Wounds

RE: Wounds

Taku — Wed, 06 Apr 2016 07:50:28 GMT

Hey Cloudy

At my practice we used to leave the scabs on as removing usually traumatising the wound however nowadays after some CPD talks we attended we dress all wounds until they are very very small.if it's a healthy wound as you said we usually put INTRASITE (it keeps the wound nice and moist)on and a non sticky wound changed usually every 2nd or 3rd day .

RE: Wounds

Alison Clare Hickman — Sun, 03 Apr 2016 20:34:40 GMT

Hiya Rhian,

I was very intrigued by your vets use of Dentisept (clearly a dental product!) so I asked wound expert Georgie Hollis about it. This is what she said...

"Aah ha! . . . Good one! Well . . . I did some homework and had a chat with the Forte people who make this . . . Technically speaking it's chlorhexidine with some flavouring and what is probably a hydrocolloid particulate to help it stick to teeth. Only thing that might not be ideal is the flavouring, but nothing wrong with using chlorhexidine to kill bugs in wounds that are infected. Just not something to use in granulating wounds as fibroblasts don't like it and it will reduce healing times. That kind of fits with the observation that inflammation reduced. Just id(entitfy) any causes of inflammation before you consider something like that 'off licence' - - - that is another argument - - - "

Interesting eh!?!

Ali h

RE: Wounds

Rhian Jones — Tue, 29 Mar 2016 20:48:14 GMT

Hi,

Just adding to this thread. Does anyone have experience of using Dentisept on wounds?

The vet I am with at the moment used it on a particularly nasty post op wound that had started to break down and saw it the next day and the difference was fantastic. Really helped to bring down the inflammation and redness. I assume because of its great anti bacterial properties?

Any experience/further advice with this would be much appreciated!

RE: Wounds

rebeccawright — Wed, 23 Mar 2016 14:55:32 GMT

I was under the impression that granulating wounds do not scab when healing via secondary intention. If a granulating wound is scabby it is usually dried discharge and should be removed to promote healthy tissue growth.

If a sutured wound has a little scabbing I tend to leave it.

RE: Wounds

Alison Clare Hickman — Sun, 20 Mar 2016 19:32:49 GMT

Hiya,

I've always gently flushed a wound post removal of eschar with warmed (body temperature) Hartmann's (the least cytotoxic agent available). Then, as you've mentioned, use a gel. Currently using 'Remend' to very good effect.

Ali h

RE: Wounds

Cloudy Weather — Sat, 19 Mar 2016 20:02:47 GMT

Thanks Robyn :) Again really helpful thank you so much. When you soak off the scabs do you dab dry after and then add moisture using something like intrasite? I have seen previous someone clean a wound but leave it quite wet and left the scab in place. I would assume this is not ideal as I thought tap water can be quite damaging to fibroblast, leaving the area so wet will just lead to maceration of healthy tissue, the scab is not really doing its job as will be macerated also, and as the previous post indicated it would result in too much moisture rather than a controlled healing environment?

RE: Wounds

Cloudy Weather — Sat, 19 Mar 2016 19:56:06 GMT

Thank you so much for this. Its extremely helpful and really helps clarify things in a nice concise account!:)

RE: Wounds

Robyn — Fri, 18 Mar 2016 16:23:39 GMT

You won't get much of a better explanation than that!

As far as my practical experience, I will clean scabs off, as I find that they can hide areas of exposed tissue which I want sealed over before I risk taking stitches out. I generally soak them off, even if they're tough (patient permitting!) and send the owner home with orders to basically give a quick wipe with some wet cotton wool daily to prevent them re-forming, or I'll send them home with manuka honey, depending on the stage of wound healing we're at. Ideally we wouldn't have a scab forming over wounds we're haling by 2ry intention!

RE: Wounds

Alison Clare Hickman — Fri, 18 Mar 2016 14:49:47 GMT

Hiya,

Not a silly question at all, it's an intelligent query!

See below - hope this helps.

The edge of an eschar ('scab') can keep a wound from closing by its normal secondary intention. And an eschar is a sign that a wound is too dry to heal as fast as possible. Having noted that, a crust is the best nature can do in many situations. It is protective.

In the best of all possible worlds, it is possible to do better, as E. Masi notes. Yes, the first time that you remove an eschar, you do traumatize the wound, so it is not good to keep doing it. But once it's done, if you never let another eschar form, you can accelerate healing.

How? The fibrocytes in a wound are trying to lay down collagen and heal the wound by drawing it together and forming the tissue that turns into skin and healed scar. You want to encourage them to divide and grow. They can't do this if they dry out. It happens well only if they are moist but not too moist. They are like amoebas-- you want (and THEY want) existence of a gooey wound soup where they can crawl around and place themselves, but not so moist that the fluid becomes a seroma that is easily turned into pus. You don't want large collections of fluid far away from capillaries, as that provides a place for bacteria to grow, but too far from the white cells that kill them.

So, you ideally need a thin layer of tissue moisture in a wound, but no more. And you need oxygen, because some of these cells need it, but don't have enough if you cover them. And you want to kill anaerobic bacteria to make sure you don't get gangrene.

Trying to get these conditions is the idea behind bio-occlusive dressings. Such a dressing is just a membrane that lets in oxygen, keeps a wound from drying out, but also allows excess fluids to get out and be soaked up by a next absorbent layer.

These things are expensive even now, and doctors of old did a reasonable job just by slathering a wound with an antibacterial ointment like Silvadene, putting down a layer of petroleum-covered gauze so that the delicate fibroblasts are not ripped off when the dressing is changed, and then adding a layer of something absorbent (can be an alginate sponge or simple dry gauze) so that excess fluids don't leak through into bedding, but have a way to get away from the wound.

Finally, on top of all that goes any dressing that protects all the rest-- an example is the self-sticking latex stuff from 3M called "Coban", or silk surgical sticky tape, or even an ACE bandage (though that's expensive if you have to keep throwing it away at each dressing change).

You change all this every 48 to 72 hours, depending on amount of exudate and the stage of the wound. The idea is that once you remove eschar, you never let it form again, due to the wound damage involved in removing it. All of these are helpful in treating a large wound bed (like a large burn, scrape, or something else where skin is gone).

A last thing: I have seen the order "wet-to-dry dressings" too many times. Why, too many? Because too many doctors have no idea what this is! Wet-to-dry was a bad old system where you put wet dressings on wounds, let them dry to eschar, and ripped the whole thing off. Clearly that is NOT what you want. There are better ways. Wet-to-dry is not a substitute for intelligent "debridement," where a doctor or wound management nurse carefully and selectively removes debris, foreign bodies, necrotic tissue, moistened eschar, and then treats the remaining wound bed healthy granulation tissue as described in the steps above.

Ali h