Wound Management

by Susan E. Davis, PT

1. First: stop the bleeding. Control it with direct pressure, even if it is your bare hand. Ideally use a clean cloth, towel or gauze pad.

2. Reduce inflammation and swelling with a cold compress, ice or cool water.

3. Prepare to examine and treat the wound. Wash your hands, use plastic or latex gloves if you feel the wound is very deep.

4. Debridement: This step is needed if a wound has debris or dead and dying tissue on it. The tissue must be removed in order for healing to begin. Debridement should be performed by a veterinarian, vet tech, or physical therapist, using forceps, scissors, gauze, water jet sprays, even a scalpel.

5. Photograph wound if possible. Measure it (length, width, depth), document this plus any details such as shape, color, any odor plus the date.

6. Irrigation: Also called lavage, is a rinsing of the wound to decontaminate it, remove surface dirt and some bacteria. It may be necessary to first clip long hair or fur around the wound site. Warm tap water can be used, or if it appears to be at risk for infection, you can substitute sterile water, distilled water, saline solution or hydrogen peroxide. There are some who feel hydrogen peroxide can further damage a wound, but my experience is that it provides a good cleaning for wounds that are deep and may contain debris hard to locate.

7. Dry the wound simply by keeping it open to the air or use a hair blow dryer on a low, cool setting.

8. Medicate: Your veterinarian and their staff are the best ones to give advice on a suitable type of medication to protect the wound and facilitate healing. Types are antibacterial ointments, hydrogels, foams, creams and sprays. Burns may require special creams and topical agents.

9. Covering the wound: Some wounds should be kept open and others covered with dressings and bandaging. Ask your vet about this. Dressings can be wet, dry and “wet to dry” type. If you are unable to reach your vet, my general advice is with deeper wounds it is usually better to cover them, providing a moist environment and re-bandage 2-3 times per day. Start by placing a non- stick pad on the wound, then secure it with a gauze roll. Cotton batting can be placed next, then finish with a rolled elastic bandage or a light vet wrap. When the wound starts to epithelialize and appear pink, at that point it is best to leave the healing wound uncovered.

10. Skin Grafts will be needed for full thickness wounds that have granulation tissue. These wounds will not epithelialize on their own without grafts, which your vet will apply to the wound. Skin grafts use normal skin harvested from areas where skin is loose, such as the lateral thoracic areas or from other donor sites.

11. Underlying diseases may cause a longer time than normal for wounds to heal.

12. Wound care can be painful, so if necessary, apply a muzzle before treatment.

13. If your dog was bitten by another animal, obtain rabies vaccination status (depending on your local statutes).

14. Puncture wounds must be treated by vet, period. Never try to treat a puncture wound at home or you risk the dog developing a serious infection, an abscess, loss of appetite, fever, lethargy and other dangerous complications.

15. Physical therapy can help most type of wounds, especially those that are complicated and present a challenge to heal. Cold laser, applied through a clear sterile barrier can be used, but only in non- infected wounds or those controlled with antibiotics. Other PT modalities used to treat wounds are electrical stimulation, hydrotherapy whirlpools with iodine additives, pulsed ultrasound delivered through water, targeted pulsed electromagnetic field, and hyperbaric oxygen chambers. Physical therapists can also be of great use with scar and fascial massage and fibrous tissue release techniques.

16. Negative pressure vacuum assisted therapy: Veterinary clinics and hospitals that handle trauma and specialty care for deeply infected wounds often have negative pressure vacuum assisted therapy units. These increase granulation tissue formation, reduce areas of pus, and help draw the edges of a complex wound together.

17. How long does it take for wounds to heal? For a dog without metabolic disease or complications, the time length is similar to human beings, though slightly faster.

18. Should a dog be allowed to lick their own wounds? Animals in the wild use their saliva and teeth to clean and heal wounds; however the methods used in veterinary care facilitate quicker, safer wound healing. It is best to keep your dog from biting or licking wounds by monitoring them or use of a barrier collar.