Wound management can be divided into two phases; initial field care, i.e., first aid, and definitive veterinary care.

Initial Field Care

The purpose of this section is to give some basic information to help assure that tissue is not further damaged, nor is definitive care complicated when providing first aid. For major wounds with considerable bleeding, a clean linen covering with pressure application is indicated followed by early transport to veterinary care. This would also apply to limb wounds; however, tourniquets should be avoided. If improperly used, tourniquets can be applied too tight and cause damage to underlying nerves, tendons and other vital structures. Pressure bandages on limbs must be applied carefully. These bandages may stop the bleeding, but they can also stop circulation to tissues and result in the loss of a paw if placed too tight and left on too long. After application, immediately transport the dog to veterinary care. Do not put a pressure bandage on a limb and then put the dog up for the day, thinking you'll take it to the veterinarian the next day. The author has had to do paw salvage surgery on animals with pressure bandages placed too tight and left too long.

For both major and minor wounds, care should be taken in putting medications in wounds. Three things should be remembered. First, if a wound antiseptic is strong enough to kill bacteria, it is strong enough to kill tissue cells. The result is prolonged healing. Second, a good rule of thumb is not to put a solution into a wound if you would not put it in your eye. Third, some creams and ointments in wounds can make it difficult to clean the wound. This is not what is needed with dirt in a wound.

Definitive Veterinary Care

This section will present some practice tips and new products that can be used in definitive wound care. If local analgesia is to be used for early wound management, rather than general anesthesia, use warm 2 percent lidocaine without epinephrine on a gauze and place it on the wound to make initial lavage more comfortable. However, no surgical debridement can be done with this. When injecting lidocaine at the wound edges prior to surgical debridement, warm it if it has been refrigerated, and add .1 milliliter of injectible sodium bicarbonate for each milliliter of lidocaine to help alleviate the initial discomfort of injection.

For wound lavage use a 1 to 40 dilution of 2 percent chlorhexidrine gluconate or diacetate (ChlorhexiDerm Disinfectant®, D.V.M., Inc. or Nolvasan Solution®, Ft. Dodge Laboratories, respectively) in sterile water. When debriding, remove only definitely dead tissue using color and attachment as guidelines. Remove excessively dark or light tissue that has no blood supply or tissue that is not attached. Questionable tissue should be left and evaluated the next day at bandage change.

Some new topical medications that stimulate wound healing are available to the veterinarian. These are Carravet® Wound Dressing, (Carrington Laboratories) which contains acemannan; Iamin Vet®, (Procyte Laboratories) which is a tripetide copper complex; and Intracell®, (Techni Vet) which is a D-glucose polysaccharide. There are new bandage materials available also. Hydrasorb®, (Ken Vet Animal Care Group) is an absorbent sponge that can be that can be used early and late in wound healing to absorb fluid or deliver liquid medications. Curasorb® , (Ken Vet Animal Care Group) is a calcium alginate dressing that can aid in removal of bacteria from the wound surface. BioDres® , (D.V.M., Inc.) is a polyethylene oxide hydrogel that can be used in the repair stage of open wound healing to enhance healing.

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Dr. Swaim may be contacted via email at: swaimsf@vetmed.auburn.edu