Bandaging and Open Wound Management Lecture 2025 PDF

BANDAGING AND OPEN WOUND MANAGEMENT - LA LIZ DEVINE DVM, MS, DACVS-LA  LEARNING OBJECTIVES 1) Describe the steps involved to assess wounds in horses, including the involvement of a synovial structure 2) Describe the steps to treat traumatic wounds in horses, includin...

BANDAGING AND OPEN WOUND MANAGEMENT - LA LIZ DEVINE DVM, MS, DACVS-LA  LEARNING OBJECTIVES 1) Describe the steps involved to assess wounds in horses, including the involvement of a synovial structure 2) Describe the steps to treat traumatic wounds in horses, including tetanus prophylaxis 3) Describe the types of wound dressings and when they are appropriate to use 4) Describe how to apply equine bandages (foot, lower limb, stack bandages) and complications associated with bandaging 5) Describe the complications associated with wound healing in large animals HORSES ARE SELF DESTRUCTIVE!! BUT SOMETIMES IT’S NOT THEIR FAULT….. WOUND HEALING PHASES (long) Granulation tissue appears at day 5 will see white Epithelialization seen at day 4-6 > - rim around wound edge Auer Equine Surgery 5th Ed.  WOUND MANAGEMENT History Initial Exam – Blood loss??? Patient Restraint Visual Assessment Clean Wound & Surrounding Tissues Wound Anesthesia Wound Exploration/Lavage Wound Debridement Wound Closure Wound dressing Bandage Aftercare  INITIAL EXAMINATION **FIRST STOP THE BLEEDING!!** Time elapsed Equine – out to 12 hours for primary closure (suturing Blood loss assess via Heart rate, resp rate, membrane color, CRT 7 Prior treatment/vaccine status anything already? has client > - given Mechanism of Injury -Smooth -Jagged Sheet metal vs Barbed wire Higher energy at impact Tissue damage Vascular Compromise  CHECK ON TETANUS STATUS No vaccination history (+/- > 12 months) Give tetanus toxoid and tetanus anti-toxin Vaccinated >/= 2 months ago Give a tetanus toxoid booster Vaccinated < 2 months ago No booster needed What is the risk of using tetanus anti-toxin??? · Tyler's Dz  PATIENT RESTRAINT Safety is most important! Twitch Tranquilizers Acepromazine – vasodilation, contraindicated with hypovolemia Alpha 2 agonists – xylazine, detomidine > - Sedation ① analgesia Opioids - butorphanol Combination / agonists > - often in C ,  VISUAL ASSESSMENT Wound location Blood supply Synovial structure involvement Other structures?? Vessels , nerves , organs , etc. Contamination/Infection Wound infection at 10^5 organisms/gram of tissue Foreign material, necrotic tissue, hematoma, blood supply compromise, immunosuppression ↑ proliferate bacteria less bacteria needed for infection  CLEAN WOUND AND SURROUNDING TISSUES Clip Apply sterile lube to wound dried up ↓ extensor tendon Clip at least 2 in around the wound Antiseptics usesee Povidone iodine, chlorhexidine 7then Sterile saline – best for lavage Alcohol?? Ouch!! Garden hose?? Causes edema in the tissues · Ok if not fresh  WOUND ANESTHESIA Many lacerations are sutured with the horse standing Medications: Lidocaine or mepivacaine Local anesthesia options: local infiltration Peripheral nerve blocks Local infiltration Techniques: Ideal – block away from the wound If needed, insert the needle at the cut edge of the tissue instead of adjacent to it I dont feel as much follow / block · can circumferential ring  WOUND EXPLORATION/LAVAGE Exploration Digital palpation Sterile probe Radiographs Sterile probe or contrast material Lavage Pressure 10-15 psi ④ 18g needle on a 35ml or 60ml syringe Water-pik – care not to drive debris into wound Solution Normal saline or LRS WOUND EXPLORATION – SYNOVIAL INVOLVEMENT? Synoviocentesis X jant ? side Sterile prep AWAY from the wound (n) > - ect sterile saline into limb. on opposite ① of wound Avoid going through edema/cellulitis and introducing bacteria Sample Fluid Cytology, Total Protein, +/- culture Pressurize the structure > - If Fluid does not shoot back synovial Structure out , likely compromised Ii Fluid wound e will come out on opposite Inject antibiotic. side) Amikacin MEDIAL LATERAL Plantar pouch  INVOLVES THE JOINT….. Treatment: We’ll get to that in 3rd year….  WOUND DEBRIDEMENT Common: 1) Sharp Scalpel blade – debride most superficial layer 2) Mechanical 4-6 Wet to dry bandage ↳ day ↑ L Not once epithelialization has started I will remove healthy new epithelial Cells) 3) Autolytic tissue granulation = wound Moist wound healing is 15 days old WBCs and enzymes degrade necrotic tissue, leave healthy tissue alone Less common: Chemical, Enzymatic & Biological  WOUND DEBRIDEMENT Common: 1) Sharp Scalpel blade – debride most superficial layer 2) Mechanical Wet to dry bandage Not once epithelialization has started 3) Autolytic Moist wound healing WBCs and enzymes degrade necrotic tissue, leave healthy tissue alone Less common: Chemical, Enzymatic & Biological (. maggots)  WOUND CLOSURE… TO CLOSE OR NOT TO CLOSE?? Types of wound closure: Primary Close immediately Warn owner of possible dehiscence - > - above d below on Skin & bandage bandage Lay it on loosely Keeps debris out of the bandage  “HOW TO” PUT ON AN OWNER’S BANDAGE Re-usable Bandage Material Standing wraps, pillow wraps, no bows, quilts Polo wraps, standing wraps  COMMON BANDAGING ERRORS Uneven pressure, uneven swipes, poor application Not enough padding, wrapping the wrong direction  BANDAGING OVER JOINTS Can do a stack wrap or center over the joint Minimize pressure over boney prominences Figure eight the bandage “Racing stripe” with elasticon Use gauze to pad the accessory carpal bone and point of hock pinch point - can cause bandage Sore - CARPAL BANDAGE TARSAL BANDAGE  SPLINTING Proper padding is VERY important Often made of PVC pipe and duct tape or white tape (not stretchy)  FOOT BANDAGE Wrap tight on the hoof, loose on the skin May or may not have padding LOTS of duct tape on the bottom of the foot FOOT BANDAGE FOOT BANDAGE FOOT BANDAGE  COMPLICATIONS OF BANDAGING Exuberant granulation tissue formation Initially good, then bad… Pressure sores Dorsal Can cause wounds bandage bow May have white hairs later “Bandage bows” > - Too tight, not enough padding Extensor or flexor tendon inflammation No actual disruption of the tendon Too little padding, wrapped too tight  BANDAGING RUMINANTS Most common for foot procedures Wounds Pressure bandage Padding under splints BANDAGING RUMINANTS – CLAW BLOCKS Sole ulcer Block goes on the unaffected claw  BANDAGING RUMINANTS DIFFERENCES FROM EQUINE Same basic principles Watch out for the dew claws Painful with too much pressure Avoid wrapping directly over them Figure 8 technique or use donuts for protection Difficult to confine LOTS of duct tape! COMPLICATIONS OF WOUND HEALING IN LA DEHISCENCE – WARN OWNERS EVERY TIME!  EXUBERANT GRANULATION TISSUE “PROUD FLESH” Distal limb wounds Carpus/tarsus and below Ruminants – less common, can occur Predisposing factors Bandaging after granulation tissue is present – hypoxia Movement Large wound, second intention healing Bone sequestrum Wound irritation – Owner’s wound ointments Treatment bleed but not painful Sharp debridement will > - Topical Steroids Skin grafting  EXUBERANT GRANULATION TISSUE “PROUD FLESH” Distal limb wounds Carpus/tarsus and below Ruminants – less common, can occur Predisposing factors Bandaging after granulation tissue is present – hypoxia Movement Large wound, second intention healing Bone sequestrum Wound irritation – Owner’s wound ointments Treatment Sharp debridement Topical Steroids 2 days after Skin grafting Entederm treatment  INVOLVEMENT OF SYNOVIAL STRUCTURES Small, seemingly innocuous wounds can be VERY serious I not be lame elst Requires immediate referral may $$$ Time is VERY important Better prognosis if treated early Contaminated vs infected  BONE SEQUESTRUM Dead, infected piece of bone Bacteria from wound Necrosis from damage to blood supply/periosteum Sequestrum Signs: Non-healing wound Body sees it as a foreign body Cloaca Typically requires surgical removal Involucrum  CELLULITIS Severe edema in the limb associated with a infection of SQ tissues relatively small wound > - May just be an abrasion Infection of the subcutaneous tissues Severe lameness (lame at a walk) - SAA titer Requires aggressive therapy Systemic Antibiotics Anti-inflammatories Bandaging QUESTIONS??