Wound Management
Wound healing is a natural and inherent biological process. The healing of a wound has got a high priority among various body functions. It is the major concern of a surgeon because it plays a very useful role in the life and survival of the animal.
The aim of the surgeon is to accelerate the healing process and avoid the factors that delay it. He tries to accomplish this, with minimum scar formation and minimum deformity of the part without any complications by Wound management practices.
Basic Principles of wound treatment are-
- Maintenance of aseptic conditions
- Careful debridement
- Proper irrigation of wound
- Gentle handling of tissues
- Layer by layer closure avoiding tissue tension
- Careful haemostasis
- Avoiding the use of irritant materials.
- Proper drainage
- Application of protective bandage
Golden Period of a wound is the first 6 to 8 hours between wound contamination at injury and bacterial multiplication. A wound is classified as infected rather than contaminated when bacterial numbers exceed 105 organisms per gram of tissue. Cardinal sign of wound infection is the presence of discoloured foul smelling exudates.
Wound Management-
Wound Management or wound therapy include-
- Surgical or aseptic wound treatment
- Contaminated and septic wound treatment
- Accidental or traumatic wound treatment
- Treating as open wound
- Maggot Wound treatment
- Exuberant granulations management
1. Surgical or aseptic wound treatment-
A surgical wound made with all aseptic precautions; in a non-infected tissue is an aseptic wound. No open wound is absolutely aseptic as slight infection may exist; however, it will have very little inhibitory effect on wound repair. Wounds less than 6 to8 hours with minimal trauma and contamination are treated by lavage, debridement and primary closure. Anesthesia is often required for initial wound inspection and care. The objective of open wound care is to convert the clean contaminated wound into a surgically clean wound that can be given a primary closure.
- Prophylaxis against tetanus should be considered, especially in equines, camels, sheep & goat.
- While doing surgery, the surgeon should observe all Tenets of Halstead, to lower the wound infection.
- Drainage should be provided, if haematoma or Seroma formation is expected.
- Systemic use of specific antibiotic is more beneficial.
- In hot summer months local application of fly repellants is useful to avoid maggot infestation.
- The patient must be kept at rest at least till the removal of sutures.
2. Contaminated and septic wound treatment-
The contaminated or infected wound should be cultured. Wound is classified as infected, when the time lapse is more than 8 hours and the bacterial numbers exceed 105 organisms, per gram of tissue. Infected wounds are often dirty and covered with thick, viscous exudates. Wound infection is the most important cause of morbidity and mortality in injured animals.
After initial inspection, the wound should be cultured.
The area surrounding the wound should be clipped and prepared. The wound may be protected from clipped hairs and detergents by applying saline soaked sponges.
Alternatively, the wound may be temporarily closed with sutures, towel clamps or staples.
Povidone iodine or chlorhexidine scrubs can be used to prepare the skin and cleaned with tap water. Alcohol kills and fixes the exposed tissues on contact and should be used only on intact skin.
Wound debridement, wound lavage and fixing of surgical drains are other special techniques.
3. Accidental or traumatic wound treatment-
The haemorrhage should be checked, and the shock is treated by fluids.
Clean the contamination and dress the wound.
Prophylaxis against tetanus must be done and Follow-up is done on similar line of the open wound management.
4. Treating as open wound-
In case wound edges cannot be brought into apposition by sutures, open wound healing by granulation tissue formation, should be allowed. With medications both topical and parenteral the wound should be protected by bandage. If defect is considerable, skin grafts may be considered.
5. Maggot Wound treatment-
In case of maggot infestation, the wound is cleaned and initially irrigated with a turpentine oil for easy removal of maggots.
6. Exuberant granulations management-
Exuberant granulations (proud flesh) can be surgically excised up to the level of epidermis and dressed for healing.