Techniques in Small Animal Wound Management

List of Contributors xv Foreword xvii Preface xix About the Companion Website xxi 1 The Skin 1 M.S. Amarendhra Kumar Cutaneus Immune Barrier 3 Pigmentation 5 The Normal Keratinization Process 11 The Abnormal Keratinization Process 12 Dermis 15 The Hypodermis (Subdermis or Subcutis or Superficial Fascia) 17 Connective Tissue and Fascia 23 Skeletal Muscle 26 Skeletal Muscle Trauma and Regeneration 28 References 30 2 Physiology of Wound Healing and Clinical Considerations 37 Daniel J. Lopez Stages of Wound Healing 37 Proliferative Stage 41 Inherent Detriments to Wound Healing 46 Conclusion 49 References 49 3 Postoperative Complications 53 Ryan P. Cavanaugh Introduction 53 Seromas 54 Wound Dehiscence (Indolent Pockets, Pseudo Healing) 57 Biofilms 65 References 68 4 Wound Types and Terminology 73 Desiree D. Rosselli Classifications of Veterinary Wounds 73 Wound Closure 80 References 82 5 Patient Presentation and Evaluation of Wound 85 Colin Chik Initial Stabilization of the Wound Patient 85 Acute Critical Wound Patients 85 Stable and/or Chronic Wound Patients 89 Evaluation of Patient Factors 90 Evaluation of Wound Factors 92 Initial Treatment 93 Decision-Making for Primary Closure 95 Debridement 95 Drain and Bandage Placement 98 References 101 6 Cleansing Solutions 103 Julia P. Sumner Cleansing Solutions 103 Tap Water 106 Isotonic Intravenous Crystalloid Fluid Preparations (e.g., 0.9% Saline, Lactated Ringer’s Solution, Hartman’s Solution, Plasmalyte, Normosol) 106 Antiseptic Solutions 106 References 109 7 Topicals 111 Nicole J. Buote Hydrogels 111 Zinc-Oxide Hydrophilic Pastes 113 Honey/Sugar 114 Antimicrobials (Nitrofurazone, Triple Antibiotic, Silver Sulfadiazine) 117 Triple Antibiotic (Neomycin, Polymixin B, and Bacitracin) 118 Silver Sulfasalazine 119 Oxygen 120 Nitrous Oxide 120 Miscellaneous Topicals 121 References 123 8 Wound Dressings 127 Nicole J. Buote Moist Wound Healing 127 Characterization of Dressings 127 Adherent Dressings – Woven Gauze and Lap Sponges 131 Non-adherent Semiocclusive (Porous-Dry or Petrolatum-Impregnated) 132 Absorbent 133 Moisture Retentive Dressings 135 Antimicrobial 138 Bioelectric Dressings 141 Xenograft Dressings 143 Miscellaneous 149 References 150 9 Drains: How and When to Place Them 155 Angela C. Banz Passive Drains 155 Closed-Suction/Active Drains 158 References 163 10 Vacuum-Assisted Bandages (Negative Pressure Wound Therapy) 165 Kathryn A. Pitt and Bryden J. Stanley Physiology 165 Increased Granulation Tissue 165 Reduced Bacterial Load 166 Increased Blood Flow 167 Decreased Hematoma and Seroma Formation 168 Increased Cytokines/Growth Factors 168 Microdeformation with In-Vitro Modeling 168 Indications of NPWT 168 Description of Technique 169 Postoperative Care 173 Outcomes/Complications 173 References 174 11 Biologic Treatments 177 Subsection A: Medicinal Leech Therapy 177 Celine S. Kermanian and Nicole J. Buote Anatomy and Physiology 177 Indications 179 Description of Technique 181 Postoperative Care 185 Outcomes/Complications 186 References 188 Subsection B: Maggot Therapy 191 Megan Mickelson Background/Physiology 191 Indications 192 Description of Technique 193 Post-Procedural Care 195 Outcomes/Complications 196 References 200 12 Bandages 205 Kristin A. Coleman and Nicole J. Buote Introduction 205 Light or Modified Robert Jones Bandage 205 Wet-to-Dry or Dry-to-Dry Bandages 208 Tie-Over Bandages 210 References 214 13 Hyperbaric Oxygen Therapy 215 Cheryl Braswell Introduction 215 Physiology 215 References 224 14 Low Level Laser, Photobiomodulation and Electromagnetics for Wound Therapy 225 Nicole J. Buote Low Level Laser Therapy 225 Photobiomodulation 226 Pulsed Electromagnetic Field Therapy 228 References 231 15 Platelet Rich Plasma and Stem Cell Therapy 233 Aarthi Rajesh, Rebecca M. Harman, and Gerlinde R. Van de Walle Platelet Rich Plasma (PRP) Therapy 233 Stem Cell Therapy 241 Combinational Therapy Using PRP and Stem Cell Therapy 246 References 247 16 Reconstructive Techniques for Wounds 253 Jill K. Luther and Nicole J. Buote Equipment 253 Basic Tissue Handling Tenants 256 Skin Tension 257 Tension-Relieving Techniques 258 Triangular, Square, Rectangle Wounds 264 Circular and Crescentic Wounds 266 Skin Flaps 267 Specific Axial Pattern Flaps 272 Skin Grafting 281 References 285 17 Specific Wounds 289 Subsection A: Bite Wounds – A Case Study 289 Nicole J. Buote Presenting Signs 289 Examination and Initial Wound Characteristics 289 Diagnostics 289 Initial Therapy and Procedure 289 Follow-up Bandage Care 290 Surgical Procedure 292 Outcome 292 Prognosis 292 Clinical Lessons 293 Subsection B: Penetrating Wounds 295 Galina Hayes Clinical Presentation 295 Triage and Imaging 297 Management Plans 298 Prognosis 301 References 301 Subsection C: Abscess Case Study 303 James D. Crowley and Julia P. Sumner Presenting Signs 303 Outcome 305 Prognosis 305 Subsection D: Burns 309 Galina Hayes Clinical Presentation 309 Anatomy and Physiology of Burns 309 Comparative Aspects of Burn Physiology 309 Acute Management Plan 310 Bandage Management 312 Split Thickness Grafts 312 Possible Complications 313 Future Directions 313 Prognosis 313 References 314 Subsection E: Wounds Over Joints 315 Galina Hayes Clinical Presentation 315 Specific Challenges 315 Management Plans 316 Prognosis 317 References 319 Subsection F: Shearing Wounds – Case Study 321 James D. Crowley Presenting Signs 321 Outcome 323 Prognosis 323 Subsection G: Necrotizing Fasciitis (Necrotizing Soft Tissue Infections) 327 Nathan Peterson Presenting Signs 327 Wound Characteristics 327 Physiologic Effects 328 Shock/Sepsis 329 Prognosis 332 References 332 Subsection H: Snakebites 335 Nathan Peterson Presenting Signs 335 Wound Characteristics 335 Physiologic Effects 337 Treatment 339 Possible Complications 340 Prognosis 340 References 342 Subsection I: Pythiosis 343 Kristin A. Coleman Introduction 343 Presenting Signs 343 Diagnosis 344 Wound Characteristics 344 Physiologic Effects 345 Treatment 345 Possible Complications 349 Prognosis 349 References 349 Subsection J: Eyelid Wounds 351 Brian Marchione Introduction 351 Presenting Signs 352 Physiologic Effects 354 Treatment 354 Possible Complications 356 Prognosis 359 References 359 Subsection K: Lip Wounds 361 Nicole J. Buote Introduction 361 Anatomic Considerations 361 Wound Characteristics 362 Surgical Treatments 362 Avulsion Injuries 365 Primary Repair 365 Wedge Resection Techniques 365 Full-Thickness Advancement Flaps Full-Thickness 365 Postoperative Care 367 Complications 369 Prognosis 369 References 369 Subsection L: Pinna Wounds 371 Nicole J. Buote Anatomic Considerations 371 Wound Characteristics 371 Surgical Treatments 372 Postoperative Care 374 Complications 376 Prognosis 377 References 377 Subsection M: Circumferential Wounds – A Case Study 379 Nicole J. Buote Introduction 379 Case 1 379 Other Examples of Circumferential Injuries 383 Case 2 383 Case 3 383 Clinical Lessons 384 References 385 Subsection N: Preputial Reconstruction – Hypospadia Case Study 387 Galina Hayes Presenting Signs 387 Examination and Wound Characteristics 387 Diagnostics 387 Surgical Procedure 387 Outcome 388 Prognosis 388 Clinical Lessons 388 Index 393