Contributors: Larry Booth, Rachel Murray, David Scarff, Elizabeth Welsh

 Species: Canine   |   Classification: Miscellaneous

History

  • Obtaining a complete history should be delayed if the patient is unstable at the time of initial presentation.
  • It is important to take a good general history to establish if the patient has any co-morbidity that may affect wound healing or be relevant if the patient is sedated or anesthetized:
  • Is the patient currently receiving any medication and if so what:
    • Long term glucocorticoid administration can delay wound healing.
    • Cytotoxic agents may delay wound healing.
  • Historical information relating to the wound(s) of importance include:
    • The time between the traumatic event leading to wounding and patient examination. This will influence whether a traumatic wound is considered contaminated or dirty.
    • Was the wound witnessed? If so a description of the trauma should be obtained, eg was the wound caused by a sharp object or as a consequence of blunt trauma?
    • What, if any treatment has already been given?

Initial assessment

Restraint

Visualization

  • In an unstable patient the wound(s) should be protected by a simple sterile dressing until management of the wound can be prioritized.
  • The presence of fur or hair will obscure the true extent of the wound(s). This is particularly the case for bite wounds.
    • Liberally clip the fur or hair surrounding the wound(s).
    • Protect the wound from further contamination during clipping:
      • Clip hair and fur from the wound edge outwards, ie away from the open wound.
      • Put sterile aqueous gel or sterile swabs moistened with sterile saline in the wound during clipping. Alternatively use towel clamps to temporarily close the wound during clipping.

Assessment of wound

  • Type of wound Wound: types - overview.
  • Location of the wound in relation to regional anatomy.
  • Size and depth of wound.
  • Level of examination.
  • Level of exudation.
  • Presence of necrotic tissue.
  • Tension of the surrounding skin.
  • Level of trauma to the surrounding tissues:
    • In limb wounds assess the neurovascular integrity distal to the wound.
  • Signs of local or systemic inflammation.

Complete physical examination

  • Physical examination.

Wound lavage/debridement

Lavage

Debridement

Antibiotics

Wound closure

Selection of suture patterns and suture material

Primary closure Wound closure: primary Wound closure: delayed primary

  • Wound sutured to allow healing by first intention with minimal epithelialization or formation of granulation tissue.

Indications

  • Clean, clean-contaminated or contaminated wounds Wound: types - overview.
  • No tension on wound edges.
  • No or minimal skin defects.
  • No severe compromise to blood supply at wound edges.
  • Minimal surrounding soft tissue damage.

Delayed primary closure

  • Primary closure is not performed immediately but delayed for a short period of time usually 1-5 days.
    • Wound management as an open wound until primary closure appropriate.
    • Granulation tissue has not yet developed in the wound bed at the time of wound closure, ie within 3-5 days of injury.

Indications

  • Contaminated or dirty wounds requiring further debridement.
  • Wounds with uncertain vascular supply, ie a clear line of demarcation between viable and non-viable skin is not present.

Procedure

  • Lavage Wound: lavage , debride Wound: debridement , and bandage Wound: primary dressing wound daily.
  • Medication if necessary.
  • Protect wound from patient interference.
  • Once the wound appears free of signs of infection and necrotic tissue and the viability of the local soft tissues is confirmed primary closure is performed.

Secondary closure

  • Primary closure is not performed immediately but delayed for a period of time usually >5 days.
    • Wound managed as an open wound until primary closure appropriate.
    • Granulation tissue has developed in the wound bed at the time of wound closure.

Indications

  • Contaminated or dirty wounds requiring more prolonged debridement than wounds selected for delayed primary closure.
  • Wounds with a greater degree of associated soft tissue damage.

Procedure

  • Same as delayed primary closure Wound closure: delayed primary until the point of wound closure.
  • Once the wound appears free of signs of infection and necrotic tissue and the viability of the local soft tissues is confirmed wound closure is performed.
  • There are two techniques by which the wound may be closed:
    • Excision of the granulation tissue bed and primary wound closure.
      • Better cosmetic outcome.
      • Less risk of infection.
    • Leaving the existing granulation bed intact, freeing the wound edges by undermining and advancing the wound edges over the granulation bed.