polyurethane foam† Hydrogel Low to minimal Hydrogel Saline-near-saturated polyurethane foam† Hydrogel * Dressings with adhesive borders may slow contraction when used in the later part of the repair phase. 19 † Polyurethane foam supports epithelialization and contraction, but its strong absorptive capacity may dry out a wound with low exudate. In such cases, polyurethane foam can be premoistened with saline. FIGURE 7. Patient from Figure 5: The calcium alginate dressing and bandage were changed 39 hours later; gelled calcium alginate is seen, contoured to the surface of the wound. FIGURE 8. Patient from Figure 5: Removal of the saturated calcium alginate; the slight malodor and purulent-like appearance are characteristic of saturated calcium alginate and do not indicate wound infection. After 7 days of MWH, the wound contained a healthy granulation bed and was surgically closed.

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