Wound Management: Key Concepts for Veterinary Nurses

WRITTEN BY: Jess Male

BSc, RN, VN, TAA.

Veterinary Nurses love Wound Care, right?

Hands up who gets excited over a good abscess?! One of the ones where you lance it and drain lots of pus?! I think I’d be hard pressed to find a vet nurse who didn’t like the satisfaction of tending to such a wound! Maybe you’re a rare breed of veterinary nurse who doesn’t like pus, but doesn’t mind the challenge of a degloving or dog attack injury? Or perhaps you just really enjoy getting stuck in with the veterinarian and tackling a tricky skin graft? No matter what, I think we can all agree that our patients can suffer a wide range of wounds that all require our skills and knowledge as vets and vet nurses to help fix.

Getting to know your wound better.

Just as there are different types of wounds, so too are there different types of approaches to fixing them and, therefore, different types of wound care products to help with the process.

So first off, what types of wounds can we end up dealing with? Well, wound types can be broken down into four categories¹:

1. Clean. Clean wounds are the simplest of them all. They are basically just surgical wounds made under aseptic conditions, so it’s unlikely that these are ever going to be tricky to deal with.
2. Clean –Contaminated. These are wounds which can be minor lacerations, though only ones that are less than a few hours old; surgical wounds made under aseptic conditions into a contaminated area such as the GI tract (minus any spillage of gut contents); or clean wounds that are now considered contaminated due to a small break in aseptic technique, eg. gloves breaking.
3. Contaminated. These wounds are those where traumatic injury has occurred but sepsis is yet to take place, or where we have spillage from a contaminated area into the wound.
4. Dirty. This ones pretty obvious – all those wounds that are infected, inflamed, discharging (remember our purulent abscess?!!), dying. Just yuck.

Ok, so how is this useful? Well, it determines just how we treat the wound. For example, a clean wound as the result of a cruciate surgery is not going to require regular lavaging, but rather we might just dress it with a simple dressing or even leave it uncovered. But that exciting, dirty purulent abscess that we’ve just drained is going to need us to lavage it and probably think about a drain placement. But how did we come to conclusion that we shouldn’t just stitch up that old abscess and send our patient on his merry way?

Wounds have needs too, you know!

Some wounds will require suturing and others won’t; they are best treated as open wounds. Knowing how wounds can and should be left to heal is also important – the last thing you want to do is suture closed the abscess wound without a drain, only to trap bacteria in it and cause more infection. As a golden rule, primary closure of a wound (first intention healing) should not occur if the wound is older than 6-8 hours^1,2 – after this period, bacteria are likely to have multiplied to high enough levels to cause infection. Wounds that fall into this category might instead be closed using delayed primary closure (ideal for those wounds that are mildly contaminated or traumatised where granulation tissue hasn’t occurred yet²), secondary intention (for those dirty, contaminated wounds often caused by trauma), or secondary closure (for those wounds that are severely contaminated or traumatised and which need extensive debridement over several days).

At the end of the day though, the things to remember when deciding how best to tackle the wound are¹:

• Time since the injury occurred
• Degree of contamination
• Amount of tissue damage
• Thoroughness of initial debridement and cleaning
• Blood supply to the wound
• The patient’s health and nutritional status
• Closure options that limit dead space/ tension
• Location of the wound

Wounds just want to have fun!

But more than anything, you’re just hanging out to be let loose with bandaging materials and funky dressings! That’s all you really want, right?! But hang on – which ones should you use and how?

Before you go treating your wound to a nice dressing, you need to know what to use to provide the best environment for healing. Ideally, a wound bed needs to be kept humid, have just the right amount of exudate present (not too much, not too little!), be warmish (between 35 and 37C), and be able to carry out gaseous exchange. We need the right dressing to help achieve these things, but bear in mind that different phases of wound healing will dictate these conditions and therefore your dressing choices. Our short course on Wound Management explains this all very well.

Most dressings are used as our primary layer in the bandage that we apply. They are arguably the most important layer of all because they are what should be creating the perfect wound healing conditions! For example, if we wanted to mechanically debride our wound, we could opt for a wet –to- dry gauze dressing as our primary layer. Or if we had, say, a simple wound with minimal exudate we might reach for something like Melolin. Then, for more heavily exudating wounds, Allevyn could be a good fit.

Then there’s the role of your secondary layer. This is largely absorption³, and support. Usually cotton wool will be used though soffban will be ok in some circumstances too. In either case, using a gauze bandage to secure the padding and provide structure and even pressure is a good idea³.

And of course, you should always finish off with a good tertiary layer – one that protects our wound’s dressing and holds everything in place. Elastoplast or vetwrap make good tertiary layer options, especially vetwrap if you have a spare few minutes up your sleeve and don’t mind a bit of bandage art!

References

1. Phillips H 2012, Wound Management, Veterinary Nurse Solutions: Melbourne
2. Klingensmith ME, Chen LE, Glasgow SC, Goers TA & Melby, SJ 2008, ‘Wound Healing and Care’, The Washington Manual of Surgery, 5^th edn, Lippincott Williams & Wilkins: Philadelphia, USA, pp.117-118
3. Swaim SF, Renberg WF & Shike KM 2011, Small Animal Bandaging, Casting, and Splinting Techniques, Wiley-Blackwell: USA, p.9

want to learn more?

Wound management

SHORT COURSE

Wound Management is an area that nurses can be actively involved in. This short course will teach you about the integument system; the physiology of wound healing; different dressings and bandages (both techniques and materials), which to use when; and how to decide on a wound care plan in conjunction with the veterinarian.

Check it out