Chapter 157 Wound Management
• The patient should always be stabilized and assessed for internal trauma (radiographs of chest and abdomen) before treating external wounds.
• In the first aid care of wounds, it is important to keep the wound moist, clean, and covered until definitive treatment can be done.
• Open wounds containing penetrating foreign bodies or projecting bone should not be manipulated until the patient has been stabilized.
• Once the patient is stable, all wounds should be cleaned and debrided, even if the animal will eventually be transferred to a surgical specialist. Surgical exploration is indicated for all penetrating wounds.
• Most wounds can be managed successfully with appropriate technique, close follow-up, cooperative owners, and minimal materials.
WOUND HEALING PRINCIPLES
Wound Classification
Wounds are classified based on degree of contamination as follows:1-3
• Clean contaminated: Minor break in aseptic surgical technique (e.g., controlled entry into the gastrointestinal, urogenital, or respiratory tracts) in which the contamination is minimal and easily removed
• Contaminated: Recent wound related to trauma with bacterial contamination from street, soil, or oral cavity (e.g., abrasion or shearing wound); can also be a surgical wound with major breaks in asepsis (e.g., spillage from the gastrointestinal or urogenital tracts)
• Dirty or infected: Old traumatic wound with exudate or obvious infection (e.g., abscess in a bite wound, puncture wound, or traumatic wound with retained devitalized tissue); contains more than 105 organisms per gram of tissue
• Grade II: Soft tissue trauma contiguous with the fracture, often caused by external trauma (e.g., bite wound, low-velocity gunshot injuries)
• Grade III: Extensive soft-tissue injury, commonly in addition to a high degree of comminution of the bone (e.g., distal extremity shearing wounds, high-velocity gunshot injuries)
INITIAL PATIENT ASSESSMENT
Before handling the patient, the clinician and patient should be protected by the use of examination gloves. Initial stabilization of the patient should address oxygenation and circulatory requirements (see Chapter 2, Patient Triage). Intravenous catheter placement, fluid therapy, and supplemental oxygen may be required for the severely traumatized patients or patients in shock (see Chapters 19 and 65, Oxyen Therapy and Shock Fluids and Fluid Challenge, respectively). A complete blood count, biochemical analysis, urinalysis, and venous or arterial blood gas analysis should be performed on admission.
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