Best Practice in Managing Wounds and Bandaging
When treating wounds, there are many things to consider to encourage optimal healing and swift return to normal function in small animals and equines.
When treating wounds and bandaging, it is vital to know how wounds heal so that an optimal environment can be created. It's important to remember the 4 stages of healing when addressing each wound.
Hemostasis, Inflammatory, Proliferative, and Remodelling
Normal wound healing is what we should all work towards, however, there are 12 key factors that can inhibit the healing of wounds.
- Infection
- Movement
- Necrotic tissue
- Foreign bodies
- Poor blood supply
- Poor oxygen supply
- Continued trauma
- Poor nutritional status
- Local factors such as tissue deficit
- Iatrogenic factors
- Genetic factors
- Cell transformation such as sarcoid formation in horses
If a wound is non-healing, it's then vital all these factors are assessed to determine, which one is holding the wound back.
Wound Cleaning
One of the ways recommended to minimise the risks of any wound becoming infected is the early stage of lavage and debridement. It's vital the area around the wound is clipped and advisable sterile Hydrogel is placed within the wound with this to prevent stray hairs contaminating the wound. This hydrogel is then removed after, so the wound can be lavaged. PPE is always advisable.
With Lavaging the wound, antiseptics should be used with caution as with their action, can compromise healing in some cases, normally Saline or Prontosan is the fluid choice for this.
Bandaging
The role of bandaging is to help support, protect from infection, self-mutilation or helps to assist dressings kept in place, to produce pressure such as stop haemorrhage or reduce swelling as well as immobilisation to restrict movement of joints, help tor reduce pain levels and provide comfort.
It is important once a bandage is applied correctly, it should be monitored regularly to reduce risks of any subsequent complications. Patients with reduced muscle, such as greyhounds, lurchers as well as Equine limb wounds, bandage sores are often seen, as these develop when pressure is applied over the thin skin in these areas.
Bandages are made up of three layers – Primary layer, a Secondary layer and a Tertiary layer.
To prevent bandage sores some top tips are to apply extra padding such as cotton wool, doughnuts made up from rolled-up cotton wool and these can be applied directly to bony prominences before the bandage is placed on top, using wider bandages such as 15cm for equine and 7.5cm for small animals, as this is thought to reduce areas of focal pressure, each layer of the bandage should overlap the previous layer by 50 per cent, so that even pressure can be applied and apply enough pressure but not too much so, therefore, it stays in place.
So, in conclusion, a bandage is a powerful tool used in veterinary practice to help patients to achieve optimal wound healing. However, it is also vital to have a good working knowledge of wound healing and factors that can interfere with this process.
A poorly applied bandage can often do more damage to the wound than no bandage at all.