SmallAnimal 36 l Veterinary Practice News l November 2015
By Don Jergler
For Veterinary Practice News
Here’s the advice many veterinary specialists of- fer in dealing with animals’ wounds: Look deeper.
While a wound itself may call
for immediate attention, beneath
the damaged tissue may lurk
a deeper injury, or a rampant
infection lying in wait in an area
critical to a pet’s future mobility.
Early and thorough exploration of wounds allow them to be
cleaned before tissue becomes
more infected or necrotic, and
more importantly, before the
bacteria spread system-wide,
said Marije Risselada, DVM,
Ph.D., Dipl. ECVS, Dipl. ACVS.
“Exploring the wound—
looking for trauma to underlying structures—is key in bite
wounds, as the act of the fight
and the motion of the dog that
is biting and the one that is bitten oftentimes tear the underlying muscles, tendons, tissues,
while the overlying skin is more
mobile and only shows some
small puncture wounds,” Dr.
She is an assistant professor
in small animal soft tissue and
oncologic surgery at the North
Carolina State University College of Veterinary Medicine.
Chad Schmiedt, DVM, Dipl.
ACVS, an associate professor of
soft tissue surgery at the University of Georgia College of Veterinary Medicine, puts such exploration atop his list of the basics
of wound care.
Dr. Schmiedt’s basics include
biopsying and culturing problem
wounds, being mindful of ten-
sion, and identifying the under-
lying problem in patients with
wounds that won’t heal.
“When dealing with hard-to-handle wounds, I think veterinarians should revert to
the basics of wound healing,”
Schmiedt said, urging practitioners to keep in mind that
there is “always a biological reason” a wound won’t heal.
If a wound is stuck in the inflammatory and debridement
stage, a treating veterinarian
should consider that something
prevents it from moving on to
the repair phase, he said.
“Usually this is dead or ne-
crotic tissue that needs to be
removed, infection, or inappro-
priate wound care—some magic
treatment one keeps slathering
on,” Schmiedt said. “If a wound
is stuck in the repair phase with
a granulation bed that will not
contract and epithelialize, this
is usually because the tension
is too great for the myofibro-
blasts, there is infection, or in-
appropriate wound care.”
Another of Schmiedt’s prior-
ities is identifying a biological
problem and correcting it.
He believes one of the big-
Start With the Basics
gest obstacles in wound healing
is a wound that forms because
of an underlying problem, such
as pressure sores or decubital
ulcers. Without doing something
to address the underlying prob-
lem, these wounds will not heal,
Schmiedt isn’t the only expert who preaches a basics-first
approach to wound care.
The application of wound
management basics is
Dipl. ACVS, an assistant
professor of small animal
surgery at the University of
Pennsylvania School of Veterinary Medicine.
Dr. Volk’s tenets of wound
management include proper
cleansing, debridement and lavage of the wound, provision
of adequate wound drainage,
adherence to surgical principles, and selection of appropriate method and timing of
“Preoperative patient assessment and client counseling are
also key, particularly in cases
with extensive wounds or co-morbidities, to successful outcome and ensuring long-term
commitment and investment
throughout the duration of the
post-operative period,” Volk
She sees no single solution in
“To optimize the healing
potential of any wound, it is
critical to have a thorough
wound-healing process for
each species, the factors that
can derail these events and
compromise healing, and the
treatment options that are available,” she said. “With these in
mind, clinicians should reassess
wounds throughout the healing process to promote an ideal wound-healing environment,
minimize complications and
intervene should healing not
progress as anticipated.”
Wound Care Toolbox
Veterinary medicine has no
shortage of wound care products and devices. They include
a large and growing variety of
dressings and topical agents
and devices, as well as biological and regenerative therapies,
“The key to their successful
application is in understanding
the advantages and limitations
to each and when to apply them
to individual wounds,” she said.
A newer technique to tackle
tough wounds, in the view of
North Carolina State’s Rissela-
da, is negative-pressure wound
therapy, in which a porous ban-
dage is kept at a constant
“This allows less frequent
bandage changes, which we
oftentimes would have to do
under sedation or anesthesia
to keep our patients comfort-
able and minimize pain and
trauma,” Risselada said. “More
classically used bandages
would have to be changed ev-
ery 12 to 24 hours, while the
[negative-pressure wound ther-
apy] would have to be reapplied
every three days.”
Georgia’s Schmiedt also is big
on negative pressure.
“We commonly use V.A.C.
Therapy on wounds in the repair
stage or after skin grafting,” he
Additionally, he has been using a more topical edetate diso-dium, or silver-based products
like Tricide, Silvalon or Silvak-lenz, from Molecular Therapeutics, in the inflammatory and
debridement stage, or if an infection is present. l
A deep look at basics of wound care
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Early and thorough exploration of
wounds allow them to be cleaned
before tissue becomes more infected.