Type	Comments	Treatment
Open wounds: There is a break in the covering of the body surface
Incised	Skin edges are clean and clearly defined. The cut edges may bleed freely. The wound will heal quickly, by first intention. Caused by sharp, cutting materials, e.g. scalpel or glass	Ensure that deeper structures are not damaged before closing the wound. Hold edges together with sutures
Laceration	The wound is irregular in shape, with possible tissue loss. There may be little blood loss. Risk of infection is high. The wound will heal by second intention, with possible scarring	Assess the wound, i.e. is any skin available for closure/partial closure by suturing? Dress the wound according to the damage sustained. Wet-to-dry or wet-to-wet dressings may be indicated to encourage a healthy bed for granulation to occur
Puncture	Surface wound is small with a deep track running down from it. The surface wound will heal quickly, trapping bacteria and causing an abscess to form. Common causes are bites, air gun pellets and thorns	Remove the cause of the injury. The wound must be kept open to allow infection to escape and granulation tissue to develop at the bottom of the tract. Application of a warm compress or poultice will encourage this
Abrasion	The epidermis has been rubbed off, exposing the dermis. Can be painful as nerve endings are exposed. Although not serious, there is a risk of contamination	Clean and dress the wound according to the degree of damage. Wet-to-dry or wet-to-wet dressings may be indicated to encourage a healthy bed on which granulation tissue will form
Abscess	A collection of pus enclosed in an area of inflamed tissue. Commonly results from a puncture wound	The abscess must be lanced (unless already burst), but only when it is ‘pointing’. This is the thinning of the skin over the abscess, indicating a point which can be lanced. Formation of a point may be encouraged by placing a warm compress on the area. Using a scalpel blade at 90°, incise the wound. Express the pus. Flush the wound with sterile saline until clear. Maintain the drainage by flushing daily. The wound will heal by second intention. Treatment with antibiotics may be indicated
Avulsion	Forceful separation of the tissue from its attachment. Commonly seen in road traffic accidents and dog fights	Assess the wound – is there any free and healthy skin available for closure or partial closure by suturing? Assess whether the patient has suffered any internal damage. Infection may be present and drainage of the wound should be considered. Dress the wound according to the degree of damage
Degloving and shearing	Similar to an avulsed wound but with loss of blood to an area resulting in sloughing of the tissue. There may be damage to underlying organs or bones	Assess the wound – is there any free and healthy skin available for closure or partial closure by suturing? A skin graft may be an option. Assess whether the patient has suffered any internal damage. Infection may be present and the wound may need to be drained during the healing process. Dress the wound according to the degree of damage. Wet-to-dry or wet-to-wet dressings may be indicated to encourage a healthy bed on which granulation tissue can develop
Closed wounds: The injury does not penetrate the thickness of the skin
Contusion	A bruise. Occurs when blood vessels are ruptured due to a blow to the skin surface. May be seen in an open wound	Arrest the internal haemorrhage by applying a cold compress
Haematoma	A collection of blood under the skin causing swelling. The wound is soft and often painless. If left the blood will clot, contract and become ‘knobbly’	Arrest the internal haemorrhage by applying a cold compress, and, if possible, apply a firm dressing. Surgical intervention may be necessary to drain the haematoma
Other types
Skin graft	A portion of skin is taken from one area of the body to fill a deficit in another part. There are two types: 1. A pedicle graft involves moving the entire skin thickness to another area. This heals by first intention 2. A free skin graft involves transplanting the epidermis and part or all of the dermis. This heals by second intention	Dress according to type
Ulcer	A local excavation of the surface of an organ or tissue. An ulcer contains inflammatory exudate within a crater. This heals by second intention	Remove the cause of the injury, dress with a moist dressing if anatomically possible. Treat bacterial infections
Tumour	Any abnormal swelling in or on part of the body that has no physiological use. May be benign or malignant	Before treatment the type of tumour must be identified. Surgical intervention is often necessary
Fistula	A tract that passes from one skin surface to another and is lined with epithelial cells. Common sites are anal sacs as a result of infection, retrovaginal as a congenital abnormality and oronasally as a result of extraction of the upper canines	Treatment depends on the site. Surgical intervention may be required
Sinus	A blind-ending tract that runs from the skin surface to deep within a tissue. Often results from infection. Commonly caused by penetrating foreign bodies, e.g. grass seeds and anal furunculosis. Treatment depends on the cause	Remove foreign bodies surgically. Anal furunculosis may be treated by surgery, cryosurgery or by the use of immunosuppressant drugs
Hernia	A hole within a muscular wall which allows the passage of organs through it. May result in strangulation of the blood flow to the organs, which can become ischaemic and/or necrotic. Common sites are umbilical, inguinal and perineal	Surgical treatment to replace the organs, close the opening in the muscle and remove damaged tissue
Rupture	A tear within a muscular wall. Most commonly seen within the diaphragm following a road traffic accident	Treat for shock and relieve pressure on the chest cavity by lifting the chest higher than the abdomen. Close the diaphragmatic tear surgically when the patient is stable

Rationale: Different types of wound need different treatment, dressings and aftercare. A general anaesthetic/sedative may be needed.

7. Action: For open wounds, fill wound with a sterile lubricant and clip hair away from around the wound.

Rationale: The lubricant prevents hair from contaminating the wound. The hair is clipped to allow the area to be cleaned aseptically.

8. Action: Clean the area surrounding the wound with a surgical scrub and warm water. Clean the wound by lavage with warm, sterile saline in a 20 ml syringe with a 19G needle. Continue until all debris has been flushed away.

Rationale: Cleaning the wound in this way will provide enough pressure to remove contamination, without damaging the cells.

9. Action: Assess the blood supply to the wound. If necessary, debride the wound using a scalpel blade to remove necrotic tissue and restore blood supply.

Rationale: Necrotic tissue must be removed. The area must have a good blood supply to start the healing process.

10. Action: Close the wound if necessary (Table 8.1). Suturing techniques are covered later in this chapter.

Rationale: First-intention wound healing occurs when the edges of the wound are held together. Second-intention healing or granulation is the healing of an open wound.

11. Action: Apply a light dry dressing to first-intention wounds. A primary layer of absorbent padding followed by a secondary conforming and a cohesive tertiary layer may be applied for protection (Tables 8.2 and 8.3).

Table 8.2

Wound dressings

Type	Comments
Primary layer of most bandages is usually a wound dressing which gives the wound the optimum conditions for healing. Materials may be as follows:
Wet-to-dry dressings using lint or gauze	Soak the dressing in Hartmann’s solution and apply to contaminated wounds. May be sutured into place. Allow to dry on the wound and then tear off to remove damaged and/or necrotic tissue to debride the wound and promote granulation
Gamgee	A cotton-wool sheet covered on each side by gauze. Dry and non-sterile
Petroleum gauze	A moist dressing. Gauze impregnated with petroleum jelly. Inhibits epithelial growth
Perforated film dressing, e.g. Melolin	Commonly used for surgical wounds (first-intention healing). Can be used to debride a larger wound by allowing the necrotic tissue to stick to it and removing it at dressing change. A painful way of debridement
Foam dressing, e.g. Allevyn	A dry, sterile dressing that promotes a moist environment. Good absorbency. Can combine with hydrogens or honey. Antimicrobial dressings are available which attack wound exudates and are useful in the treatment of MRSA
Hydrogels, e.g. Intrasite, Biodres	A moist gel, high in water content, applied into and on to the wound. They donate and transfer water
Hydrocolloids, e.g. Granuflex, Tagesorb	A moist, sterile dressing that rehydrates the wound and promotes debridement and granulation. Contraindicated in active infection
Calcium alginates, e.g. Kaltostat	A moist, haemostatic dressing derived from seaweed. A gel is formed over the wound which promotes wound healing by stimulating macrophages and fibroblasts
Semipermeable film dressing, e.g. Opsite, Bioclusive, Tegaderm	A sterile film dressing which retains moisture within the wound. No absorbency but can be left in place for longer periods
Sodium chloride dressing 20% hypertonic saline	Use on heavily infected highly exudative wounds
Manuka honey	Available in impregnated dressing or alone in a tube. Bacteriostatic with a low pH
Silver-impregnated dressings	Broad-spectrum antimicrobial and effective against MRSA
Poultice	A dry dressing which is soaked in hot water and applied to a wound to draw out infection from the wound

MRSA, meticillin-resistant Staphylococcus aureus.

Table 8.3

Bandaging techniques

Type	Indications	Comments
Robert Jones	Support and immobilization of fore- and hindlimbs, commonly used in fractures. Reduction of pain, oedema and haemorrhage (Fig. 8.1)	A light but firm cylindrical bandage
Velpeau sling	Support and immobilization of the shoulder joint following luxation or surgery (Fig. 8.2)
Ehmer sling	Support and immobilization of the hip, following reduction of a luxation (Fig. 8.3)
Ear	Support and protection of the ear following trauma, or post-operatively following resection or haematoma (Fig. 8.4)	One or both ears can be included. Ensure that the ear position is marked with a pen
Chest	Support and protection of wounds and dressings. Useful for holding chest drains in place (Fig. 8.5)
Limb	Support and protection of wounds, reduction of pain, swelling and movement (Fig. 8.6)	Ensure toes and dewclaws are padded. Work from distal to proximal. Include the whole foot and joint above the injury
Tail	Protection of wounds from environmental trauma and/or self-mutilation (Fig. 8.7)	Elastoplast may be applied directly to the hair to prevent this bandage from slipping
Ring	Indicated where there is a foreign body protruding from a wound. A ring bandage protects the wound while preventing further penetration by the object. Usually used in a ‘first aid’ situation	Ready-made rings can be obtained. To make a ring wind conforming bandage around your hand five times (size of ring depends on area of wound to be covered). Remove carefully, maintaining the ring shape and with the same bandage wind it around the ring, creating a bound circle like a doughnut. Continue until you have the desired size and shape (Fig. 8.8)
Splint	Immobilization of an injury below the elbow or stifle	Limited to lower limbs. Immobilization cannot be achieved above the elbow and stifle due to the large mass of muscle that surrounds the bones. Application is often painful for the patient and therefore limited to a first aid procedure. Common splints used in practice: Gutter splints – made of hard plastic, lined with foam and snap off to the correct length Zimmer splints – made of pliable aluminium backed in a foam composite
Cast	Immobilization of a limb	Common cast material: Plaster of Paris – bandage covered in gypsum (calcium sulphate) that sets hard when water is added. Polyurethane-based and thermoplastic materials – lightweight, waterproof, short drying time and more radiolucent than plaster of Paris