Knowing which dressings to make use of on horses for which wounds and when can significantly enhance therapeutic occasions and cut back remedy prices. Keeping an applicable moisture steadiness also can assist. Combined, they’ll restrict disagreeable unwanted effects akin to itching, ache, and scarring.
The many kinds of dressings obtainable to veterinarians possess totally different qualities with various results and dangers. So being acquainted with and utilizing them correctly all through a horse’s wound-healing course of is paramount, stated Dean Hendrickson, DVM, MS, Dipl. ACVS, professor of equine surgical procedure at Colorado State University’s College of Veterinary Medicine & Biological Sciences, in Fort Collins.
“You can’t just grab your favorite dressing and use it throughout the whole healing process; you have to use them specifically based upon what’s going on with the wound,” he stated in the course of the 2021 American Association of Equine Practitioners conference, held Dec. 4-8 in Nashville, Tennessee.
“We have to get over the perspective that a wound is a wound is a wound,” he stated. “They are not the same; they change; they’re different as they go through the healing process. And our dressing should change with them.”
When first evaluating a wound, veterinarians ought to decide if they’ll suture it closed—and, if that’s the case, do it. “It’s always better to close a wound than it is to let it heal over time,” he stated. Wounds with an excessive amount of tissue loss for closing are robust candidates for a pores and skin graft later within the therapeutic course of. Veterinarians can deal with some smaller contaminated wounds first and suture them later.
A wound can current in any of 4 main phases, every of which ought to information the veterinarian’s selection of dressing, Hendrickson stated. If it’s:
- Necrotic and/or weeping giant quantities of exudate—a yellow liquid—it wants debridement.
- Dry, it wants moistening.
- Healing with poor-quality granulation tissue, it wants dressings that promote wholesome granulation tissue progress and wound contraction.
- In the epithelialization section—when epithelial cells develop and begin to cowl the wound floor with new top-skin—it wants dressings that keep the suitable temperature and humidity ranges to assist that progress.
Veterinarians ought to acknowledge which section the wound is in—even totally different elements of the wound, as therapeutic can happen inconsistently—and alter their wound remedy course, Hendrickson stated. That cannot solely optimize therapeutic but in addition stop caretakers from making errors that impede the therapeutic course of.
“If we’re not paying attention to what the wound is telling us, we’re going to keep using the same dressing, and the wound healing is going to slow down,” he stated.
Leaving a wound dry and open to the air, stated Hendrickson, could make it extra infected, painful, and itchy, and it could actually even trigger extra scarring. Veterinarians ought to pack dry wounds with a moisturizing dressing like a hydrogel, which “donates” its water to the wound. As lengthy because the dressing stays moist, caretakers can change it each 5 days till the wound has reached the following section of therapeutic or is smooth and moistened sufficient for debridement.
Wounds with necrotic tissue and/or an infection want common debriding, beginning first with what Hendrickson calls “sharp debridement”—utilizing a scalpel to chop or scrape off the floor of the wound. This section requires a debridement dressing with a gauze wrap, which permits for autolytic debridement. In this course of, the moist setting encourages the physique’s personal enzymes to slough off lifeless tissue. “Autolytic debridement is incredible,” he stated.
A saline dressing can work for this however requires fixed saline reapplication to the gauze as much as six occasions a day, he stated. Hypertonic saline dressings require much less intervention and work nicely on visibly contaminated wounds and people with giant quantities of exudate. They must be modified each three days and could be lined with plastic wrap or a deconstructed rectal examination glove to carry within the moisture. Veterinarians also can select an antimicrobial dressing or an evidence-based honey dressing, modified each three days—or each 5 days in surgical wounds (that are particularly susceptible to environmental an infection).
Veterinarians additionally want to know when to cease utilizing a debriding dressing. And that depends upon the wound—“not on the calendar,” Hendrickson stated.
“Once the wound has been effectively debrided, you shouldn’t use debridement dressing anymore, because that’s actually just causing more damage to the wound,” he defined.
Clinicians can encourage wholesome granulation tissue growth through the use of a seaweed-based product referred to as calcium alginate built-in into smooth cloth pads. The product interacts with the sodium within the wound and elicits a light inflammatory response that may promote therapeutic.
“One of the biggest challenges with horses is that they don’t provide a very good inflammatory response in the early wound-healing stages,” Hendrickson stated.
However, calcium alginate is very absorptive, able to holding 20 occasions its personal weight, he added. While that’s useful for very moist wounds, it could actually draw an excessive amount of moisture out of wounds with little exudate. So, calcium alginate dressings usually must be moistened with saline and lined with plastic to take care of good wound hydration. They could be modified each 5 to seven days however no extra steadily than each three days. For causes but to be decided, calcium alginate seems to be only if left undisturbed for 3 days at a time, Hendrickson stated.
Finally, for wounds on the epithelialization section, veterinarians can use a semiocclusive foam, he stated. The dressing could be modified each 5 to seven days relying on the kind of exudate the wound has produced.
While preserving wounds moist is vital for therapeutic, and might double the epithelialization fee, it could actually additionally put them vulnerable to bacterial infections and make them extra susceptible to traumatic impacts. With that in thoughts, veterinarians ought to observe wounds carefully and intervene with debridement and topical antimicrobials however not antiseptics (which may kill wholesome tissue), within the occasion of an infection, Hendrickson stated.