Veterinary Advanced veterinary wound care
An introduction to veterinary wound management Wounds are a common occurrence in veterinary practice and are most likely traumatic or resulting from surgical procedure. Clinical management aims to provide a rapid return to function while eliminating risks of delay. A moist environment encourages essential cellular activity, collagen formation and vital contraction processes. Wound s have subsequently developed to manage the wound environment more actively, by managing the factors associated with delayed healing. The need for specific properties varies according to the wound and different wounds will require different s at different stages to get the best results. Advanced s are principally designed to actively re-hydrate or to absorb and retain excess wound fluid as well as protecting against further trauma. They may also be required to manage infection, contamination and inflammation. There are several key principles to adopt when using advanced s which will maximise the outcome and make for easy application and removal. Preparing the wound to heal In all cases a full health history should be attained to establish related or unrelated conditions that may affect healing, management or recovery. Prior to examination, the area around the wound should be clipped with a generous margin so that the extent of injury is visible and to allow the to overlap the wound by at least 2cm. Common causes of delayed healing in animal wounds: Dehydration of the wound environment Maceration of the wound environment Contamination or infection within the wound Foreign material, devitalised tissue and wound debris Physical interference, friction and movement Compromised blood flow Dehydration (Physiological) Poor nutrition Lack of immune response Wound Early traumatic wounds (less than 4 hours old) Longstanding traumatic wounds Surgical wounds General guide to preparation prior to : Wounds that are treated within 4 hours of occurring have a good chance of uneventful direct closure. The wound should be generously lavaged using saline and explored to establish the extent of trauma and any presence of foreign material. Anaesthesia may be required to do this effectively. Closure may be achieved by surgical means if the wound is sufficiently clean and enough viable tissue is available. Wounds that are over a day old may begin to show signs of deterioration in the form of contamination, infection and dead or devitalised tissue. The wound should be explored thoroughly and non-viable tissue removed. Anaesthesia is likely to be required to examine the extent of injury thoroughly. Thorough lavage with normal saline is recommended. Surgical wounds, following closure should be simply cleansed with normal saline and patted dry with woven gauze prior to. 1.
Activon Manuka Honey 100% Medical Grade Manuka honey Why Manuka? The properties of Activon Manuka honey provide a combination of beneficial wound healing effects not found in other types of s. Activon Manuka honey has an osmotic effect that helps to de-slough and debride necrotic tissue 1 that can harbour bacteria and impede wound healing. There is a marked reduction in odour 2,4 when Activon Manuka honey is applied to a malodorous wound. Activon Manuka honey will protect the wound bed and provide a moist wound healing environment known to be beneficial to optimise wound healing 3. Aids in the reduction of bioburden Osmotic effect Draws fluid from the wound bed, promoting healing Enhanced healing Promote granulation and epithelialisation 100% Manuka honey tube, suitable for application into wounds. 99% Manuka honey and 1% Manuka oil for use on low to moderate exuding wounds. The is designed to protect a wound, promote healing and allow the passage of exudate. It is an ideal choice for wounds that are perceived to be at risk of re-infection. Activon Tulle is a triple layer primary wound gauze and can be unfolded to wrap around a limb. Additional layers should be applied to maintain osmotic pressure. An alginate, absorbent, sterile, nonadherent wound contact impregnated with 100% Manuka honey, comprising calcium alginate (High M) fibres impregnated with Activon Medical Grade Manuka honey. Algivon has absorbent properties ideal for use on wounds that are exuding. A reinforced alginate, with strengthened alginate fibres, ideal for wetter wounds. The same features as the Algivon Plus in a ribbon shape for application within cavities and sinuses. 2.
Advazorb hydrophilic foam Moist wound management Advazorb is a comprehensive range of patient friendly, absorbent foam s presented in non-adhesive and atraumatic silicone adhesive format. The range is designed to overcome the complex challenges of managing exudate whilst protecting at risk fragile skin, a combination of excellent fluid handling capabilities of Advazorb with a layer of atraumatic soft silicone adhesive. Benefits Reduces excess fluid at the wound site, preventing maceration. Maceration is the break down of skin after prolonged exposure to moisture. Helps to maintain a moist wound healing environment. Winter. G et al (1962) reported that moist wounds heal quicker than dry wounds. 5 Gentle and conformable. The Advazorb range can also be cut to shape for difficult to dress areas. Low-friction backing provides environmental protection. Advazorb and Advazorb Lite are soft and conformable, non-adherent foam s with excellent fluid handling properties. Combination of the excellent fluid handling capabilities of Advazorb with a layer of atraumatic soft silicone allowing for gentle adhesion. The silicone wound contact layer has small pores which enable the passage of exudate into the absorbent foam whilst protecting the fragile wound bed. Advazorb Sacral has the same features as Advazorb Border, but is anatomically shaped for use on canine wounds to the sternum or abdomen. Advazorb Heel has the same features as Advazorb, but is anatomically shaped for use on equine wounds located on the hock or fetlock. Advazorb, Advazorb Silfix and Advazorb Border are available in both a regular thickness for low to moderate exudate and Lite versions for wounds with low exudate levels. Visit www.advancisveterinary.com for ordering codes. 3.
Eclypse superabsorbent range High exudate management How do the layers of the Eclypse s work? The backing The water-resistant barrier backing on Eclypse s are bacteria and viral proof and critically prevent strike-through. Secondary layer This layer sits underneath the backing and on top of the moisture locking layer. Moisture locking layer The central layer of the Eclypse consists of a sheet of highly absorbent crystals and a mechanically bonded cellulose pad. Rapid wicking layer This layer draws up the exudate from the wound bed delivering the exudate into the moisture lock layer. Soft silicone contact layer The silicone contact layer gently adheres to skin but due to the hydrophobic nature of silicone it will not adhere to the wound bed. Backing Secondary layer Moisture locking layer Rapid wicking layer Eclypse is a highly absorbent, high capacity wound exudate management product designed to absorb fluid, reduce potential leaks and reduce risk of maceration. The absorbent layer provides a large capacity with rapid fluid uptake forming a gel, locked away from the wound, when in contact with exudate. Super absorbent s are particularly suited to equine limb wounds, but can also be used on smaller animals. Adherent The soft silicone layer provides gentle adherence and will not stick to a wound or damage the surrounding skin or hair. Particularly suited to equine limb wounds, Eclypse and Eclypse Adherent are designed to absorb and retain fluid from medium to highly exuding wounds. Eclypse Adherent gently adheres to clipped fur preventing slippage and movement after bandaging. Eclypse Adherent Sacral is a super absorbent wound exudate management with a Silfix soft silicone wound contact layer. The will only adhere to dry skin surrounding the wound and can be easily lifted for adjustment without losing its adherent properties. The is an ideal shape for using on chest wounds e.g. stick injuries. Benefits The soft silicone layer provides gentle adherence that will facilitate atraumatic removal. The hypo-allergenic, dual adhesive border, provides additional security. The Eclypse Border range is available in a variety of shapes and sizes. The Eclypse Contour uniquely moulds to body contours, ensuring optimum contact with the wound. It is designed to reduce nursing time and the cost associated with exudate, as the doesn t need to be changed as often. The trauma associated with a high frequency of change is reduced. Rapid absorption High capacity Fluid repellent backing Strength and durability Thin and conforming Ideal for use with drains 4.
Silflex Soft silicone Why soft silicone? Soft silicone s have been used in wound care for a number of years and were developed to minimise pain that can arise during change, to provide protection of the wound site and be conformable to provide patient comfort when the is in situ. Traditional adhesive s Soft silicone s Benefits Adheres only to dry skin not to a moist wound Atraumatic soft silicone, reduced pain on change Soft and conformable Silflex Silflex is a wound contact nonadherent made from polyester mesh coated with Silfix soft silicone. Silflex is designed to gently adhere to the skin surrounding a wound and not to the wound bed. This is an atraumatic which means it is designed to minimise the pain and trauma associated with change. The allows the passage of exudate. Vellafim Vellafilm is a polyurethane film with Silfix soft silicone contact layer, designed to protect the wound whilst minimising the pain and trauma associated with change. The soft silicone adheres to dry surrounding skin but not to a moist wound. Vellafilm can be written on with a regular ball point pen, for such information as dates and wound mapping. Siltape Soft silicone tape which is gentle on the skin, this is particularly useful in animals with very delicate, friable skin which is vulnerable to damage. Silicone does not cell strip in the same way that other adhesives may damage tissue. 5.
Other products Dog and Cat Irrigation Catheters Advancis Veterinary is extending its product portfolio adding a range of dog and cat irrigation catheters. The catheters are made out of polypropylene providing the desired amount of rigidity and are ideal for all breeds of cat and dog. Additionally cat catheters are also manufactured from low density polyethylene to provide a soft and flexible tube and these are supplied with or without a wire introducing stylet. They also have a rotating leur lock suture end allowing natural rotation while in position. Code Gauge Type Size Colour Code BG1001 4FG Dog Catheter 1.3mm OD x 50cm White BG1002 6FG Dog Catheter 2.0mm OD x 50cm Yellow BG1003 8FG Dog Catheter 2.6mm OD x 50cm Orange BG1004 10FG Dog Catheter 3.3mm OD x 50cm Red Code Gauge Type Size Colour Code Material Stylet BG2001 3FG Cat Catheter 1.00mm OD x 13cm Pink Polypropylene No BG2002 3FG Cat Catheter 1.00mm OD x 13cm Pink Polyethylene Yes BG2004 3FG Cat Catheter 1.00mm OD x 16cm Pink Polyethylene Yes BG2005 4FG Cat Catheter 1.3mm OD x 13cm White Polypropylene No BG2006 4FG Cat Catheter 1.3mm OD x 13cm White Polyethylene Yes BG2007 4FG Cat Catheter 1.3mm OD x 16cm White Polypropylene No BG2008 4FG Cat Catheter 1.3mm OD x 16cm White Polyethylene Yes *All catheters come in packs of 12 Advasoft Soft wadding bandage A soft comfortable and conformable wadding bandage. The product combines a high level of absorbency, making it comfortable to wear, with a high degree of pressure distribution and resistance to the forces exerted under compression. 6.
Case studies Use of Activon, Eclypse & Advazorb on canine bite wounds Presentation The patient (12 year old female Lurcher) presented with a four day old bite wound that the owner had previously been treating themselves at home. Management The initial clip and clean revealed 2 bite wounds, the larger measuring 2.5cm x 1cm and 0.5cm deep. The smaller more superficial wound measured 1cm x 1cm. Both wounds were inflamed with necrotic areas and debris present (fig 1). The necrotic tissue was debrided and the wound thoroughly lavaged with warm Hartmanns. The wound was then dressed with Activon Medical Grade Manuka Honey and covered with a layer of sterile swab. An Eclypse Adherent was used as a to absorb exudate and to hold the whole in place (fig 2). Elastoplast was used to provide additional security. The remained in place for 36 hours but had come off prior to its planned removal. The wound was again lavaged and it was then showing signs of granulation and contraction (fig 3). It was then redressed with Activon and this time Advazorb hydrophilic foam was used as a layer due to the lower levels of exudate that were present. Dressing change was planned for 4-5 days and the owner was advised to bathe the wounds in warm water and dress with Activon should the s come off. The second remained in place for 2 days, unfortunately the dog returned from the garden without it on the second day. The owners followed the advice to lavage and apply Activon twice daily and the wounds continued to improve. After 6 days of further Activon treatment the smaller wound was completely reepithelialised and the larger wound was partially healed (fig 4). Outcome The wound went onto fully heal despite having spent a considerable time without a in place. The wound was at significant risk of infection but the Activon Medical Grade Manuka honey helped to prevent infection developing. Use of Activon & Algivon following a canine RTA Presentation The male patient (Crossbreed) presented with a wound to its left fore following an RTA (fig 1). Management Initially the wound was debrided and cleaned with the patient under general anaesthetic and then dressed with Activon Medical Grade Manuka honey (fig 2). After 2 days the wound was looking clean and healthy (fig 3). The digit was then filleted out and the remainder of the wound closed with a pad flap (fig 4). 5 days after surgery the flap was holding well, although after a further 2 days a small area of the wound had begun to break down (fig 5). The dog was again examined under general anaesthetic, the wound edges were freshened up and extra sutures placed on the flap. The wound was then dressed with Algivon, Activon impregnated alginate to support the healing environment. Outcome Following with the alginate 100% of the pad flap survived (fig 6). Within 16 days from the initial date of injury the s had been removed and the dog was sent home with a buster collar. The wound healed with good cosmetic and functional results. Dressing summary The Activon Medical Grade Manuka honey was used to help manage the local infection risk. Autolytic debridement was also aided by the Activon as the high sugar level of 80% has an osmotic action of drawing fluid from the wound and softening and lifting necrotic tissue. www.vetwoundlibrary.com - Dog #43 Dressing summary The Activon Medical Grade Manuka honey was used to help manage the local infection risk within the wound. Autolytic debridement was also aided by the Activon as the high sugar level of 80% has an osmotic action of drawing fluid from the wound and softening and lifting necrotic tissue. The Eclypse Adherent absorbed and helped to lock away the exudate initially and the Advazorb foam s helped to protect the wound later on. Alison King RVN, Animal Medical Centre www.vetwoundlibrary.co.uk Dog #60 7.
Case studies Use of Activon Tulle in an equine limb wound Applying Activon Tulle or Algivon Open the pack after the wound has been cleansed and examined. Apply the directly to the wound allowing the to overlap the wound edge by a minimum of 2cm. For large wounds more than one may be required to ensure the wound area is fully covered. For smaller wounds the may be cut to size using sharp scissors or folded to fit. Dressing Changes Remove the by gently lifting from one of the corners. The properties of honey will likely cause the wound to appear moist and gooey. The beneficial osmotic action of the honey will have drawn exudate and debris from the wound and should be removed using saline. As the wound reduces in size exudate levels should decrease and the can be left in place for longer between changes. Honey s are unlikely to adhere to the wound due to their osmotic properties. However, should this occur gently irrigate the area with saline and consider applying a layer of Activon Tube honey to the wound prior to re. Secondary s: Use an absorbent to allow for an increase in initial exudate level. This is due to the osmotic effect of the Manuka honey and is beneficial in nature. The Advazorb or Eclypse ranges are suitable for use over the Activon honey range. It is recommended that s are reviewed at one to two days initially to observe wound progression and ensure adequate exudate management. As the wound begins to heal the s may be left in place for up to five days. Appearance after cleansing and loose tissue debridement at 1st change. Appearance at first change. Wound at third change (seven days). Wound is clean and contracting. Further debridement between changes is not required. Using Activon Manuka honey and Silflex on a horse with a laceration to the forelimb Presentation The horse presented with a full thickness vertical laceration to the dorso-proximal cannon of the forelimb. The wound had marked contamination and swelling of the subcutaneous tissue which was pushing the wound edges apart. The extensor tendon was also exposed with some fibre disruption evident (fig 1). Management The contamination within the wound needed to be controlled and granulation encouraged. The wound was lavaged and dressed with Activon Medical Grade Manuka honey and redressed the same 2 days later. After 5 days there was moderate purulent exudate, granulation was occurring rapidly and the fibre disruption to the extensor tendon was now obvious (fig 2). The wound progressed, showing a moderate discharge and rapid granulation with moist wound edges that were not adhering to the underlying tissue. After a further 24 days the excessive granulation tissue that had formed was debrided and the wound continued to be dressed with Activon. 7 days later the proliferation of the granulation tissue had reduced but the epithelialisation edge was quite inactive, this was again debrided and redressed with Activon. At the subsequent change 7 days later the wound now showed a flat bed of healthy granulation tissue and a healthy epithelialising edge (fig 3). The wound was now dressed with a hydrogel wound gel and a hydrophilic foam. The had to be changed 4 days later due to it having become rain soaked as the horse could not be box rested. However the wound continued to look healthy with more obvious epithelialisation occurring. The wound was then dressed with a Silflex soft silicone to encourage epithelialisation. The wound continued to progress towards healing with continuing epithelialisation occurring over the following weeks (fig 4). Outcome The wound continued to be dressed with Silflex soft silicone s until it had completely healed, leaving only a small thin hairless scar. Dressing summary The Activon Medical Grade Manuka honey was used to help manage the local infection risk within the wound due to its antibacterial properties. The high osmotic nature of the Activon honey also helped to aid autolytic debridement and reduce inflammation within the wound. The Silflex soft silicone contact layer was used to protect the fragile granulation and epithelialisation tissue. Poppy Mitchell-Moth - Veterinary Wound Library Acknowledgements: Professor Derek Knottenbelt OBE, BVM&S, DVMS, DipECEIM, MRCVS fig.1 fig.2 fig.3 fig.4 8.
Phases of wound healing Phase 1 Haemostasis Stop Bleeding Phase 2 Inflammation (Day 1 to 4) Natural debridement process Phase 3 Proliferation (Day 4 onwards) New tissue formation Phase 4 Maturation (Up tp 1 year post-healing) Scar tissue reorganisation Dressing selection guide Product Necrotic Sloughy Contaminated/ Infected Granulating Epithelialising Exuding Delicate tissue/ grafts Activon Tube Algivon Algivon Plus* Actilite Activon Tulle Eclypse range Yes Eclypse can be used as a primary or on highly exuding wounds Yes Eclypse Adherent, Border & Border Oval have soft silicone wound contact layers Advazorb range Yes Advazorb can be used as a primary or on lowmedium exuding wounds Yes Advazorb Silfix & Border have soft silicone wound contact layers Silflex *Algivon Plus is also available as a ribbon To view, download and display our full selection of guides, visit www.advancisveterinary.com 9.
Ordering information Product Advazorb Advazorb Silfix Advazorb Border Advazorb Sacral Size No. per box Stock code 5cm x 5cm 10 CR4221 7.5cm x 7.5cm 10 CR4165 10cm x 10cm 10 CR4166 12.5cm x 12.5cm 10 CR4167 15cm x 15cm 10 CR4168 10cm x 20cm 10 CR4169 20cm x 20cm 10 CR4170 7.5cm x 7.5cm 10 CR4177 10cm x 10cm 10 CR4178 12.5cm x 12.5cm 10 CR4179 15cm x 15cm 10 CR4180 10cm x 20cm 10 CR4181 20cm x 20cm 10 CR4182 7.5cm x 7.5cm 10 CR4190 10cm x 10cm 10 CR4191 12.5cm x 12.5cm 10 CR4192 15cm x 15cm 10 CR4193 10cm x 20cm 10 CR4194 20cm x 20cm 10 CR4195 10cm x 30cm 10 CR4196 17cm x 19cm 10 CR4402 22cm x 23cm 10 CR4402 Advazorb Heel 17cm x 21cm 5 CR4428 Product Size No. per box Stock code 5cm x 7cm 10 CR3922 8cm x 10cm 10 CR3923 Silflex 12cm x 15cm 10 CR3924 20cm x 30cm 10 CR3925 35cm x 60cm 5 CR4006 2cm x 3m 1 CR3938 Siltape 4cm x 1.5m 1 CR3939 Vellafilm 12cm x 35cm 10 CR3917 12cm x 12cm 10 CR3919 15cm x 20cm 10 CR3921 Product Size No. per box Stock code Activon Tube 25g 12 CR3830 5cm x 5cm 5 CR3761 Activon Tulle 10cm x 10cm 5 CR3658 5cm x 5cm 5 CR3831 Algivon 10cm x 10cm 5 CR3659 5cm x 5cm 10 CR4281 10cm x 10cm 10 CR3849 Actilite 10cm x 20cm 10 CR3852 20cm x 30cm 10 CR4366 30cm x 30cm 5 CR4367 30cm x 60cm 5 CR4368 Algivon Plus 5cm x 5cm 5 CR4230 10cm x 10cm 5 CR4225 Algivon Plus Ribbon 2.5cm x 20cm 5 CR4231 Product Eclypse Eclypse Adherent Eclypse Border Eclypse Border Oval Size No. per box Stock code 10cm x 10cm 20 CR3818 15cm x 15cm 20 CR3769 20cm x 30cm 20 CR3743 60cm x 40cm 10 CR3808 10cm x 10cm 10 CR3881 10cm x 20cm 10 CR3883 15cm x 15cm 10 CR3863 20cm x 30cm 10 CR3864 15cm x 15cm 10 CR4296 22cm x 23cm 10 CR4297 10cm x 20cm 10 CR4300 15cm x 20cm 10 CR4299 20cm x 30cm 10 CR4298 Eclypse Contour 30cm x 51cm 10 CR4398 Product Size No. per box Stock code Advasoft 3.5m x 10cm 6 CR3661 Shop online UK based veterinary healthcare professionals can buy our full range of s online. We ship products from our UK based manufacturing facility to any address in the UK excluding Northern Ireland. Standard delivery is free if you order over 50 (including V.A.T) - this usually takes between 3 and 5 days. You can also choose next day delivery at the checkout (for orders placed by 1pm). This service is not possible for some parts of the UK. If you require delivery to Northern Ireland or countries outside the UK then please contact our Customer Service team on +44 (0)1623 751 500 and they will be happy to help you. We accept payment by credit / debit card and also via PayPal - you can choose the option most suitable to you as you proceed through the online shop. Once your order has been placed you will receive an email confirmation. www.advancisveterinary.com Accounts can also be set up and orders sent via email. To open an account, email info@advancisveterinary.com 10.
Advanced wound care solutions References 1. Molan. P December 2001 Honey as a topical antibacterial agent for treatment of infected wounds. Available: http://www.worldwidewounds.com/2001/november/molan/honey-as-topical-agent.html 2. S Natarajan, D Williamson, J Grey, KG Harding and RA Cooper (2001) Healing of an MRSA-Colonized, hydroxyurea induced leg ulcer with Honey. Journal of Dermatological Treatment (2001) 12, 33-66 3. Dunford C et al (2000) The use of honey in wound management. Nursing Standard, 15,11,63-68 November 2000 4. Thomas P 1998 April 1998 Odour Absorbing Dressings: A comparative laboratory study. (On-line) Available: http://www.worldwidewounds.com/1998/march/odour-absorbing-dressings/odourabsorbings.html 5. 1. Winter G. Review of classic research: moist wound healing. Nature. 1962;193:293-294. Advancis Veterinary has provided this brochure for general information only. It is intended for a health care professional and not for public use. Please note that: 1. Not all products are available in all regions or from all wholesalers. 2. Indications for use and contra-indications may vary from time to time depending on current clinical information. Always read the package insert prior to use. 3. Advancis Veterinary makes no representations, or warranties regarding the accuracy or completeness of this brochure. 4. Customer Service is available to help with product information or questions during normal office hours. Copyright Brightwake Ltd (Trading as Advancis Veterinary) 2017 MAR452/5 @AdvancisVeterinary Advancis Veterinary @AdvancisVet Veterinary www.advancisveterinary.com Phone: 01623 751500 Fax: 0871 264 8238 Email: info@advancisveterinary.com Lowmoor Business Park, Kirkby-in-Ashfield, Nottinghamshire, NG17 7JZ