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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Ó°Ê li>nin}Ê ÀoÕn`ÊÌhiÊ7oÕn`\ÊThe gel is flushed from the wound with sterile saline (see below) and the skin around the wound is scrubbed with chlorhexidine until debris is removed. Care should be taken to avoid introducing the surgical scrub into the wound as this may cause tissue damage.
Î°Ê li>nin}Ê ÌhiÊ7oÕn`\Ê Irrigating the wound with adequate volumes of a sterile, balanced electrolyte solution will help decrease bacteria and flush debris
from the wound. » The wound should be irrigated using a 20-mL syringe and an 18-gauge needle or catheter to provide the appropriate pressure.
» It is important to remember that higher-pressure irrigation can cause tissue trauma and seed bac- teria into the wound.
GLOSSARY OF TERMS UÊCoaptation: Joining 2 surfaces together (ie, broken bone, wound edges)
UÊFenestration: Creation of a new opening UÊHigh-viscosity fluid: Thick fluid that resists flow
UÊLow-viscosity fluid: Thin fluid that flows easily UÊOpen-cell polyurethane foam: Contains pores connected to each other that fill with the surrounding material (ie, fluid or air)
Wound Debridement All dead and devitalized tissue should be surgically removed from the wound by debridement ( i}ÕÀiÊÓ). This is best performed with a scalpel or sharp scissors under aseptic surgical conditions. UÊ/hiÊ ÜoÕn`Ê >n`Ê ÃÕÀÀoÕn`in}Ê ÃÕÀ}iV>lÊ viil`Ê iÃÊ draped.
UÊ iLÀi`iminÌÊiÃÊÃÌ>ÀÌi`ÊÃÕ«iÀviVi>llÞ°Ê7hiliÊ`iLÀi`i- A
THE BENEFITS OF BANDAGING The purpose of bandaging is to:
UÊProvide support to the wound and surrounding tissues
UÊImmobilize incisions under tension and skin grafts UÊFacilitate coaptation of wound edges UÊProvide protection from contaminants and, subsequently, infection.
ment of skin can be somewhat conservative, fat and muscle tissue that does not bleed should be removed.
UÊ"nViÊ ÌhiÊ inÌiÀiÊ ÜoÕn`Ê h>ÃÊ LiinÊ `iLÀi`i`Ê ÌoÊ healthy tissue, it is again irrigated under appropri- ate pressure.
A decision on closing the wound is then made. UÊ7oÕn`ÃÊÌh>ÌÊ>ÀiÊ`iimi`Êhi>lÌhÞÊ>n`ÊV>nÊLiÊVloÃi`Ê ÜiÌhoÕÌÊ ÌinÃionÊ in`iV>ÌiÊ«Àim>ÀÞÊ VloÃÕÀi°Ê"niÊoÀÊ more gravity or closed suction drains (discussed later in the text) may be required to prevent fluid accumulation in wound dead space.
UÊ vÊ ÌhiÊÜoÕn`Ê iÃÊ ÃÌillÊ VonÃi`iÀi`Ê VonÌ>min>Ìi`Ê oÀÊ if, when closure is attempted, there is excessive tension on the wound edges, the wound should initially be left "open" and, ideally, bandaged.
Bandaging Technique "nViÊiniÌi>lÊV>ÀiÊiÃÊVom«liÌi`]ÊÌhiÊVliniVi>nÊ`iÌiÀminiÃÊ the most appropriate type of bandage to apply (see /hiÊ iniviÌÃÊovÊ >n`>}in}). The most common types of ban-
dages are the modified Robert Jones bandage and the tie- over bandage. Tie-over bandages can be used anywhere on the body and are convenient for wounds occurring in areas that would preclude the use of a modified Robert Jones bandage (ie, the head, flank, or inguinal region). Tie-over bandages ( i}ÕÀiÊÎ, page 64) used for con- taminated wounds usually have:
B
Figure 2. (A) Bite wound from Figure 1; the clinician is scraping it with a #10 scalpel blade to remove dead tissue and promote granulation tissue formation. (B) Irrigation with 0.9% sodium chloride to flush debris leftover from debridement and decrease bacterial numbers.
January/February 2012 Today's Veterinary Practice 63
Principles of Wound Care & Bandaging Techniques