Techniques in Small Animal Wound Management

Nicole J. Buote, DVM, DACVS-SA, ACVS Founding Fellow Minimally Invasive Surgery (Soft Tissue), is Associate Professor of Small Animal Surgery, Department of Clinical Sciences at Cornell University College of Veterinary Medicine in Ithaca, New York, USA.

List of Contributors xv

Foreword xvii

Preface xix

About the Companion Website xxi

1 The Skin 1
M.S. Amarendhra Kumar

Cutaneus Immune Barrier 3

Pigmentation 5

The Normal Keratinization Process 11

The Abnormal Keratinization Process 12

Dermis 15

The Hypodermis (Subdermis or Subcutis or Superficial Fascia) 17

Connective Tissue and Fascia 23

Skeletal Muscle 26

Skeletal Muscle Trauma and Regeneration 28

References 30

2 Physiology of Wound Healing and Clinical Considerations 37
Daniel J. Lopez

Stages of Wound Healing 37

Proliferative Stage 41

Inherent Detriments to Wound Healing 46

Conclusion 49

References 49

3 Postoperative Complications 53
Ryan P. Cavanaugh

Introduction 53

Seromas 54

Wound Dehiscence (Indolent Pockets, Pseudo Healing) 57

Biofilms 65

References 68

4 Wound Types and Terminology 73
Desiree D. Rosselli

Classifications of Veterinary Wounds 73

Wound Closure 80

References 82

5 Patient Presentation and Evaluation of Wound 85
Colin Chik

Initial Stabilization of the Wound Patient 85

Acute Critical Wound Patients 85

Stable and/or Chronic Wound Patients 89

Evaluation of Patient Factors 90

Evaluation of Wound Factors 92

Initial Treatment 93

Decision-Making for Primary Closure 95

Debridement 95

Drain and Bandage Placement 98

References 101

6 Cleansing Solutions 103
Julia P. Sumner

Cleansing Solutions 103

Tap Water 106

Isotonic Intravenous Crystalloid Fluid Preparations (e.g., 0.9% Saline, Lactated Ringer’s Solution, Hartman’s Solution, Plasmalyte, Normosol) 106

Antiseptic Solutions 106

References 109

7 Topicals 111
Nicole J. Buote

Hydrogels 111

Zinc-Oxide Hydrophilic Pastes 113

Honey/Sugar 114

Antimicrobials (Nitrofurazone, Triple Antibiotic, Silver Sulfadiazine) 117

Triple Antibiotic (Neomycin, Polymixin B, and Bacitracin) 118

Silver Sulfasalazine 119

Oxygen 120

Nitrous Oxide 120

Miscellaneous Topicals 121

References 123

8 Wound Dressings 127
Nicole J. Buote

Moist Wound Healing 127

Characterization of Dressings 127

Adherent Dressings – Woven Gauze and Lap Sponges 131

Non-adherent Semiocclusive (Porous-Dry or Petrolatum-Impregnated) 132

Absorbent 133

Moisture Retentive Dressings 135

Antimicrobial 138

Bioelectric Dressings 141

Xenograft Dressings 143

Miscellaneous 149

References 150

9 Drains: How and When to Place Them 155
Angela C. Banz

Passive Drains 155

Closed-Suction/Active Drains 158

References 163

10 Vacuum-Assisted Bandages (Negative Pressure Wound Therapy) 165
Kathryn A. Pitt and Bryden J. Stanley

Physiology 165

Increased Granulation Tissue 165

Reduced Bacterial Load 166

Increased Blood Flow 167

Decreased Hematoma and Seroma Formation 168

Increased Cytokines/Growth Factors 168

Microdeformation with In-Vitro Modeling 168

Indications of NPWT 168

Description of Technique 169

Postoperative Care 173

Outcomes/Complications 173

References 174

11 Biologic Treatments 177

Subsection A: Medicinal Leech Therapy 177
Celine S. Kermanian and Nicole J. Buote

Anatomy and Physiology 177

Indications 179

Description of Technique 181

Postoperative Care 185

Outcomes/Complications 186

References 188

Subsection B: Maggot Therapy 191
Megan Mickelson

Background/Physiology 191

Indications 192

Description of Technique 193

Post-Procedural Care 195

Outcomes/Complications 196

References 200

12 Bandages 205
Kristin A. Coleman and Nicole J. Buote

Introduction 205

Light or Modified Robert Jones Bandage 205

Wet-to-Dry or Dry-to-Dry Bandages 208

Tie-Over Bandages 210

References 214

13 Hyperbaric Oxygen Therapy 215
Cheryl Braswell

Introduction 215

Physiology 215

References 224

14 Low Level Laser, Photobiomodulation and Electromagnetics for Wound Therapy 225
Nicole J. Buote

Low Level Laser Therapy 225

Photobiomodulation 226

Pulsed Electromagnetic Field Therapy 228

References 231

15 Platelet Rich Plasma and Stem Cell Therapy 233
Aarthi Rajesh, Rebecca M. Harman, and Gerlinde R. Van de Walle

Platelet Rich Plasma (PRP) Therapy 233

Stem Cell Therapy 241

Combinational Therapy Using PRP and Stem Cell Therapy 246

References 247

16 Reconstructive Techniques for Wounds 253
Jill K. Luther and Nicole J. Buote

Equipment 253

Basic Tissue Handling Tenants 256

Skin Tension 257

Tension-Relieving Techniques 258

Triangular, Square, Rectangle Wounds 264

Circular and Crescentic Wounds 266

Skin Flaps 267

Specific Axial Pattern Flaps 272

Skin Grafting 281

References 285

17 Specific Wounds 289

Subsection A: Bite Wounds – A Case Study 289
Nicole J. Buote

Presenting Signs 289

Examination and Initial Wound Characteristics 289

Diagnostics 289

Initial Therapy and Procedure 289

Follow-up Bandage Care 290

Surgical Procedure 292

Outcome 292

Prognosis 292

Clinical Lessons 293

Subsection B: Penetrating Wounds 295
Galina Hayes

Clinical Presentation 295

Triage and Imaging 297

Management Plans 298

Prognosis 301

References 301

Subsection C: Abscess Case Study 303
James D. Crowley and Julia P. Sumner

Presenting Signs 303

Outcome 305

Prognosis 305

Subsection D: Burns 309
Galina Hayes

Clinical Presentation 309

Anatomy and Physiology of Burns 309

Comparative Aspects of Burn Physiology 309

Acute Management Plan 310

Bandage Management 312

Split Thickness Grafts 312

Possible Complications 313

Future Directions 313

Prognosis 313

References 314

Subsection E: Wounds Over Joints 315
Galina Hayes

Clinical Presentation 315

Specific Challenges 315

Management Plans 316

Prognosis 317

References 319

Subsection F: Shearing Wounds – Case Study 321
James D. Crowley

Presenting Signs 321

Outcome 323

Prognosis 323

Subsection G: Necrotizing Fasciitis (Necrotizing Soft Tissue Infections) 327
Nathan Peterson

Presenting Signs 327

Wound Characteristics 327

Physiologic Effects 328

Shock/Sepsis 329

Prognosis 332

References 332

Subsection H: Snakebites 335
Nathan Peterson

Presenting Signs 335

Wound Characteristics 335

Physiologic Effects 337

Treatment 339

Possible Complications 340

Prognosis 340

References 342

Subsection I: Pythiosis 343
Kristin A. Coleman

Introduction 343

Presenting Signs 343

Diagnosis 344

Wound Characteristics 344

Physiologic Effects 345

Treatment 345

Possible Complications 349

Prognosis 349

References 349

Subsection J: Eyelid Wounds 351
Brian Marchione

Introduction 351

Presenting Signs 352

Physiologic Effects 354

Treatment 354

Possible Complications 356

Prognosis 359

References 359

Subsection K: Lip Wounds 361
Nicole J. Buote

Introduction 361

Anatomic Considerations 361

Wound Characteristics 362

Surgical Treatments 362

Avulsion Injuries 365

Primary Repair 365

Wedge Resection Techniques 365

Full-Thickness Advancement Flaps Full-Thickness 365

Postoperative Care 367

Complications 369

Prognosis 369

References 369

Subsection L: Pinna Wounds 371
Nicole J. Buote

Anatomic Considerations 371

Wound Characteristics 371

Surgical Treatments 372

Postoperative Care 374

Complications 376

Prognosis 377

References 377

Subsection M: Circumferential Wounds – A Case Study 379
Nicole J. Buote

Introduction 379

Case 1 379

Other Examples of Circumferential Injuries 383

Case 2 383

Case 3 383

Clinical Lessons 384

References 385

Subsection N: Preputial Reconstruction – Hypospadia Case Study 387
Galina Hayes

Presenting Signs 387

Examination and Wound Characteristics 387

Diagnostics 387

Surgical Procedure 387

Outcome 388

Prognosis 388

Clinical Lessons 388

Index 393