VET STEPS TO TEND A WOUNDED ANIMAL By: Aubrey McMahan

Context ◦ Overview of Emergency Procedure ◦ Procedure ◦ Owner Discussion ◦ Assessing Damage ◦ Different Wounds & Anatomy of Healing ◦ Treatment of Wounds and Bandages ◦ Healing Process ◦ Assessing the Results

Vet Procedure ◦ Information to obtain from the owner: ◦ What happened ◦ Location of wound ◦ Wound tension and possibility of closure? ◦ How much time had elapsed from the time of injury to now. (1237, McCurnin) ◦ Prep the vet clinic ◦ Inform clinic of animal to be treated and possible arrival time ◦ Provide Injury Assessment ◦ Describe patient mentally and physically ◦ Prepare the surgical room ahead of time for the patient. (It is important that the owner stays calm so that they can be clear in their thinking, and follow the instructions and closely as possible.)

Overview of Emergency Procedure ◦ Inform Owner to Come to the Vet Clinic as soon as possible ◦ Assess Injury by asking owner specified questions ◦ Assess Owners Condition ◦ If ruffled, reinforce the owner to remain calm (When the owner is calm, so is the patient) ◦ Inform owner of what they can do (i.e. they can apply sugar or honey) note: “Honey has hypertonic/bactericidal properties which help with natural debridement” (Bowlt). ◦ Apply a clean bandage over the wound to prevent further contamination. ◦ If the wound is a couple of days old, have the owner bring it in as is, so that the vet and staff can assess what to do next.

Owner Discussion ◦ After the owner arrives with the patient the vet will ◦ Assess the damage and decide what type of closure would be the best option ◦ Lavage the wound and clean the debris ◦ After a period of time, say two days, the vet may debride the area to initiate proper healing ◦ Educate the owner about ◦ questions about the pet history ◦ the different stages of healing ◦ discuss conditions that may hinder the wound healing.

Assessing the Damage ◦ When assessing the damage: Initiate the ABC’s ◦ Airway ◦ Breathing ◦ Circulation ◦ Preparation with emergency drugs and rebreather will be at hand depending on the damage. ◦ Bandaging material will be prepared after surgery.

Bring the animal back to the vet when: ◦ The bandage becomes wet, infection and inflammation could occur ◦ Chest bandages ◦ Do not leave on for more than 2 hours because otherwise it can cause chest depressions ◦ For slings, bandages, and casts ◦ If the bandage is too tight and swelling of the phalanges occur ◦ Make sure you can see and feel the phalanges so that you can feel the toes, smell for necrosis, and see possible swelling. ◦ When any of these occur, than the bandage could be more of a hindrance than a help to the patient.

Different Wounds & Closures ◦ Lacerations ◦ Abrasions ◦ Debridement ◦ Avulsions ◦ Shear (All of the information about these wounds can be found by Bowlt, “Nonhealing wounds”)

Lacerations/ Incisional Wounds: Wounds that are a clean cut through the skin. Primary closure is the primary surgical fixture performed.

Abrasion: Abrasions are superficial wounds caused to the epidermis and partially to the dermis by friction, during a road traffic accident. They are often contaminated with debris and bacteria, some of which are forced into the deeper tissues and these wounds require careful and copious flushing. Primary closure unwise.

Degloving: Degloving injuries occur when the skin is torn away from an extremity.

Avulsion: Avulsion injuries are often seen following dog fights, particularly around the mandible and involve the tearing of tissue from its attachments.

Shear: Shearing injuries are similar to degloving injuries, but also involve deeper structures, such as joints.

Treating the Wound ◦ Closure: depends on nature of the wound (Small animal wound management: Options for wound closure, 1) ◦ Bowlt states in “Options for wound closure” that, ◦ Primary closure: is appropriate if the wound has occurred recently and is clean or clean-contaminated. ◦ Delayed primary closure: is performed three to five days after the wound occurs and allows time for elimination of contamination and evidence of ischaemia. ◦ Contraction and epithelialization: Closure is performed before a granulation bed forms ◦ Secondary closure: occurs after the formation of a granulation bed and follows open wound management for more than five days. This would be desirable for an infected wound healing by contraction and epithelialisation.

Discuss the 4 levels of Wound Healing: ◦ McCurnin gave four examples to wound healing: ◦ Inflammatory ◦ Begins immediately after injury ◦ Releases growth factors ◦ Debridement ◦ Part of inflammatory phase ◦ Occurs 6 hours after injury ◦ Repair ◦ Begins 3 – 5 days after injury ◦ Lag phase ◦ Maturation ◦ Scar

Defining Lavage ◦ “Wound lavage is necessary to remove debris and loose particles and tissue from the wound. Warm sterile balanced electrolyte solution is preferred” (1234, McCurnin) ◦ Bowlt states that for lavage, certain surgical principles are involved: ◦ Table 1: Halstead’s surgical principles ◦ Strict asepsis ◦ Meticulous hemostasis ◦ Minimal wound tension ◦ Atraumatic tissue handling ◦ Accurate tissue apposition ◦ Minimize dead space ◦ Preservation of local blood supply

Defining Debridement ◦ “Removes all contaminated, devitalized, or necrotic tissue and foreign material from the wound” (McCurnin, 1234) ◦ Three methods of debridement: ◦ Layered debridement: “Beginning at superficial layers of wound and progressing to depths; indicated for large wound with substantial tissue trauma; may be repeated for heavily contaminated/ traumatized wounds” ◦ En bloc: “Complete excision of wound; indicated for small wounds in areas with loose skin that can be closed primarily.” ◦ Enzymatic: “Use of trypsin products that dissolve necrotic tissue; slow method of debridement; indicated in minimally contaminated/traumatized wounds or as an adjunct to surgical debridement.”

Factors which may delay Repair: ◦ Age ◦ Youth verses an elderly patient ◦ Delay of healing due to certain diseases ◦ Diabetes mellitus/ Hyperadrenocorticism/ Cushing’s disease ◦ Wound characteristics ◦ Foreign bodies ◦ Infection ◦ Toxins ◦ Damage to blood supply ◦ External factors ◦ Certain drugs ◦ Therapy (All of this is needed to assess the best treatment for the patient.)

Different Bandages ◦ Chest bandages ◦ Do not leave on for more than 2 hours because otherwise it will cause chest depressions ◦ Casts and Splints like the Robert-Jones or Modified Robert Jones Bandages ◦ These help immobilize fractures, “distal to the elbow or stifle before surgery” (McCurnin, 1239). ◦ Tail bandage ◦ Ehmer sling bandage/ Velpeau’s sling bandage ◦ The Ehmer immobilizes the hind limbs to reduce, “luxation of the craniodorsal coxofemoral head and prevent weight bearing of the limb till surgery” (McCurning, 1239). ◦ Velpeau’s sling prevents movement in all joints and is used mainly for, “scapulohumeral joint luxation oar immobilization of scapular fractures” (McCurnin, 1240). ◦ Hobbles ◦ “Prevent excessive abduction of the limbs” (McCurnin, 1240).

Benefits of Bandaging ◦ McCurnin states benefits of bandage: ◦ Protects from further contamination ◦ Prevents wound desiccation ◦ Prevents hematoma and seroma formation ◦ Immobilizes the wound and prevents cellular disruption ◦ Minimizes surrounding edema ◦ Absorbs wound exudate and debris ◦ Promotes retention of carbon dioxide and creation of an acid environment, which facilitates oxygen dissociation ◦ Keeps wound warm, which facilitates healing (1237, McCurnin)

Work Cited ◦ Bassert, J. M., McCurnin, D. M., & McCurnin, D. M. (2009). McCurnin's clinical textbook for veterinary technicians. Elsevier Saunders. ◦ Bowlt, K., & Friend, E. (2011). Small animal wound management: Options for wound closure. Companion Animal, 16(5), doi: /j x ◦ Bowlt, K., & Friend, E. (2011). Small animal skin wounds: management of simple, open wounds and non-healing wounds. Companion Animal, 16(4), doi: /j x