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InFocus

Supporting the healing process

Nikki Cumberbeach recalls a recent case of wound management in a greyhound and suggests it is nurses who are ideally placed to take the lead

VETERINARY NURSES LOVE A
GOOD WOUND
. Anything that can
be squeezed (the more disgusting the
expelled contents, the better) can cause fights between who can do the deed
(I’ve seen it happen!) – it is just such a satisfying experience to see a painful abscess
shoot
smelly
pus across
the exam
table and
the cat
breathe a sigh of
relief at the pressure being released.

It never ceases to amaze me the
amount of pus that can accumulate.
I also find it interesting how this
mechanism works, and fascinating as to
how rabbits create cottage cheese pus
as opposed to the creamy yellow pus
from cat bite abscesses – all to do with
how their neutrophils engulf bacteria.

Pus has also been on my mind just
recently as my horse has had a foot
abscess which after bursting out at the
coronet band is still draining weeks
later.

But I digress – I wanted to talk about
wounds as a case we had in recently
reminded what an important part us
veterinary nurses can play in wound
management.

Stanley was brought in to us one
evening by his owners. They had
returned from a trip out and were
greeted by an excited Stanley who ran
across the shingle gravel drive to greet
them and promptly fell over.

This sounds like a fairly innocent
incident, but Stanley was a greyhound.
Greyhounds have thin skin and the
grazing that occurred from the fall
was not only extensive but full skin
thickness, and Stanley presented to
us with a posterior which made us all
wince and a degloving type injury to
his tarsus.

Extent unknown

His owners had not realised the extent
of his injuries, thinking he had just
grazed himself and decided initially
that the best course of action was
giving him his evening meal to cheer
him up!

This unfortunately meant we were
unable to anaesthetise Stanley on
presentation to sort the injuries and
the “golden hour” for dealing with
the wounds had already passed by the time his owners realised he was in
discomfort and came to us.

Initial treatment was pain relief,
antibiotics and a brave Stanley let
us lavage and clean the wound,
conscious to try to remove some of
the contamination before we were able to do a
proper job.
I have to
say in my
experience
greyhounds
tend to be
wimps –
often even before we have done anything! Stanley,
however, was a particularly stoic
individual.

When anaesthetised, the wounds had
KY jelly applied, were clipped, with an
initial cleansing with dilute iodine and
then copiously lavaged with saline.

The saying that “dilution is the
solution to pollution” is so very true
and I believe cannot be overdone. A
minimum of 100ml of lavage per cm
of wound should be used as a guide.

The skin was then prepped for
surgical debridement using iodine
again. Scrub solutions of chlorhexidine
or iodine should not be used on open
wounds as damage to the tissue can
occur.

More lavage using a 20ml syringe
and a 19g needle after the surgical
debridement followed, which helps
debride the tissue.

The main wounds to Stanley’s left
rump were able to be closed and a
penrose drain was used. The degloving
injury to his tarsus was bandaged after
cleansing and lavage using melolin with
intrasite and manuka honey applied
against the wound.

We used the honey as we were
worried about contamination as it
would be healing as an open wound.

Post-surgery

Stanley came in every three days
after the surgery to have his bandage
changed and re-applied, and his
wounds checked as we were worried
about breakdown.

He proved to be a great healer and
there was only a small area on his
rump where the wound broke down,
and the tarsus wound granulated
beautifully and after four bandage
changes we stopped bandaging and
using the intrasite/honey as there
was a danger of overgranulation and proud tissue. The owners were
advised to just keep the area clean and
gently bathe with swabs and water if
required.

The main reason for issues with
healing wounds is patient interference
or excessive movement, so a
buster collar was issued and strict
instructions to continue with lead
exercise only.

A rewarding case

What was so rewarding about this case
was that the nurses were able to use
their experience and knowledge to
deal with Stanley’s wounds. Bandaging
and wound care is something that if done well can yield great results,
but done badly can cause further
problems.

I remember when at college (many
years ago now!) we bandaged our own
forearms. I was shocked how tight it
felt despite padding and the finished
bandage was uncomfortable to say the
least. Friction wounds from bandages
that are too loose or tight can be
worse than the wound you were trying
to help heal!

Following bandaging rules is
important and not only for the
comfort of your patient. We are
taught to bandage correctly and can
help the vets learn – I certainly have
had a sharp intake of breath at the
sight of a vet applying a bandage and
had to gently advise re-application.

Dressings in bandaging seem to
go in and out of fashion and there
seems to be an exhausting variation
of dressings, from silver to honey-
impregnated and all those in between
– but what shouldn’t be forgotten
is that it is the body that heals the
wounds, not us.

We can help, but mostly our role is
to support the healing process which
is already taking place.

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