wound dressings

Re: wound dressings

Hanna Bennett — Wed, 23 Dec 2009 09:33:35 GMT

[quote user="Evelyn Barbour-Hill"] wrap it all up in what is referred to technically in this practice as a big soggy bandage,[/quote]

sounds like a wet to dry dressing to me! mine aren't any more technical than that to be honest

Re: wound dressings

Evelyn Barbour-Hill — Wed, 23 Dec 2009 00:47:26 GMT

[quote user="Hanna Bennett"] And i wouldn't fancy debriding them conscious.[/quote]

No of course not.

What I do if they are not fit for general anaesthesia is to wash the wound as far as possible with, say, Hibiscrub and then sluice (no pressure) with saline and then wrap it all up in what is referred to technically in this practice as a big soggy bandage, and that's how we keep it until it's ready for a GA. A case like that would have systemic antibiotic too.

I hope you would all agree that we are all talking in general terms and there will always be occasional cases that are treated differently.

Re: wound dressings

Hanna Bennett — Tue, 22 Dec 2009 20:52:35 GMT

[quote user="Evelyn Barbour-Hill"]Yes indeed, but I'd prefer to get all the grot off by physically debriding right at the start. Then the healing is starting with your very first dressing[/quote]

if poss, but alot of these patients are not fit for sedation, and seriously shocked, so whacking on a wet to dry while you stabilise them for 24 hours helps get things started - better than leaving them open surely? And i wouldn't fancy debriding them conscious.

Re: wound dressings

Evelyn Barbour-Hill — Tue, 22 Dec 2009 01:15:29 GMT

[quote user="Hanna Bennett"]I'm a big fan of the wet to dry for the first 24 hours for these infected contaminated wounds - at this stage it's all about debriding and you just need to get all the grot off the wound [/quote]

Yes indeed, but I'd prefer to get all the grot off by physically debriding right at the start. Then the healing is starting with your very first dressing.

Re: wound dressings

Utlendigur — Mon, 21 Dec 2009 21:59:34 GMT

[quote user="Toby Birch"]

I'm waiting for a wound where I can use maggots!

[/quote]

Most rabbits and some lderly cats seem to try this as a first line - before they present to a vet

Re: wound dressings

stuart mcmorrow — Mon, 21 Dec 2009 21:42:48 GMT

[quote user="Toby Birch"]

I'm waiting for a wound where I can use maggots!

[/quote]

There is a man in Nottingham University (David Pritchard, not a vet) who is currently looking into identifying the secretions maggots use to help debride the wounds. This may mean you could get the benefits from the maggots without problems by just using this preparation.

Although I agree - I think it would be cool to use them!

Re: wound dressings

Toby Birch — Mon, 21 Dec 2009 21:38:18 GMT

I'm waiting for a wound where I can use maggots!

Re: wound dressings

Georgie Hollis — Mon, 21 Dec 2009 20:57:06 GMT

Sorry i should have said... If you want to see a honey case on a contaminated/dirty rta - it was lavaged, surgically debrided then honey applied to granulation, then graft.

http://www.vetwoundlibrary.com/smartweb/sample-case-study

Once on the case study, click on the pictures to zoom in. it may be of interest if not familar with honey?

Re: wound dressings

Anonymous — Mon, 21 Dec 2009 20:33:03 GMT

I think it matters very little how you go after the first 48hrs of getting the muck off with WTD, providing the area is immobilised. If it's a hock or carpus, or even other areas, you need ESF and you might need to get quite creative in, for instance, axilla collar injuries, but - if it moves it will heal more slowly. I've put all sorts from Cod Liver Oil to Intrasite and honey but have not really been able to get any data out of the noise except cats like CLO dressings (to eat). But, if you really keep it immobile, the wound closes in much less time, IMO

Re: wound dressings

stuart mcmorrow — Mon, 21 Dec 2009 20:25:45 GMT

I have used Cutimed sorbact (a hydrophobic dressing so the bacteria stick to it, or something like that?) on these type of wounds and had great results. You can get it through the vet wound library ( www.vetwoundlibrary.com ).

I used to use intrasite and allevyn for these type of wounds and have found that it is expensive - i.e. why use the two dressings when the intrasite alone may do? Having said that does using the allevyn (or another foam dressing) mean you can reduce the frequency of dressing changes? That is one of the reasons I like honey for these wounds. It seems to reduce the frequency of dressing changes. A w-t-d it would possibly need changed in 12-24hrs. Honey can last 3-4days in certain cases. This can make the more expensive honey dressing more cost effective? The cutimed sorbact can also give longer time between dressing changes - good for a wound that would need a dressing change on a Sunday :]

I definately don't use a topical antibiotic. I have never had the need and especially with a w-t-d where that seems to get rid of most nasty things. Honey is also great for bugs. I have used honey sucessfully in pseudomonas ears!

Thanks for all the replies in this topic. It has give me loads of great ideas

Re: wound dressings

Utlendigur — Mon, 21 Dec 2009 20:14:57 GMT

Surgical debride/flush. Then wet-to-dry for 24-48hrs. Do not usually use them for longer as, once the wound starts granulating, it doesn't often need debriding (unless some areas are worse than others). Sometimes intrasite + allevyn where there are awkward nooks and crannies eg between toes, where the wtd dressing can't reach. Then when most of contamination/necrotic tissue removed go onto allevyn +/- flamazine. Once healthy granulation bed develops, I stop antibiotics.

Re: wound dressings

Georgie Hollis — Mon, 21 Dec 2009 19:55:44 GMT

I have to admit i may have had a part to play in why some people are saying intrasite and Allevyn together is a bit of an anomaly!

It has to be remebered that many of these dressings were invented for the £6 billion - or thereabouts human market! with very little research into the dynamics of the veterinary wound (ie. smallies don't exude much (unless its peritonitis or a gushing sinus) so you need a dressing that keeps the wound moist between dressing changes) Dressings are really just designed on the basis that wounds produce exudate that needs managing so they either create a moist environment by adding moisture (ie. Intrasite) or soak it up (ie. Allevyn) The very non-scientific way to choose a dressing is supposed to be to assess weither exudate is low, medium or high and to choose the dressing appropriately. On that basis, using two dressings together that effectively cancel each other out is possibly a costly method? However, it can not be denied that it has been a very successful combination in animal wound management, but i doubt many people think about it being a cunning trick to sell two dressings when you may only really need one. The question arises when you say what else do i use as a secondary dressing then... this then leaves limited choices that may not be considered the norm. But i think it is good to challenge what and why you use these things.

Sorry this is a bit of a soapbox for me as you may be able to tell! but i very much welcome thoughts to the contrary in practice.

Re: wound dressings

Hanna Bennett — Mon, 21 Dec 2009 19:34:47 GMT

I'm a big fan of the wet to dry for the first 24 hours for these infected contaminated wounds - at this stage it's all about debriding and you just need to get all the grot off the wound so any granulation bed is not going to be affected so early on. Interestingly our rep told us the other day you shouldn't use intrasite with allevyn as the allevyn will just soak up the intrasite, preventing either from from doing it's job on the wound. Either just intrasite + melolin or allevyn on it's own. New one to me!

Anyway, we might then use allevyn changed every 2-3 days until good granulation bed formed, or would agree on the honey, it really seems to speed things up.

Re: wound dressings

Martin Jones — Mon, 21 Dec 2009 16:02:30 GMT

[quote user="Malcolm Ness"]

Avoid any kind of topical antibiotic or other preparation and stop all antibiotics once granulation is established - they're not needed and all you will do is select out the resident staphs in favour of the MRSAs.

[/quote]

Duly chastised, Malcolm; I was being tongue-in-cheek about the cyclicity of these things - we're all into our seaweed and honey right now, but pretty soon, resistance and backlash will start to reduce their popularity - and then we'll be throwing antibs back at nasty wounds and finding that in the interim period, they've largely become sensitive again.....

And so on and so forth.

I challenge you to use a little honey, though. It does work extremely well in many cases. Certainly, for those of us in the cheap seats, it can be an absolute boon.

The plantain and comfrey can be applied as a poultice of dried leaves, or concoctions made from the roots of both. Comfrey is also known as knit-bone, because of its deep healing properties; all anecdotal, but open minds and all that.

To be honest, in cows I often used bran bread stuffed inside a rectal glove with the hand cut off, then left to sweat. Worked a treat, but unlikely to be useful for a pedigree Pomeranian.

Martin

Re: wound dressings

Georgie Hollis — Mon, 21 Dec 2009 14:26:40 GMT

PS. Would love more info on the comfrey and plantain recipe, sounds really interesting! I have some interesting references on the use of cinnamon, turmeric and dried rosemary (not all on the same wound!) - (perhaps i'm referring to my mulled wine recipe!)

BR Georgie.

Re: wound dressings

Georgie Hollis — Mon, 21 Dec 2009 14:23:02 GMT

Honey is not just for toast, although i am partial to a bit. Rhododendron honey from the Black Sea is best avoided though - it can bring on some major cardiac issues :-)

There's more evidence for honey as a wound dressing than any modern wound management product....wierd but true!

Debrides, Anti-microbial and anti-inflammatory - the research to support this microbiology is due out very soon re. Manuka particularly. Will be on the Waikato Uni site in NZ i believe.

Best wishes, Georgie.

Re: wound dressings

Ian Mostyn — Mon, 21 Dec 2009 11:13:41 GMT

I would second the vote for intrasite and allevyn. That is my dressing of choice and we have had some nasty degloving wounds clean out nicely. I could never get my head around some of the other more complicated dressings.

Ian

Re: wound dressings

Malcolm Ness — Mon, 21 Dec 2009 11:06:24 GMT

I have always struggled with the concept of wet-to dry dressings - it just doesn't seem sensible to allow granulation tissue to form, then rip it off.

We see a lot of degloving injuries referred, usually with concommitant ortho injuries (hock or carpal luxation/ shear). I favour colloid gel dressings (eg Intrasite) initially covered with an absorbant foam layer (eg Allyevyn) which is changed/moved as INFREQUENTLY as possible. Once granulation is established (typically within 72 hours) a non adherent dressing is applied without the gel and again changed as infrequently as possible. The down side is a nasty looking moist mess which collects over the wound surface, but this is not pus and the cells just love it.

The colloid gel preparations are not cheap but anyone charging properly for the time and materials involved in multiple redresses will find them very cost effective.

Honey is for toast!

Re: wound dressings

Toby Birch — Mon, 21 Dec 2009 04:02:58 GMT

Flush flush flush, flush some more and then I am a big fan of honey - have had some fantastic results and in not that long either. If cost is an issue any unpasteurised honey will do (only a small risk of botulism). I used to use this before the Dechra products were so easily available. It really depends where the wound is as to what is most user friendly. If there is a hole (eg ruptured mastitic wound) then granulated sugar works fantastically.

You need to redress as soon as the honey dressing looks wet at all. This may be TID initially but I tend to find the frequency decreases fairly rapidly.

Re: wound dressings

Evelyn Barbour-Hill — Mon, 21 Dec 2009 00:31:00 GMT

Debride, debride, debride.

Then alginate (Kaltostat for instance) wetted with saline and big padded dressing. Changing frequency tailored to individual case, but usually after one day first, then ever-increasing intervals until the wound is granulated enough to be left open or have a light dressing.

The cost is the only disadvantage I can see.

Re: wound dressings

Martin Jones — Sun, 20 Dec 2009 21:30:13 GMT

Completely in agreement re honey - our current first choice for most things.

Was the degloved skin replaced, or are you looking at an open, denuded area of tissue? Two other possibilities are silver - which seems to be the current choice of the NHS in Cornwall - or comfrey, plus-or-minus plantain. Have used this more in large animal, generally my own preparation, with great effect.

Alternatively, the good old back-to-basics opened antirobe capsule seems to do the trick. Fairly soon, this will probably be the new kid on the block and we'll all be raving about it......

Martin