Wounds healing
Suture the animal wounds
August 5, 2020
Keratoma in horses
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Wounds healing
Moist environment favors wound healing through the use of MDRs
The practice suggesting to let wounds exposed to air to form a scab for a faster healing, it is demonstrated as incorrect. Wounds tend to heal better in a moist environment, so that platelets can build a scaffold and white blood cells, fibroblasts and epithelial cells can migrate through the wound.[1]
There are two main tips to moist wound healing: 1) Do not use disinfectants over the wound because disinfectants such as iodine, sodium hypochlorite and hydrogen peroxide are toxic to cells. 2)Use moist materials . The second tip refers to the fact that lacerations, abrasions, crush injuries and burns heal faster and with less scarring when the treatment promotes a moist wound bed. [2]
WOUND DEBRIDEMENT
The debridement is the first step of wound care, it consists in removing all contaminants, foreign materials and bacteria, and damaged tissue from the wound, through a selective or nonselective debridement. While in the first case we have only a removal of unhealthy tissue, with the nonselective one we have a removal of both kind of healthy and unhealthy tissue.[3]
3 kinds of debridement can be:
• Autolytic debridement: Performed by white cells during the first 3 to 5 days after the wound occurs in the inflammatory phase. This is a selective form of debridement because it spares healthy cells and intact matrix molecules while removing damaged cells and matrix.
• Surgical debridement: operated by the surgeon
• Mechanical debridement: A not indicated form of debridement is the physical removal of tissue adhered to a dried-on dressing; nonselective.
Debridement chirurgico
the wound exudate, the moisture that naturally seeps out from a wound site, serves as a transport vehicle for a variety of bioactive molecules such as enzymes, growth factors and hormones. Exudate levels are proportionate to the amount of contamination, infection, and tissue damage in a wound. Persistent exudate is an indication that more aggressive surgical debridement may be needed.
Only after all contaminants and nonviable tissue have been removed, it is possible to proceed with the treatment of the wound.
OPEN WOUND MANAGEMENT
Stages of healing
wet-to-dry bandages are no longer the standard of care because they compromise wound healing in many ways (nonselective tissue removal, macerate, environmental bacteria can penetrate gauze, etc..)
Moist wound healing (MWH) is now the standard of care.
Choice of a moisture-retentive dressing (MRD) is based on the specific needs of the wound at a specific healing-time-point (eg, debridement, granulation, epithelialization) and on the amount of exudate the wound is likely to produce:
A MRD has to support selective autolytic debridement in the inflammatory phase as well as be able to absorb the exudate; the MRD must support function of growth factors and fibroblasts, endothelial cells, and epithelial cells responsible for granulation, epithelialization, and contraction during the repair phase.
[3].
Repair
Collagen begins to fill in the wound to bind the torn tissues, a process that will take several weeks to be completed. New blood vessels begin to grow into the area from the uninjured blood vessels nearby. The wound edge begins to produce “granulation tissue,” the moist pink tissue that will ultimately fill in the wound. The wound will actually shrink in a process called “wound contraction” to create new skin and cover the wound. [4]
Types of MRDs
Types of moisture-retentive dressings are
1. Calcium alginate
2. Polyurethane foam
3. Hydrocolloid
4. Hydrogels.
MRDs are typically applied after surgical debridement and lavage.
MRDs retain moisture in the wound. To avoid maceration (overhydration) of the skin and the compromise of its epithelial barrier function, ensure the dressing is in contact with the wound surface but not with the skin.
Our experience
To satisfy this need, we created a moist medicament, PRP-based (platelet rich plasma). Ematik Ready is a “patch” soaked in PRP obtained from patient’s own blood. It is autologous, with no side effects, rich in growth factors allowing a fast healing keeping the wound moist.
A scaffold in biopolymers acts as a support of the patch and allows to suture it directly with the skin flaps; the entire treatment is completely absorbable and with no need to be changed until the healing process comes to an end.
Under the economic point of view, in the treatment of difficult wounds, the use of MDRs reduces overall costs of wound management, reducing healing time and frequent bandage changes.
Sources
1 - https://www.veterinarypracticenews.com/advances-in-veterinary-medicine-improve-wound-care/2 - https://www.woundsource.com/blog/clearing-air-about-moist-vs-dry-wound-healing
3 - https://todaysveterinarypractice.com/moist-wound-healing-the-new-standard-of-care/
4 - https://www.marvistavet.com/wound-healing.pml
