Bandaging & Wound care

Question 1

What is secondary intention wound healing?

Answer 1

Wound healing is delayed, healing occurs by a process of granulation, contraction, epithelialisation (& keratinisation in reptiles), scarring results

Question 2

Wound dressing provide an optimal environment, what are these factors?

Answer 2

Good moisture balance
-> fragile cells are kept viable, pain reduced as nerve endings are kept moist

Constant warm temperature
-> increased mitotic activity results in faster healing

Low oxygen tension
-> leads to a low pH which stimulates angiogenesis and collagen formation, inhibits bacterial growth

Minimisation of foreign bodies
-> infection, wound debris, dressing products (cotton wool fibres, paraffin)

Question 3

Why is wound healing in wildlife particularly challenging?

Answer 3

Wounds in wildlife are typically infected, contain debris and/or inflicted by predation.

Wounds are outside the “golden period” the few hours after wound initiation during which they can be closed safely with sutures.

Question 4

What should we do in step 1 of wound care for wildlife?

Answer 4

Wound Cleansing
-> use sterile isotonic saline product (of choice)
- warm fluids before use
- recommend a 25 ml syringe + 18G needle to flush or bathe in 0.9% saline for 5-10 minutes

Question 5

What should we do in step 2 of wound care for wildlife?

Answer 5

Wound Assessment
(use TIME - from the international Wound Bed Preparation Advisory Board)

-> Type of Tissue (viable/non viable), tissue loss, necrotic burden, foreign bodies.
-> Infection/Inflammation
-> Moisture (desiccation, maceration)
-> Edges of wound/Epithelium (advancing, undermined, non-responsive)

Consider:
Stage of healing, presence of infection, aetiology (burns, trauma), depth

Question 6

What should we do in step 3 of wound care for wildlife?

Answer 6

Wound Debridement
-> surgical debridement often initially required
-> thoroughly clean, remove all hyperkeratotic, infected, nonviable tissue, foreign debris & residual material from prior dressings

Question 7

Which wound product/bandaging material would we use for dry wounds, non exudative, sloughy wounds, exposed soft tissue like tendon or bone

Answer 7

Hydrogels

Question 8

Which wound product/bandaging material would we use for non infected, minimal exudate, shallow wounds or epithelialising wounds that require protection?

Answer 8

Film dressings

Question 9

Which wound product/bandaging material would we use for low to moderately exudative wounds or non-infected granulation beds?

Answer 9

Hydrocolloids

Question 10

Which wound product/bandaging material would we use for moderate to heavy exudating wounds that control bleeding and clot formation in wounds?

Answer 10

Calcium Alginates

Question 11

Which wound product/bandaging material would we use for moderate or heavy exudative wounds, proud flesh, where pressure or padding is required?

Answer 11

Polyurethane Foams

Question 12

What are some other factors to consider for the animals wound healing process? (environment etc.)

Answer 12

Housing & husbandry to support wound healing, enclosure substrate & housing decisions to keep the wound clean, supply excellent nutrition and consider systemic AB based on MCS, anti-inflammatories or sedatives

Question 13

Which type of bandaging should we avoid in birds or generally wildlife?

Answer 13

Avoid sticky adhesive dressing! use fixomull instead.

Question 14

Bandaging reptiles can be tricky (also because wound healing is slow), what can we use/do particularly for reptiles?

Answer 14

Tie over dressing (using sutures)
Fixomull plus tissue glue at the edges
Full body bandage

Environmental management important!