Wound Care Management for the Equine Practitioner

Contents Section 1 Wound Care Dressings Introduction 3 Some Helpful Hints 3 Dressings used for Cleaning and Prepping 4 Dressings Used for Debridement 6 Dressings Used for Packing 7 Dressings Used for Absorption 9 Dressings Used for Compression 11 Dressings Used for Support 12 Dressings Used for Protection 13 Dressings Used for Moisture 14 Methods of Dressing Application 14 Splint Application 16 Emergency Transport 19 Section 2 Wound Preparation, Cleaning, and Debridement Wound Preparation 26 Wound Infection 28 Wound Cleaning Agents 29 Scrubbing 30 Lavage 31 Saline 32 Antiseptic Agents 32 Povidone Iodine 34 Chlorhexidine 35 Hydrogen Peroxide 36 Acetic Acid (Vinegar) 36 Dakin's Solution 37 Topical Antibiotics 38 Silver 38 Nitrofurazone 39 Triple Antibiotic 39 Surfactant Based Agents 40 Wound Debridement 41 Mechanical Methods 41 Sharp Debridement 42 Physical Debridement 43 Chemical Debridement 44 Chemicals 44 Hypertonic Saline Dressings 44 Natural Methods 45 Autolytic Debridement 45 Enzymatic Debridement 46 Section 3 Wound Exploration Head Wounds 52 Neck and Back Wounds 54 Chest Wounds 55 Abdominal Wounds 57 Leg Wounds 58 Important Anatomical Considerations 60 Foreign Body Detection 64 Exploration 64 Ultrasound 65 Plain Radiology 66 Contrast Radiography 67 Computed Tomography and Magnetic Resonance Imaging 67 Section 4 Primary Wound Closure Appropriate Wounds for Primary Closure 70 Closure Techniques for Primary Wound Closure 73 Suture Closure 74 Needle Type 74 Absorbable versus Non-Absorbable 75 Monofilament versus Multifilament 76 Suture Patterns 77 Appositional 77 Simple Interrupted 77 Simple Continuous 78 Interlocking 79 Intradermal 80 Tension Relieving 80 Cruciate 81 Near-Far-Far-Near 81 Vertical Mattress 82 Horizontal Mattress 82 Knot Types 83 Staple Closure 83 Suture/Staple Removal 84 Tissue Adhesive Closure 85 Other Tension Relieving Techniques 85 Wound Protection and Immobilization 87 Section 5 Delayed Primary Wound Closure Appropriate Wounds 92 Intermediate Wound Care 92 Preparation for Closure 93 Section 6 Second Intention Wound Healing Moist Wound Healing Concepts 100 Dressing Choices 103 Hypertonic Saline Dressings 105 Antimicrobial Dressings 111 Hydragel Dressings 115 Calcium Alginate Dressings 117 Topical Dressings: Collagens, Maltodextrans 122 Replacement Tissue Dressings 124 Growth Factors 125 Semi-Occlusive Dressings 126 Steroids 131 Summary 132 Caustic Agents 134 Excess Granulation Tissue 134 Non-Healing Wounds 136 Section 7 Skin Grafting Immediate Wound Care 140 Bed Preparation 141 Types of Grafts 142 Healing Stages of Grafts 142 Skin Graft Types 143 Grafting Techniques 144 Skin Graft Donor Sites 145 Animal Positioning, Anesthesia, and Sedation 146 Pinch Grafting 147 Punch Grafting 151 Tunnel Grafting 154 Mesh Grafting 155 Pedicle Grafting 158 Grafting Aftercare 158 Dressing Choices 158 Frequency of Dressing Changes 159 Wound Immobilization 159 Reasons for Graft Failure 161 Inappropriate Type of Graft 161 Inadequate Graft Preparation 161 Inadequate Recipient Bed Preparation 162 Infection 162 Separation of Graft from Wound Bed 162 Graft Movement 163 Section 8 Specific Wound Considerations Heel Bulb Lacerations/Hoof Wall Avulsions 166 Lacerations of Synovial Structures 173 Tendon and/or Ligament Lacerations 178 Chest Lacerations 181 Abdominal Wall Lacerations 183 Head Lacerations 185 Lacerations to the Axillary Region 190 Index 193 Recommended Readings 208