Initial wound management

Local wound management: A review of modern techniques and products

Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.

A Prototype Skin Substitute, Made of Recycled Marine Collagen, Improves the Skin Regeneration of Sheep

Simple Summary

Marine ecosystems are a huge source of unexplored “blue” materials for different applications. The edible part of sea urchin is limited, and the vast majority of the product ends up as waste. Our studies intend to fully recycle wastes from the food industry and reconvert them in high added-value products, as innovative biocompatible skin substitutes for tissue regeneration. The aim of the present work is to apply the pioneering skin substitute in in vivo experimental wounds to test its regenerative potential and compare it, in a future study, to the available commercial membranes produced with collagen of bovine, porcine, and equine origin. Results are encouraging since the skin substitute made with marine collagen reduced inflammation, promoted the deposition of granulation tissue, and enhanced a proper re-epithelialization with the adequate development of skin appendages. In summary, our findings might be of great interest for processing industries and biotech companies which transform waste materials in high-valuable and innovative products for Veterinary advanced applications.

Abstract

Skin wound healing is a complex and dynamic process that aims to restore lesioned tissues. Collagen-based skin substitutes are a promising treatment to promote wound healing by mimicking the native skin structure. Recently, collagen from marine organisms has gained interest as a source for producing biomaterials for skin regenerative strategies. This preliminary study aimed to describe the application of a collagen-based skin-like scaffold (CBSS), manufactured with collagen extracted from sea urchin food waste, to treat experimental skin wounds in a large animal. The wound-healing process was assessed over different time points by the means of clinical, histopathological, and molecular analysis. The CBSS treatment improved wound re-epithelialization along with cell proliferation, gene expression of growth factors (VEGF-A), and development of skin adnexa throughout the healing process. Furthermore, it regulated the gene expression of collagen type I and III, thus enhancing the maturation of the granulation tissue into a mature dermis without any signs of scarring as observed in untreated wounds. The observed results (reduced inflammation, better re-epithelialization, proper development of mature dermis and skin adnexa) suggest that sea urchin-derived CBSS is a promising biomaterial for skin wound healing in a “blue biotechnologies” perspective for animals of Veterinary interest.

Current Applications and Future Perspectives of Fluorescence Light Energy Biomodulation in Veterinary Medicine

The purpose of this review is to determine the state of the art of the mode of action and potential applications of fluorescence photobiomodulation in veterinary medicine. After a summary of the assets that have led the translation of such light-based therapies from bench side into clinical use, recent advances in canine dermatology using this brand-new approach are presented, and future scenarios where this type of care may provide benefits over the current standard care are highlighted.

Design and evaluation of atorvastatin-loaded chitosan-hydroxyapatite composite bioscaffolds for wound-healing activity

Background

The study aimed at the formulation of atorvastatin-loaded chitosan-hydroxyapatite composite bioscaffolds and determination of its wound-healing activity on animals. Hydroxyapatite was prepared from the biowaste eggshell cross-linked with calcium chloride and loaded with atorvastatin. The prepared bioscaffold was characterized for physicomechanical properties, morphological studies, differential scanning calorimetry, and in vitro drug release study. In vitro antibacterial activity was determined using the agar diffusion method, and in vivo wound-healing activity was evaluated using the excision wound-healing model.

Results

Results exhibited that bioscaffold containing 1:1 ratio of chitosan to hydroxyapatite (Hac1) with calcium chloride of 1.5 g (Hbc3) and loaded with atorvastatin (Hcc3) showed effective physicomechanical properties, i.e., thickness (60 μm), swelling behavior (68%), folding endurance (101), tensile strength (0.0283 Mpa), and burst time (1.9 s). Hcc3 scaffold was highly effective and exhibited the highest zone of inhibition against Bacillus subtilis (3.2 cm), Staphylococcus aureus (3.0 cm), Escherichia coli (3.5 cm), and Pseudomonas aeruginosa (2.7 cm). The group treated with Hcc3 scaffold was significant in healing wounds by showing 100% wound contraction.

Conclusion

It can be concluded from the study that atorvastatin-loaded chitosan-hydroxyapatite composite bioscaffolds may be a significantly more effective scaffold in healing excision wounds.

Reconstruction of Finger Pulp Defects With an Innervated Distally-Based Neurovascular Flap

PURPOSE

Finger pulp resurfacing is a challenging reconstructive problem. This article introduces sensory reconstruction of finger pulp defects using an innervated distally-based neurovascular flap raised from the dorsum of the thumb.

METHODS

From May 2015 to May 2017, the innervated distally-based neurovascular flap was used in 36 patients. The mean age at surgery was 37 years (range, 18-61 years). All patients were assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand. The sensitivity of the flap was tested using static 2-point discrimination.

RESULTS

Full flap survival was achieved in 35 cases. Partial necrosis at the distal margin of the flap was observed in 1 case. At the final follow-up (mean, 20 months; range, 18-23 months), the mean TAM of the thumb was 206° (range, 188°-238°), including 8 excellent and 28 good results. The mean TAM of fingers was 266° (range, 251°-282°), including 4 excellent and 32 good results. The mean value of static 2-point discrimination was 5 mm (range, 4-7 mm) in the flap, including 31 excellent and 5 good results.

CONCLUSIONS

The innervated distally-based neurovascular flap raised from the dorsum of the thumb is a reliable alternative for sensory reconstruction of finger pulp defects.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Pretreatment aerobic bacterial swab cultures to predict infection in acute open traumatic wounds: A prospective clinical study of 64 dogs

OBJECTIVE

To determine the value of initial aerobic bacterial cultures of acute open traumatic wounds to predict bacterial species in wounds that become infected.

STUDY DESIGN

Prospective clinical trial.

ANIMALS

Sixty-four dogs with naturally occurring acute cutaneous traumatic wounds (2017-2018).

METHODS

Initial swabs were taken from each wound prior to and after lavage and debridement for quantitative and qualitative aerobic bacterial culture. Cultures were repeated on wounds that displayed any clinical sign of infection within 14 days of presentation.

RESULTS

Fewer bacteria were cultured from postlavage than from prelavage swabs in 43 of 50 (86%) acute wounds. All primary clinicians prescribed β-lactam antibiotics to the dogs at initial presentation. All bacteria cultured from postlavage/debridement cultures at initial presentation were susceptible to the prophylactic antimicrobial prescribed. Postoperative infection was subsequently diagnosed in 14 of 64 (22%) dogs; 13 of these dogs had positive culture results. No correlation was detected between the results of initial wound cultures and the subsequent development of wound infection. Bacterial species present in the initial wound swab did not correlate with those subsequently cultured from infected tissues.

CONCLUSION

Results of pretreatment wound cultures from open traumatic wounds in dogs were not predictive of bacterial species subsequently recovered from infected wounds. The bacterial burden present in pretreatment wounds was not predictive of whether wounds would ultimately become infected after surgical management.

CLINICAL SIGNIFICANCE

Routine bacterial culturing of acute wounds is not likely to help predict subsequent wound infection, nor is it likely to accurately guide early selection of antimicrobials to treat wounds that become infected.

Cutaneous and Renal Glomerular Vasculopathy: What Do We Know so Far?

Cutaneous renal glomerular vasculopathy (CRGV), colloquially named "Alabama rot," is an emerging condition in the United Kingdom, previously reported from the United States and Germany. The cause of CRGV is not yet determined; no definitive link to an infectious agent has been made. Dogs diagnosed with CRGV initially develop cutaneous lesions, and a proportion of these dogs go on to manifest acute kidney injury, which may result in oligoanuric acute renal failure. Antemortem diagnosis is challenging given the lack of a specific diagnostic test, and confirmation of CRGV is therefore currently dependent on identification of thrombotic microangiopathy on renal histopathology.

Deep tissue culture and hemoculture in dogs with wounds and sepsis

ABSTRACT: Contaminated and infected wounds occur very frequently in veterinary medicine and can cause systemic inflammatory response syndrome, sepsis, and death. This study aimed to test the feasibility of collecting wound material by deep-tissue or punch biopsy for microbial culture, determine the frequency of bacteria in the wound(s) and blood cultures and the susceptibility of these microbes to antimicrobials, and evaluate clinical parameters that could be related to prognosis. Thirty dogs with wounds and signs of SIRS/sepsis were included in this study. Bacteria were isolated from all wounds and 41 bacterial isolates could be identified based on culture of the materials collected by punch biopsy; 53.66% of the isolates were gram-negative, mainly involving Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus spp., and 46.34% were gram-positive bacteria such as Streptococcus spp., Enterococcus spp., and Staphylococcus spp. The survival rate was 66.67%. Based on blood culture analysis, we identified bacteremia in seven patients, predominantly of gram-negative bacteria, which negatively affected patient survival, as six dogs died. Hypoglycemia (≤60mg/dL) and severe hyperglycemia (≥180mg/dL) also negatively affected survival as 23.33% of the hypo/hyperglycemic dogs died. Factors such as blood lactate level at admission and hematocrit levels, and mean arterial pressure were not significantly correlated with death or survival of the dogs.

Initial Management of Traumatic Wounds

When traumatic wounds are quickly and accurately treated, morbidity and costs can be significantly decreased. Several factors, such as time delay between injury and treatment, the degree of contamination, extension and depth of the wound, and the mechanism of injury, influence the treatment and prognosis and stress the importance of a patient-specific approach. Although all traumatic wounds are contaminated, antibiotic therapy is seldom required if correct wound management is installed.

Anatomical distribution and gross pathology of wounds in necropsied farmed mink (Neovison vison) from June and October

BACKGROUND

Wounds are regarded as an indicator of reduced welfare in mink production; however, information on the occurrence and significance of wounds is sparse. To provide a basis for assessment and classification of wounds in farmed mink, the distribution pattern and characteristics of wounds in farmed mink in June and October, respectively, is described. A total of 791 and 660 mink from 6 to 12 Danish mink farms, respectively, were examined. The mink were either found dead or were euthanized due to injury or other disease. Mink included from June were kits in the pre-weaning and weaning period (1-2 months old). Mink included from October were juveniles in the late growth period (approximately 5-6 months old) or older. Macroscopic pathology and wound location was systematically recorded.

RESULTS

There was considerable variation in morphology as well as location of wounds between June and October. Wounds were primarily located on the front parts of the body and in the head in June (1-2 month old kits) and mainly on the rear parts of the body and on the tail in October (5-6 month old kits and older). Moreover, there were significantly more females than males with wounds for most wound types, and significant differences in occurrence of ear and tail base wounds between certain colour types.

CONCLUSIONS

Wounds varied significantly from June to October with respect to morphology and anatomical location. Wounds in June were primarily located on the front parts of the body and in the head, while wounds in October were mainly present on the hind parts of the body and on the tail. The majority of the wounds were found in specific well defined skin areas and could therefore be grouped into categories according to anatomical location.

Application of hyaluronic acid in the healing of non-experimental open wounds: A pilot study on 12 wounds in 10 client-owned dogs

Aim:

Veterinarians have frequently to deal with wounds to the skin, subcutis, and underlying muscle. The aim was to explore the application of hyaluronic acid (HA)-containing dressing on open skin wounds in dogs. The progress of healing was assessed by wound area reduction and two scoring scales applied in human medicine.

Materials and Methods:

Ten client-owned dogs with 12 cutaneous open wounds healed by the second intention were included. All wounds were treated using available in commerce HA-containing wound dressing from admission to complete re-epithelialization. At every clinical examination, wound area and scale scoring assessments were performed.

Results:

After debridement, an increased wound size was obtained while an improvement was determined by both grading systems. The median numbers of return to the clinic for bandage change were 5 times. The median time to complete wound healing was 34.5 days. The mean wound area at day 7, 14, 21, and 28 were, respectively, 90.4%, 47.7%, 22.4%, and 14.8% of the original size (for linear measurement) and 95.5%, 54.4%, 23.10%, and 14.8% of the original size (for software measurement). Regarding wound healing assessment tools, the agreement between two operators was considered high for both scales.

Conclusions:

HA-containing dressing may be a possible wound treatment for cutaneous open wounds in dogs. The assessment of wound quality using scale scoring system could be useful especially in the 1^st week and to direct clinical decision-making process.