IN-DEPTH: TRAUMA/WOUND MANAGEMENT


necrotic tissue is removed from the wound prior to dressing application.


Hypertonic Saline


Hypertonic saline dressings are woven gauze dress- ings impregnated with 20% saline. They provide an aggressive, nonselective debridement. They work by drawing the fluid out of bacteria and dis- eased cells, reducing their attachment to the wound bed, and then lifting them out of the wound when the dressings are changed. The author uses the most effective debridement dressings commercially availablea. You can make your own hypertonic sa- line by dissolving 200 g salt in 1 L boiling water. Lower concentrations of hypertonic saline do not seem to be as effective. This debridement dressing should be discontinued when the wound no longer seems infected.


Antimicrobial Dressings


One manufacturer’s antimicrobial dressingb is a loosely woven gauze impregnated with polyhexameth- ylene biquanide (PHMB). PHMB is an antimicrobial that disrupts the cell walls of microorganisms. There is no developing resistance known to PHMB. The dressing was originally developed to apply over a wound to stop bacterial penetration (it is also used in baby wipes and contact lens cleaning solutions). It is now accepted that the dressing will kill bacteria when placed into a wound as well. It comes as a dry dress- ing and should be moistened with saline prior to use in a wound. Similar to hypertonic saline, this dressing should not be used as a primary dressing after the wound has been effectively debrided and the bacterial numbers have been appropriately reduced. It can, however, be used as a secondary dressing to limit bacterial penetration to the wound bed.


Honey


Honey has been used to improve wound healing for centuries. Some types of honey, such as honey de- rived from specific plants like the Manuka bush, seem to have even more antimicrobial effect than would be seen with the natural hyperosmolality present in all honey. Not all honey is created equal in this effect, so only honey that is known to have antimicrobial benefits (Manuka honey) should be used in wound care.14,15


13. Moistening Dressings


Although most of the wounds presented to the vet- erinary practitioner are necrotic and infected, some wounds are dry, often from inappropriate wound care. In these wounds, a gel dressing should be applied to “donate” moisture to the wound and im- prove the wound healing process. Gel dressings commonly contain water, glycerin, and a polymer. Some gel dressings incorporate a gauze that helps them maintain their normal shape. Either the amorphous or the formed dressings can be used to


Declaration of Ethics The Author declares that he has adhered to the Principles of Veterinary Medical Ethics of the AVMA.


Conflict of Interest


The Author has written a book on equine wound care but has no conflict with the companies that manufacture the dressings and cleaning agents de- scribed in this article.


AAEP PROCEEDINGS  Vol. 61  2015 11


add moisture to a dry wound. As soon as the wound is moist, another dressing should be used.


14. Granulation Tissue Development and Wound Contraction Dressings


Calcium Alginate (Alginate)


In the past, exuberant granulation tissue has been the bane of the equine practitioner, and to think that you might choose a dressing specifically to encour- age granulation tissue would have been frowned upon. However, one of the complications of equine wound healing is the lack of inflammatory response that is formed by the horse after wounding. Cal- cium alginate dressings will lead to an effective in- flammatory process that will help wound healing proceed in an effective order. Another valuable benefit of the alginate dressings is that they contain a lot of calcium that is “donated” to the wound to encourage wound contraction. These dressings can also be placed directly on exposed bone that has been curetted to minimize bone sequestrum forma- tion. As soon as granulation tissue fills the wound, these dressings should be discontinued.


15. Epithelialization Dressings


Semiocclusive foam dressingsc help to finish off the wound healing process. The foam dressings will increase the surface temperature of the wound by 1–2°F, which will preferentially select for epithelial- ization. They are a relatively closed-cell design so that the granulation tissue does not grow into the foam. The added benefit of the AMD foam is that it contains the same PHMB as described above in the debridement dressings to limit bacterial growth on the surface of the wound. It is not recommended to add any other agent to the wound during the epithe- lialization process. In summary, there are many options for wound- cleaning agents and wound dressings that have ei- ther negative effects or unknown effects on the wounds. It is the veterinarian’s job to make sure to select a wound cleaning agent or a dressing that will encourage the most functional and cosmetic end re- sult. If you are not sure what the dressing does, you should make sure to find out before using it. Many of these materials have quite detrimental ef- fects on the wound.


Acknowledgments


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