Author |
Topic: Wound Management (Read 1451 times) |
|
DL
Administrator
member is offline
 
Posts: 833
|
 |
Wound Management
« Thread started on: Sep 13th, 2006, 06:04am » |
|
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/160707.htm&word=wounds%2cavian
MANAGEMENT OF SPECIFIC WOUNDS
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/160702.htm
"Wound Lavage:
Irrigation of the wound washes away both visible and microscopic debris. This reduces the bacterial load in the tissue, which helps decrease wound complications. Assuming the solution is nontoxic, the most important factor in wound lavage is use of large volumes to facilitate the removal of debris. The recommended lavage is a moderate pressure system using a 35-mL syringe and a 19-gauge needle that delivers lavage fluid at 8 lb/sq in. The use of antibiotics in the lavage fluid is controversial.
The ideal lavage fluid would be antiseptic and nontoxic to the healing tissues. Although isotonic saline is not antiseptic, it is the least toxic to healing tissue. Surgical scrub agents should not be used because the detergent component is damaging to tissue. Dilute antiseptics can be used safely. Chlorhexidine diacetate 0.05% has sustained residual activity against a broad spectrum of bacteria, while causing minimal tissue inflammation. However, gram-negative bacteria may become resistant to chlorhexidine. Stronger solutions of chlorhexidine are toxic to healing tissue. Povidone-iodine 1% is an effective antiseptic, but it has minimal residual activity and may be inactivated by purulent debris. "
http://www.avonvets.co.uk/2ndyr_hands/Inflammation.html
Inflammation/Wounds
The following links are to two articles on AVIAN WOUND MANAGEMENT...great stuff in here to help with many common (and uncommon) emergencies involving WOUNDS of all types.
A two part article (please consult both) on treating avian wounds
http://www.worldwidewounds.com/2003/november/Cousquer/Avian-Wound-Management-Part-2.html
Beak injuries
Head injuries
Barbed wire injuries
Keel wounds
Caught-by-cat flesh wounds
Dog bite wounds
Carpal injuries
Power cable injuries
Foot injuries and bumblefoot
http://www.worldwidewounds.com/2003/august/Cousquer/Avian-Wound-Assessment.html
excerpt summary on TREATMENT measures:
First aid
Traumatised birds often have multiple injuries and may be further compromised by dehydration, malnutrition and other problems, especially if there has been a delay (hours or days) between injury and presentation [1]. Fluid and nutritional therapy and treatment for shock are critical in the early management of all traumatised birds. Overzealous wound and fracture treatment before stabilisation of the bird may prove fatal [1]. Some first aid of the wound, however, will inevitably be required.
Wound first aid will usually be performed at the time of the initial or subsequent clinical examination. It need not be high tech but should fulfil a number of basic objectives:
Cleaning - The wound should be cleaned quickly to remove as much contamination as possible. A more thorough cleaning should await veterinary examination of the wound. This is usually performed under general anaesthetic to help minimise stress . Sterile isotonic saline (0.9%) or a solution of 0.05% chlorhexidine may be used. Care should be taken not to wet the bird excessively as this is likely to increase the risks of hypothermia.
Haemostasis - veterinary attention should be requested if there is excessive bleeding. Bleeding from most small wounds will stop following the application of a wound dressing.
Protection from dehydration - the use of a hydrogel (e.g. Intrasite) will help protect a wound. This can be covered by a vapour permeable film dressing (e.g. Opsite) to provide further protection.
Immobilisation - certain wounds may benefit from immobilisation or splinting. A figure of eight dressing can be used to immobilise the lower wing, for example, or the limb can be strapped to the body.
Analgesia and antibiotics - broad spectrum antibiotics can be provided in the first instance: clavulanic acid potentiated amoxycillin (150mg/kg orally or subcutaneously) will provide cover against most aerobes and anaerobes. Analgesia can be provided with NSAIDs (e.g. carprofen (Rimadyl)) 5mg/kg subcutaneously or intravenously. Local anaesthetics should not be used in birds due to the suggested sensitivity of birds to drugs of the procaine group "."
http://www.ronsvetsupply.com/granulexv.html
supplier of a difficult to find component described in the wound management articles (thinking specifically on bumblefoot):
A "must have" product for advanced wound care. This is an over the counter, veterinary version of a prescription human product that has been used for many years to treat bed sores, deep abrasions and thermal burns. The active ingredient, Trypsin, is an enzyme that digests necrotic (dead) tissue, enabling it to be removed while at the same time, stimulating healthy epithelial cells to develop so that they can cover open or slow healing wounds. Can be used with or without bandaging. Use twice daily, washing debris away between applications. Labeled for use on dogs, cats, horses and cattle. Manufactured by Bertek Pharmaceuticals for Pfizer Animal Health."
http://www.vettechjournal.com/avecct/VT_21_08_463.pdf#search='bandages%20slings%20splints%20casts%20veterinary'
THE ROBERT-JONES BANDAGE (illustrated step-by-step)
http://www.worldwidewounds.com/1997/july/Heenan/Tariff.html
http://www.worldwidewounds.com/1997/july/Heenan/Tariff.html
(Describes / defines the different types of wound dressings and their applications)
http://www.anmldr.com/PalmVet/Mixed-13-1-2-3.htm#bumblefoot
(excerpt)
"Treatment of bumblefoot in raptors includes both nonsurgical and surgical. Wound management is often the most challenging aspect of treatment and is usually accomplished by application of ball bandages. These bandages consist of gauze sponges placed on the plantar surface of the foot that are incorporated into a bandage by wrapping the digits (using cast padding and an elastic nonadhesive dressing) in a circular-longitudinal fashion in a "ball" around the sponges. It is important to incorporate the distal tarsometatarsus into the bandage to support the phalangeal and tarsometatarsal joints and to use many sponges to provide adequate cushioning of the plantar surface. Ball bandaging with a dimethyl sulfoxide "cocktail" is often effective for treating mild cases of bumblefoot. The formula consists of 8 ml DMSO, 2 ml dexamethasone (2 mg/ml), and 2 ml piperacillin or carbenicillin (500 mg/ml). Other common topical medications include udder cream to soften the feet, and hemorrhoid medication to promote epithelialization. Sharon Lynn Deem, DVM, PhD - Compendium, April 1999"
http://www.worldwidewounds.com/2004/december/Steenvoorde/Tar-Removal-From-A-Burn-With-Butter.html
On hot tar injuries(it has happened with birds too!):
-Hot tar and asphalt boil at high temperatures and can cause serious burn injuries if they come into contact with the skin.
-Most accidents involving hot tar affect young workmen; accidents can be prevented through the adoption of safe working practices.
-The prompt removal of tar from a burn is essential in order to allow early assessment and to prevent infection.
-Butter has been shown to be an effective, safe and cheap method of removing moderate amounts of tar from a burn injury.
http://www.thecapsulereport.com/sa18,1-3.htm
Nonhealing wounds-burns and abraded skin respond to a mixture of antibacterial ointment, such as Silvadene or Nolvasan, and topical insulin. Insulin stimulates the formation of granulation tissue. This author often adds 100 U NPH insulin to 1 oz of antibacterial cream. Bandage with nonadherent dressing. Alice Wolf, DVM, Dip ACVIM - Veterinary Forum, 15:1
http://www.worldwidewounds.com/2004/january/Collier/Management-of-Wound-Infections.html
(Recognition and Management of Wound Infections)
http://dermatlas.med.jhmi.edu/derm/
|
| « Last Edit: Jul 20th, 2008, 08:19am by DL » |
 Logged
|
|
|
|
DL
Administrator
member is offline
Posts: 833
|
|
Re: Wound Management/BANDAGING
« Reply #1 on: Sep 25th, 2006, 5:47pm » |
|
http://cal.vet.upenn.edu/saortho/chapter_15/15mast.htm
Bandaging / Immobization and Splinting EXTENSIVE AND COMPLETE WITH ILLUSTRATIONS (though not written for birds the principles remain applicable)
(small excerpt):
EMERGENCY MANAGEMENT OF FRACTURES
One of the most widely repeated maxims of emergency care is "Splint them where they lie." The use of a splint to prevent further damage to soft tissue as well as to prevent the possibility of open fracture demands correct emergency splinting procedures. The casts and splints that are described in this chapter can be used in emergency treatment for immobilization, as a temporary measure for transportation, and as immobilization in the hospital prior to and including definitive fracture treatment. The problem with emergency splinting is related to the quality of the procedure. When a splint is applied to an extremity it is very important that it immobilize the part of the extremity for which it is intended. All too often emergency splints are used in such a way that the splint or immobilizing qualities of the splint end at or near the fracture. This can be more detrimental to the animal than would be the absence of splinting altogether. Once an animal is properly splinted, greater freedom can be allowed in his general movement and transport than with an animal that has no splint. If, however, the splint is improperly applied, more severe damage may be done to muscles, nerves, blood vessels, or the integument. Therefore, it is important to use temporary emergency splinting to adequately immobilize the injured part.
THE FOLLOWING LECTURE NOTES ON BANDAGING HAS SOME GOOD INFORMATION I THOUGHT MIGHT BE USEFUL...THE ORIGINAL PDF ARTICLE IS NO LONGER ACCESSIBLE AND BELOW IS THE YAHOO CACHE.
Below is a cache of http://vets.amedd.army.mil/vetcom.nsf/13156867828e3a528625657d006dc0a8/30db402ee4d0ba1086256e7600443994/$FILE/L1_Basic%20Small%20Animal%20Bandaging.ppt. It's a snapshot of the page taken as
The web site itself may have changed. You can check the current page (without highlighting) or check for previous versions at the Internet Archive.
Yahoo! is not affiliated with the authors of this page or responsible for its content.
Basic Small Animal Bandaging
R. Randall Thompson, DVM, MSpVM
Major, US Army Veterinary Corps
Deputy Chief of Surgery & Dentistry
DOD Military Working Dog
Veterinary Service
If all else fails, fear is a great motivator.
Dr. P. T. Purinton. Freshman anatomy professor, University of Georgia, College of Veterinary Medicine
Bandage Injury
To a pet owner or a military working dog handler, a bandage injury is like saying it was caused by “Pilot Error.”
Bandage Injury
Yes…you too can go from “Hero to Zero”!
The best thing that a bandage can do is …
Speed wound healing
The worst thing that a bandage can do is …
Kill your patient
Good things that bandages do:
Provide wound cleanliness
Control wound environment
Reduce edema and hemorrhage
Eliminate dead space
Immobilize injured tissue
Minimize scar tissue
Make patient more comfortable
Bad things bandages cause:
Patient discomfort
Patient mutilation of bandage and wound
Bacterial colonization of wound
Ischemic injury
Damage to healing tissues
Three basic layers of a bandage:
1. Primary (contact layer)
2. Secondary (intermediate layer)
3. Tertiary (outer layer)
Functions of the Primary Layer
Debrides tissue
Delivers medication
Transfers wound exudate
Forms an occlusive seal
Minimizes pain
Prevents excessive loss of body fluids
Functions of the Secondary Layer
Removes and stores deleterious agents
Retards bacterial growth
Pads wound from trauma
Splints wound to prevent movement
Holds primary bandage layer in place
Functions of the Tertiary Layer
Holds the other bandage layers in place
Protects against external bacterial colonization
Cosmesis
Types of Primary Layers
Adherent
Nonadherent
Occlusive
Semi occlusive
Types of Primary Layers: Adherent vs. Nonadherent
Adherent
Used when wound debridement is required
May be wet or dry
Nonadherent
During repair phase or if no necrotic debris
Retains moisture to promote epithelialization and prevent dehydration
Drains excess fluid and prevents maceration
Types of Primary Layers: Occlusive
Impermeable to air
Use on nonexudative wounds to keep moist
Speed rate and quality of healing compared to dressings that allow desiccation
Use in partial thickness wounds without necrosis or infection
Types of Primary Layers :
Semi Occlusive
Allows air to penetrate
Allows exudate to escape
Most commonly used primary layer
Adherent Bandages: Wet or Dry?
How to decide
Wet Adherent Bandages
Use when wound surface has necrotic tissue, foreign matter, or viscous exudate
Sterile wide mesh gauze soaked in
Sterile saline solution
1:40 (0.05%) Chlorohexadine diacetate
Necrotic tissue and foreign material adhere to gauze and are removed with bandage
Dry Adherent Bandages
Use when wound surface has loose necrotic tissue and foreign material
Use when wound has large quantity of low-viscosity exudate that does not aggregate
General Types of Bandages
Absorbent
Adherent
Wet-to-dry (most common adherent)
Wet-to-wet (contact layer expected to stay wet)
Dry-to-dry
Nonadherent
Occlusive
General Types of Bandages (Continued)
Semi Occlusive
Tie-Over
When the wound is in an area inaccessible by standard bandaging techniques
Stabilizing
Post-operative or Closed Wound
Over a closed incision or drain
General Types of Bandages (Continued)
Pressure
Pressure Relief
Usually over a bony prominence
To treat pressure sores
Indications for Bandages
Protect wounds or devices
Injuries
usually below elbow and stifle
reduce pain, swelling, local tissue damage
For transport
Bandages, Splints & Slings
Robert Jones*
Immobilizes
Decreases/limits soft tissue swelling
Absorbs wound exudate
Soft padded (Modified Robert Jones)*
Similar benefits as with Robert Jones
Add splint material (premade, thermoplastics, fiberglass, aluminum rods)
*Fracture MUST be below the elbow / stifle
Bandages, Splints & Slings (cont)
Spica splint
For immobilization of shoulder
Ehmer sling (Ehmer for the Femur)
Post hip reduction or acetabular fractures
Velpeau sling (Velpeau for the Elbow)
To prevent forelimb weight bearing after shoulder / forelimb procedures
Thomas splint – “Historical Significance”
Casts for Fractures
Stable, minimally displaced fractures
Young, rapidly healing animals
Only injuries distal to the elbow / stifle
Unable to repair with surgical techniques
Expense (But BE CAREFUL)
Casts for Fractures (cont.)
Swelling needs to be reduced prior to cast
Greenstick fractures may not need sedation
Displaced fractures require general anesthesia
Open fractures should NOT be casted
Always radiograph after casting
Must have >50% overlap of fracture ends
Casts for Fractures (cont.)
Check at least every two weeks
Place cast with limb in standing position
Encourages use when walking
Limits muscle atrophy & joint stiffness
Shortens recovery period after removal
*Casts may also be used for tendon repair protection or to support arthrodeses
Rules to Remember
Leave middle 2 toes exposed when possible
Bandages start at the toes and go up the limb
Overlap 1/3 to ½ the width of your wrap
Sedation anesthesia may be required
Apply even tension during application
Tension proportional to amount of padding
Checking and Changing
Bandages require a high degree of client compliance
Discharge should include verbal, written, and visual instructions for clients
Check frequently
Checking and Changing (cont.)
Change frequency depends on :
age
activity
cleanliness
associated wounds
swelling
General Complications
Slipping / loosening
Wet, urine-soaked
Joint stiffness, muscle atrophy
Pressure sores
hard materials, constricting bands
prominences
More padding less well immobilized
Assessing a Bandage
Clean
Dry
Protect during post-op recovery
Plastic bag when going outside
Position
Comfort
Chewing at bandage
Lameness greater than at discharge
Assessing a Bandage (cont.)
Odor
Swelling
Toe Temperature
compare to other foot
Nail bed cyanosis
If any of these signs are seen, or if in doubt, remove the bandage!
Special Consideration Cases
Predator – Prey Scenario
Cats
Bandage Paralysis
Some Exotics
QUESTIONS?
|
| « Last Edit: Sep 25th, 2006, 5:55pm by DL » |
Logged
|
|
|
|
DL
Administrator
member is offline
Posts: 833
|
|
Re: Wound Management
« Reply #2 on: Apr 20th, 2007, 03:54am » |
|
http://www.medscape.com/viewarticle/456304_print
(excerpt)
The following abstracts offer a preview of the research selected by the Symposium on Advanced Wound Care (SAWC) 2003
The Effects of Silver-Based Wound Dressings on Protease Activity and Cell Proliferation
Breda Cullen, PhD; Janine MacAdam, BSc; Sarah-Jayne Gregory, BSc; Alicia Essler, BSc; David Greenhalgh, PhD
Johnson & Johnson Wound Management, Gargrave, United Kingdom
Abstract
A delicate biochemical balance exists within a normal wound environment ensuring rapid closure. This balance can be disrupted by external stimuli, such as critical colonization by bacteria or increased host inflammatory response, and result in impaired wound healing. An antimicrobial dressing having an impact on other factors attributed to nonhealing wounds without causing detrimental effects to normal wound healing may offer a useful approach in the management of chronic wounds. The effect of two silver-based dressings on the activity of a protease, elastase, commonly found to be elevated in many nonhealing wounds was examined. The impact of these dressings on cell proliferation was also evaluated as an indication for normal wound repair. After 24 hours exposure to elastase solution, both test dressings were found to result in a significant reduction in protease activity when compared to a gauze control. When a solution extract from each dressing was added to fibroblast cultures only, the silver impregnated activated charcoal dressing* (SIAC) was found to have no detrimental effects on cell proliferation. These results suggest that silver-based dressings may help reduce protease activity although only SIAC was found to have no detrimental effect on cell proliferation in this in-vitro study.
*Actisorb® Silver 220 (Johnson & Johnson Wound Management Worldwide, a division of Ethicon, Inc.)
Infection Control Properties of Absorbent Dressings
P Bowler, BSc, MPhil, FIBMS; S Jones, BSc Hons
Wound Healing Research Institute, ConvaTec Global Development Centre, Deeside, United Kingdom
Abstract
The majority of acute and chronic wounds are polymicrobial involving both aerobic and anaerobic bacteria, many of which are potentially pathogenic. Wound (self) infection and cross contamination could be minimized by the ability of dressings to provide beneficial infection control barrier properties. This could be achieved via the absorption, effective retention, immobilization of the bacteria associated with wound fluid, and the provision of an effective barrier to the transmission of human bloodborne viruses. An in-vitro method has been designed to compare the bacterial retention properties of a range of absorbent dressings including a new adhesive exudate management dressing. In-vitro data indicate wide variations in the ability of absorbent dressings to immobilize and to retain the bacteria commonly found in wounds. Additionally, a validated in-vitro surrogate viral barrier test (using a nonpathogenic virus) has been used to evaluate the ability of absorbent dressings to prevent the transmission of human bloodborne viruses while dressing remains intact without leakage.
In-vitro Studies to Measure Intimacy of Wound Surface Contact by Modern Wound Care Products
M Walker, BSc, MPhil, PhD, C Biol, MI Biol; SM Adams, FIMLS; DC Pritchard, BSc, MRSC
Wound Healing Research Institute, ConvaTec Global Development Centre, Deeside, United Kingdom
Abstract
Exudate management is a key factor in wound management. It is essential that any dressing applied to an exuding wound can absorb exudate in such a manner that the underlying wound surface environment is optimized. Another essential property of a modern wound dressing is its ability to conform to the contoured surfaces presented by chronic wounds. An intimate contact at the wound/dressing interface is also important in minimizing deadspace across the entire wound surface. In these studies, an in-vitro wound model was developed to allow a cross-sectional area of the wound to be visualized by placing a small piece of wound tissue between two glass slides. An image of an applied wound dressing could then be captured by a digital camera attached to a light microscope illustrating the level of intimate contact with the wound surface. In a second in-vitro model, simulated exudate was pumped through a model wound at a rate of 12mL/24 hours (equivalent to a moderately exuding wound at 0.5g/cm2/24 hr[1]) to visualize the ability of modern wound dressings to handle exudate. Photographic evidence also demonstrated the dressing's ability to maintain intimate contact with the hydrated wound surface.
Reference
Thomas S, Fear M, Humphreys J, et al. The effect of dressings on the production of exudate from venous leg ulcers. WOUNDS 1996;8:145-50.
Moisture Balance vs. Moist Wound Healing: Is There a Difference?
Vanessa Jones, MSc, RN, NDN, RCNT, PGCE; Keith G. Harding, MB, MRCGP, FRCS
Wound Healing Research Unit, University of Wales College of Medicine, Medicentre, Heath Park, Cardiff, United Kingdom
Abstract
The concept of healing within a moist environment has directed the evolution of modern wound healing products since the 1970s. Winters's work[1] identified a possible mechanism for reepithelialization under occlusion in the presence or absence of eschar. It is around this effect that dressing manufacturers have focused on the ability of dressings to increase the rate of epithelialization. The added effect of wound fluid being left at the wound site was not necessarily considered, as, at this time, research in this area was nonexistent. The constituents of wound fluid are now known with proteins and cytokines paramount in the early stages of healing essential to degradation of fibrin and the provisional matrix.[2] Moisture balance is achieved by absorbing or donating fluid and is dependent on the moisture vapor transmission rate (MVTR).[3] When dressings cannot effectively handle the level of exudate produced, maceration of the surrounding wound edges will occur. The components of acute wound fluid are known to differ considerably from that of chronic fluid that may be detrimental to healing.[4] Should concerns be about the amount of wound fluid, if any, left at the wound site? Or is merely keeping the wound humid enough to promote epithelialization enough? The balance of moisture becomes a key component in the healing of wounds and poses the question: If wound fluid differs, how do we know at what stage of healing and in what type of wounds is a moist environment most effective?
References
Winter GD. Formation of a scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293-4.
Chen WYJ, Rogers AA, Lydon MJ. Characteristics of wound fluid collected during early stages of wound healing. J Investigative Dermatol 1992;99(5):59-64.
Thomas S. Vapour-permeable film dressings. J Wound Care 1996;5(6):271-4.
Wysocki AB, Staiano-Coico L, Grinnel F. Wound fluid from chronic leg ulcers contains elevated levels of metalloproteinases MMP-2 and MMP9. J Invest Dermatology 1991;101:64-8.
The Effect of Topical Tripeptide-Copper-Complex on Healing in a Chronic Wound Model
Sherman O. Canapp Jr., DVM, MS; James P. Farese, DVM, Diplomate ACVS; Gregory S. Schultz, PhD; Santosh Gowda, MBBS, MS; Anthony M. Ishak, DVM; Steven F. Swaim, DVM, MS; James VanGilder, BS; Linda Lee-Ambrose, PhD; Frank G. Martin, PhD
Departments of Small Animal Clinical Science, University of Florida College of Veterinary Medicine, Gainesville, Florida (Canapp, Farese, VanGilder, Lee-Ambrose, Ishak); School of Medicine Institute for Wound Research, Gainesville, Florida (Schultz, Gowda); Department of Statistics (Martin); and Auburn University College of Veterinary Medicine, Scott-Ritchey Research Center, Auburn, Alabama (Swaim)
Abstract
Introduction. Chronic wounds can be extremely difficult to manage. This study will evaluate the effects of topical Glycyl-L-histidyl-L-lysine tripeptide-copper complex (TCC) on the healing of ischemic open wounds.
Materials and methods. Six full-thickness wounds were created within a bipedical skin flap on the dorsum of each of 24 rats. Rats were randomly divided into three groups: topical TCC, topical TCC vehicle (hydroxypropyl-methylcellulose), and control (no treatment) and treated daily for 13 days. On each day, the perimeter of each wound was traced. On days 6, 10, and 13, selected wounds were biopsied and analyzed for tumor necrosis factor-alpha (TNF-a) and matrix metalloproteases (MMP) 2 and 9. Differences in median wound area, TNF-a, and MMP-2 and -9 concentrations were compared between groups (p < 0.05).
Results. TCC significantly decreased wound area when compared to control. On day 13, wound area had decreased by 64.5 percent in the TCC group, 45.6 percent in the vehicle group, and 28.2 percent in the control group. TCC-treated wounds contained significantly lower concentrations of TNF-a and MMP-2 and -9 than control wounds.
Conclusion. Topical TCC resulted in accelerated wound healing in ischemic open wounds and may be an effective stimulant of healing in chronic wounds.
(contd. below)
|
|
Logged
|
|
|
|
DL
Administrator
member is offline
Posts: 833
|
|
Re: Wound Management
« Reply #3 on: Apr 20th, 2007, 03:57am » |
|
(contd)
Clinical Evaluation of a New Bioengineered Wound Dressing With a Unique Dual Fluid Handling Capability
Gonzalo Serafica, PhD; Oscar Alvarez, PhD; Marie Etris, RN, CETN
Vice President for Research and Development, Xylos Corporation (Serafica); University Wound Healing Center, Bronx, New York (Alvarez); President, Etris Associates, Philadelphia, Pennsylvania (Etris)
Abstract
A novel biosynthetic cellulose material has been engineered to create a new wound dressing* with dual fluid handling ability capable of maintaining an optimal moist wound healing environment by hydrating and/or absorbing fluid from the wound. The physical properties of the cellulose biomaterial that provide the unique fluid handling ability will be discussed. The new wound dressing has the hydration ability of wet saline gauze, donating up to 80 percent of its weight to a dry wound bed and, at the same time, is capable of absorbing fluid comparable to existing hydrogels and hydrocolloids. The wound dressing's capability to carry and deliver bioactive agents is also described briefly. Finally, the results of a wound dressing clinical evaluation on various types of chronic wounds are presented. The key wound dressing performance indicators observed during the 12-week study on venous ulcers include 1) ability to help promote autolytic debridement resulting in a complete granulating wound bed and reduction of nonviable tissue; 2) cleansing of wound margins; 3) evidence of epithelial migration; and 4) wound healing. Additional clinical variables noted include wound pain reduction, wound odor, and overall appearance. Lastly, an economic analysis assessing the clinical performance of the cellulose wound dressing is proposed.
*XCell Cellulose Wound Dressing (Xylos Corporation, distributed by PDI Medical Device and Diagnostics, Langhorn, Pennsylvania))
Spray-Applied Living Keratinocytes and Fibroblasts as a Biologically Active Wound Dressing
Chris Rinsch, PhD; Béatrice Mis, PhD; Vincent Ronfard, PhD; Eric Rolland, PhD
Isotis SA, Lausanne, Switzerland
Abstract
Primary fibroblasts and keratinocytes residing in the skin naturally secrete a cocktail of growth factors and cytokines that act to stimulate the wound healing response following interruption of the cutaneous barrier. To mimic this natural process, a living cell-based wound dressing was developed for the treatment of chronic venous ulcers. It consists of two components: keratinocytes and fibroblasts suspended in thrombin and cryoprotectant and a solution of fibrinogen. The product is stored frozen at -80°C until use, at which time it is thawed, with the two components applied sequentially to the wound surface using a spray applicator. In this manner, polymerization of the fibrin occurs on the wound with delivered cells becoming trapped in a thin layer of fibrin at the ulcer site. Mixtures of allogeneic, growth-arrested primary keratinocytes and fibroblasts were observed to secrete different levels of therapeutic proteins (VEGF, HGF, GM-CSF, bFGF, and KGF) depending on the ratios employed. Secretion of GM-CSF was dependant on the synergy derived from the mutual presence of fibroblasts and keratinocytes. Increasing the cell concentration in the final wound dressing from 1.25 x 106 cells/mL to 5 x 106 cells/mL led to an elevated secretion of growth factors and cytokines. Preliminary studies have shown that cell preparations remain biologically active for at least two months when stored at -80°C.
Clinical Experience Using Ultrasonic-Assisted Wound Treatment
Jeffrey A. Niezgoda, MD, FACEP; Kathleen M. Nelson, RN, CWCN; Dawn Walek, RN
St. Luke's Medical Center, Milwaukee, Wisconsin
Abstract
Low-frequency ultrasonic wound treatment (UAW) is emerging as an alternative method for wound bed preparation and debridement. Low-frequency ultrasound when applied to the wound bed via a wound treatment solution allows for deep-tissue penetration of ultrasonic vibration and energy. This results in microcavitations, which cause bacterial destruction. In-vitro wound models have proven highly effective bactericidal effects. The solution also provides a gentle flushing of the wound, cleansing it of fibrin deposits and bacterial growth while preserving granulation tissue. This debridement technique is particularly useful in deep, tunneling, and undermining wounds. UAW is well tolerated by patients due to minimal associated pain. We illustrate the effectiveness of the UAW as a debridement tool and wound treatment technology with a photographic series of clinical cases studies.
http://www.cliniciansbrief.com/?p=articles&newsid=187
(excerpt)
Application of a sustained-release silver hydrogel dressing sheet in avian wound management. Mans C, Guincho M, Smith D,Taylor M.EXOTIC DVM 9:21-24, 2007.
Avian Wound Bandaging
A Quaker parakeet approximately 5 years of age presented with a full-thickness, 1- to 2-day old wound on its leg.The bird appeared otherwise normal and was anesthetized with isoflurane to treat the leg.The wound was mechanically debrided and lavaged with sterile saline and 50% dextrose solution; then sutured at the proximal and distal ends of the wound using tension sutures with stents. SilvaSorb Gel (Medline Industries,
Inc) was thinly applied to the wound to help the adherence of a SilvaSorb Sheet cut to match the shape of the wound. A light cotton bandage followed by a light elastic bandage layer was applied on top of the cotton bandage. An Elizabethan collar was placed on the bird and a 10-day course of cephalexin (100 mg/kg PO Q 12 H) and 7-day course of meloxicam (0.5 mg/kg PO Q 12 H) started. ...... It appears use of Silvasorb Sheets promotes healing of avian tissue with the added benefits of providing extensive antimicrobial activity for up to 7 days and reducing the frequency of
dressing changes.
COMMENTARY: The bandage material described in this case is a type of slow-release silver hydrogel dressing. Preliminary studies have suggested that these dressings can provide an environment that encourages healing ........Hydrogels absorb wound exudate and can donate moisture to the wound bed, promoting autolytic debridement and reducing pain at the wound site. Silver hydrogel dressings also release silver ions for
up to 7 days when exposed to moisture from the wound.This creates the additional benefit of a controlled-release antimicrobial effect, an excellent
option for treating partial- and full-thickness wounds.—Jennifer L. Schori,VMD"
|
| « Last Edit: Oct 21st, 2008, 03:30am by DL » |
Logged
|
|
|
|
DL
Administrator
member is offline
Posts: 833
|
|
Re: Wound Management
« Reply #4 on: Jun 27th, 2009, 03:51am » |
|
http://www.vetmed.auburn.edu/uploads/images/1569/a-z_boardreview.doc
(excerpt > general info non-avian specific)
"Wound Healing – 4 stages that overlap. 1) Inflammatory phase, NÆ are 1° cells. 1st 2-3 days usu. 2) Debridement phase, w/in 6-12 hrs and lasts 12hrs to 5 days dependent on amt of debris to clean up. Healing will not proceed until necrotic tissue is removed. NÆ and monocytes. 3) Repair phase, begins w/in 1st 12 hrs. Fibroblasts, capillary infiltration, collagen = granulation tissue, which appears 3-6 d after injury. “Proud flesh” when in excess. Epithelialization involves sliding of epithelial cells across wound surface, can take wks to mos. This phase tensile strength. 4) Maturation phase. Remodeling. Begins 15 d after wound and continues for 6-12 mos or longer. Cont’d tensile strength, checks an balances. Regression of caps and fibroblast. Results in scar which is never as strong as tissue it replaced (15-20% weaker). Skin heals by contraction and/or epithelialization, it does not regenerate.
· First Intention – Primary closure. Close apposition of skin edges. Fresh, clean, w/ adeq vascularization. Perform during the “Golden Period”, which is ~ 6 hrs after wound (up to 12 hrs). Healing is rapid, scarring minimal.
· Second Intention – Nature’s method. Contraction and epithelialization have occurred to some degree. Many factors inhibit contraction including steroids, NSAIDs (in high doses), infection, proud flesh, shape. Epithelialization is by heat (bandaging), oxygenation (bandaging, casting), moisture, silver sulfadiazine, insulin. ¯ by infection, necrotic tissue, proud flesh, too frequent of bandage changes.
· Third Intention - Delayed Primary Closure. Apposition of wound after golden period but before appearance of granulation tissue. 4-5 days after injury. Debride, irrigate, pack and dress. Close when ready w/ primary closure.
· Delayed Secondary Closure – After gran bed, after 4-5 days. Chronic, contaminated wounds. Often excise and debride until primary closure can be performed."
|
|
Logged
|
|
|
|
|
