2012.11.05.

1

WoundWound management, management, bandagingbandaging

Dr. Dr. CsébiCsébi, Péter, PéterSZIE ÁOTK SZIE ÁOTK SurgicalSurgical DepDep..

20122012

WoundWound typestypes

►► lacerationlaceration, , contusioncontusion((bruisebruise), ), penetratingpenetrating, , bitebite, , shearingshearing, , burnburnetcetc..

WoundWound typestypes byby thethe degreedegree of of contaminationcontamination

�� „„CleanClean””�� „„CleanClean--contaminatedcontaminated””�� „„ContaminatedContaminated””�� „„DirtyDirty””

GradingGrading byby timetime: :

►►GradeGrade 1 : 1 : MildMild contaminationcontamination, , freshfresh woundwoundinin thethe firstfirst 6 6 hourshours („(„goldengolden periodperiod”)”)

►►GradeGrade 2: 2: ModerateModerate contaminationcontamination, 6, 6--12 12 hourshours

►►GradeGrade 3: 3: SevereSevere contaminationcontamination, , afterafter 12 12 hourshours

WoundWound healinghealing

2012.11.05.

2

BeforeBefore wewe dodo anyany woundwound treatmenttreatment::

�� UseUse sterilesterile glovesgloves (MRSA, MRSI)!(MRSA, MRSI)!�� FirstFirst stabilisestabilise thethe patient’spatient’s vitalvital functionsfunctions inintraumatictraumatic casescases !!►►IvIv. . cathetercatheter, fluid , fluid resuctitationresuctitation, , analgesiaanalgesia, , oxygenoxygenetc.etc.

FirstFirst aidaid::

(0. (0. MuzzleMuzzle thethe dog!)dog!)I. I. Stop Stop thethe bleedingbleeding!!

►►PressurePressure bandagebandage►►ArterialArterial compressioncompression proximallyproximally

II. II. KeepKeep thethe woundwound moistmoist withwith salinesaline soakedsoakedspongessponges

III. III. CoverCover thethe woundwound withwith sterilesterile bandagebandagematerialmaterial oror atat leastleast withwith anyany kindkind of of cleancleandressingdressing toto preventprevent furtherfurther contaminationcontamination

WoundWound treatmenttreatment stepstep--byby--stepstep: :

1. 1. ClipClip thethe hairhair►►ClippingClipping withwith widewidemarginesmargines

►► PreventPrevent thethe woundwound fromfrom furfurcontaminationcontamination!!�� CoverCover thethe woundwound withwith salinesalinesoakedsoaked spongesponge oror KK--Y Y jellyjellybeforebefore clippingclipping

2. 2. WoundWound lavagelavage►► LavageLavage thethe woundwound withwith copiouscopious amountamount of of sterilesterilefluidfluid!!

►►UseUse::►► SalineSaline, , RingerRinger oror LactatedLactated--RingerRinger

►►DoDo notnot useuse!: !: �� AntisepticsAntiseptics ((BetadineBetadine, , HydrogenHydrogen--peroxydperoxyd, , alcoholalcohol etc.)etc.)

►►TheseThese areare toxictoxic forfor thethe cellscells!!

2012.11.05.

3

3. 3. DisinfectionDisinfection aroundaround thethe woundwound

►► BetadineBetadine oror ClorhexidineClorhexidine onon thethenormalnormal skinskin surfacesurface

4. 4. DebridementDebridement

NecroticNecrotic tissuetissue must be must be removedremoved!!

►► ProperProper anaesthesiaanaesthesia is is necessarynecessary..►►Must be Must be donedone asas an an asepticaseptic surgicalsurgical procedureprocedure!!

►►SurgicalSurgical►►AutolyticAutolytic►►EnzymaticEnzymatic►►LarvaeLarvae

5. 5. WoundWound closureclosure oror bandagingbandaging??

►►GradeGrade 1: 1: primaryprimary closureclosure►►GradeGrade 2, 3: 2, 3: delayeddelayed closureclosure afterafter initialinitial openopenwoundwound management management oror secondsecond intentionintention woundwoundhealinghealing�� DelayedDelayed primaryprimary closureclosure (2(2--5 5 daysdays laterlater))�� SecondarySecondary closureclosure ((closureclosure withwith completecomplete excisionexcision of of thethe healthyhealthy granulationgranulation tissuetissue))

DrainDrain

►►PenrosePenrose--draindrain►►ClosedClosed--suctionsuction draindrain

PrimaryPrimary closureclosure is is contraindicatedcontraindicatedwithwith rarerare exceptionsexceptions inin casecase of: of:

►►PenetratingPenetrating woundwound►►BiteBite woundwound►►LargeLarge contusedcontused woundwound

2012.11.05.

4

Most Most commoncommon microbesmicrobes inin woundswounds::

►►StaphylococciStaphylococci-- and and PseudomonasPseudomonas--spsp..

►►MiMicrobiologicalcrobiological examinationexamination is is recommendedrecommended!!

►►AB AB treatmenttreatment shouldshould be be basedbased onon cultureculture and and sensitivitysensitivity resultsresults! ! InproperInproper useuse of of ABsABs resultresult ininmultiresistantmultiresistant bacteriasbacterias!!!!

BandagingBandaging

WhyWhy??::►► ImmobilisationImmobilisation►► ProtectionProtection►►DecreaseDecrease painpain, , oedemaoedema, , bleedingbleeding►► FacilitateFacilitate woundwound cleaningcleaning►►DecreaseDecrease deaddead spacesspaces

BandagingBandaging

LayersLayers::�� ContactContact layerlayer ((sterilsterilee gauzegauze oror othersothers))�� IntermediateIntermediate absorbingabsorbing layerlayer ((cottoncotton, , absorbingabsorbing padspads))

�� OuterOuter layerlayer

ContactContact layerslayersDryDry woundwound management management

►► „„DryDry--toto--drydry””�� CleaningCleaning upup

►► „„WetWet--toto--drydry””�� CleaningCleaning upup

MoistMoist woundwound managementmanagement

►► CalciumCalcium--alginatealginate,, FoamFoam�� CleaningCleaning upup withwith heavyheavyexsudateexsudate

►► HydrogelHydrogel oror hydrocolloidhydrocolloid�� CleanClean granulationgranulation tissuetissue, , drydrywoundwound

AlginateAlginateAlginateAlginate + + FoamFoam

2012.11.05.

5

HydrocolloidHydrocolloid, , HydrogelHydrogelOtherOther specialspecial contactcontact layerslayers

►►Silver Silver impregnatedimpregnated dressingdressing►►IodineIodine impregnatedimpregnated dressingdressing►►Paraffin Paraffin oror otherother creamcream impregnatedimpregnateddressingsdressings

►►ActivatedActivated charcaolcharcaol impregnatedimpregnated dressingdressing►►ManukaManuka honeyhoney impregnatedimpregnated dressingdressing

TopicalTopical woundwound treatmenttreatment::

►► TripleTriple antibioticantibiotic creamcream:: BacitracinBacitracin, , NeomycinNeomycin, , PolymixinPolymixin B B toto preventprevent an an infectioninfection; ; notnot effectiveeffective againstagainst PseudomonasPseudomonas spsp..

►► SilverSilver--sulphadiazinesulphadiazine creamcream:: antisepticantiseptic effecteffect withwith widewidespectrumspectrum. . RecommendedRecommended onon burnsburns and and decubitaldecubital ulcersulcers. .

►► NitrifurazonNitrifurazon (Furacin): (Furacin): antisepticantiseptic effecteffect withwith widewide spectrumspectrum. . RecommendedRecommended onon exsudativeexsudative woundswounds..

►► AloeAloe VeraVera: : burnsburns, , PseudomonasPseudomonas infectionsinfections..

►► CreamsCreams toto helphelp epithelisationepithelisation

SugarSugar:: hyperosmotichyperosmotic, , goodgood efficacyefficacy onon heavilyheavilyexsudativeexsudative, , septicseptic woundswounds duringduring thethe cleaningcleaning upup..

►► AfterAfter initialinitial woundwound management 1 cm management 1 cm thickthick sugarsugar layerlayershouldshould be be powderedpowdered onon thethe thethe woundwound surfacesurface..

►► The The woundwound shouldshould be be lavagedlavaged and and resugarisedresugarised inin everyevery 4 4 hourshours toto keepkeep it’sit’s antibacterialantibacterial effecteffect..

2012.11.05.

6

ManukaManuka honeyhoney -- metilglioxalmetilglioxalComplicationsComplicationsof of bandagingbandaging

Pressure sores

►► InfectionInfection,,►►MacerationMaceration,,►►SwellingSwelling -- necrosisnecrosis

►►BandageBandage has has toto be be checkedchecked and and changedchangedregularlyregularly toto preventpreventcomplicationscomplications!!

ModifiedModified RobertRobert--Jones Jones bandagebandage

2012.11.05.

7

Dr. Diószegi Zoltán: Kisállat ortopédia Dr. Diószegi Zoltán: Kisállat ortopédia

Dr. Diószegi Zoltán: Kisállat ortopédiaDr. Diószegi Zoltán: Kisállat ortopédia

Dr. Diószegi Zoltán: Kisállat ortopédia Dr. Diószegi Zoltán: Kisállat ortopédia

2012.11.05.

8

SpecialSpecial bandagesbandages

►►„„TieTie--overover bandagebandage””►►„„PressurePressure--reliefreliefbandagebandage””

ThankThank youyou forfor youryour attentionattention!!

FurherFurher readingsreadings::

►► FossumFossum: : SmallSmall AnimalAnimal SurgerySurgery TextbookTextbook, 2006., 2006.►►SwaimSwaim: : WoundWound Management, An Management, An IssueIssue of of VeterinaryVeterinary ClinicsClinics: : SmallSmall AnimalAnimal PracticePractice, 2006., 2006.

►►BSAVA BSAVA ManualManual of of CanineCanine and and FelineFeline WoundWoundManagement and Management and ReconstructionReconstruction, 2009., 2009.

►►SwaimSwaim: Small Animal Bandaging, casting and : Small Animal Bandaging, casting and splinting techniques, 2011.splinting techniques, 2011.

►►Web:Web:�� VVeterinaryeterinary wound management societywound management society�� VeterinaryVeterinary woundwound healinghealing associationassociation