Arsani Presentation

Management of
traumatic wound
By :DR Arsani S. Seidhom
DVM & Vet Serg.
!1
Management of traumatic wounds
Learning objective
Decrease the tissue damage
Prevent contamination
Provide an ideal environment

for Healing
What would you do First ?
Stabilize First
Stabilize First :
Full clinical status of the patient
Avoid Shock
1st Aid at the beginning
Iv- fluid therapy
Analgesia
Iv- antibiotic
Heat pad _ oxygen therapy

Management of traumatic wound
Once stable
• Lavage, debridement, dressing

( IV-fluids ,IV-antibiotics ,IV-
analgesia ,Cleaning ,Debridement ,
sedation for
surgical debridement ,Wet-to-dry (change 2-3 times/day) ,
Or Amputation)
.N.B:
•
Never attempt to suture or perform surgery on infected
tissue.
Arterial bleeding needs to be ligated, venous ooze not.
Remember THE GOLDEN PERIOD –6-8 hours max.
Classification of wound
Acc. To etiology: Acc. To cleaning:
Laceration • Clean
-surgical wound: not entering
Abrasion GI/Resp/UG
tracts
Avulsion • Clean-Contaminated
-surgical wound entering GI/
Shearing Resp/UG tracts
• Contaminated
Puncture wounds -Acute open traumatic wounds
(<6-8 hours)
Bandage or Cast Injuries -Major break in aseptic
technique (video)
Snake or Insect Bites • Dirty
Burns (heat, chemical, -Traumatic wound >6-8 hours
electrical,Radiation or clinically infected
Wound Biology
Estimate the following :
Degree of contamination
Degree of tissue loss
Any expected complication of healing
Thermal / Radiation burns
Fractures
Goals of wound Management
A. Prevention of further wound contamination.
B. Remove foreign debris and contamination.
C. Debride dead / dying tissue.
D. Promote viable vascular bed.
E. Choose appropriate method of closure.
F. Provide drainage.
G. Immobilize.
The Golden Role :
• On a fresh wound, do not apply anything that you could not apply
under your own eyelid. (don’t irritate it )
• If a wound is not fresh when presented to you,
• MAKE IT FRESH! ( •Debridement •Lavage)

Maggot Wound
Remove foreign debris and contamination,
Injectable ivermectin topically to pockets where you suspect still maggots.

Components that slow healing
• A. Tincture Iodine :• • •
• 7% solution is strong antibacterial agent
• VERY destructive to tissues
• Only safe indication is to apply to the soles and frogs of a hoof to
control thrush or toughen the feet
• Never apply on intact skin irritation, rash, skin inflammation
• B.. Alcohol: • • • •
• Never apply to open wounds
• Destroys protein in the open tissue
• Use only to wide around a wound to loosed debris
• Not to contact open skin
•
Components that slow healing
• C. Hydrogen peroxide:
• 3% solution commonly used in wounds.
• Useful in human wounds with ANAEROBIC bacterial growth.
• Foaming action increases oxygen tension in a wound destroys anaerobic bacteria.
• Toxic for cells, especially for migrating fibroblasts.
•
D. DDT:
• VERY harmful & VERY dangerous

•
Initial open wound
What would you do ??
Before After
Now we can suture
Choose appropriate method of closure
1. Primary Closure
- tension relieving techniques ( near-far-far-near suture ) or tension relieving
incisions
2. Delayed Primary Closure

-With or without reconstructive techniques
-E.g. Sub-dermal plexus flaps
3. Secondary Intention Healing
!14
Primary closure :
1ry closure
Preferred if possible
- restores skin continuity. – barrier function
- prevents functional problems caused by contraction
Sometimes requires tension relieving techniques
• - Undermining / walking sutures
•
- Tension relieving incisions
Skin Tension
Undermining
!Local Skin Mobilization
• Dissecting under each edge of

defect.
• Subdermal Plexus.
! Careful With
• Distal Extremities
• Face
• Perineum
2- Delayed Primary Closure
•Ideal in rescue shelter/hospital
situations.
•Not a ‘quick fix” but may
make overall healing time
shorter than in open wound
management.
• Initially manage with wet-to-
dry for couple of days until
volume of exudate reduces
change daily until healthy
granulation tissue appear.(tie
over bandage)
2-Delayed 1ry Closure
- Granulation tissue is the key
in secondary intention wound
healing.
- In case of delayed primary
closure, thick granulation tissue
has to be removed before
wound can be sutured, to
ensure adequate blood supply
from below to the skin.
Reconstructive techniques
1. Rotation flap
2-Transposition Flap
3-Advancement Flap
3. Bipedicle Advancement Flap
Large Defects
•Thorax
•Abdomen
3- Secondary intention healing -Open wound
-Healing occurs by
a. Granulation
b. Epithelialization
c. Contraction
-Granulation tissue
• provides a barrier against infection
• A surface for epithelial migration
• The mechanism for wound contraction
Dressings
Stage 1 2 3 4
Phase Bleeding Inflamation Proliferation Remodling
• Anti-bacterial Granulation tissue

• Prevent • Debridement resistant to infection
• Moist wound
contamination • absorbe exsudat environment maintain moist
• • immobilize • moist wound
Function • Absorb lower environment
• Absorb environment • oxygenation
volume of exudate
hemorrhage • prevent further
• compression trauma
-Daily lavage
essential.
-hemorrhage should -surgical Dead and infected
be ligated or debridement. Dress with Aloe Vera
Note tissues removed
compressed directly -wet-to-dry excellent and/or panthenole
HONEY(manoka)
choice in grossly
contaminated wound
Drains
Active Drain Passive Drain
Bandage Application
Tension balance most important
Cover damaged area then apply correct tension or

compression
Robert Jones
Modified Robert Jones
Spica Splint
Amputation
Complication Of Amputation
• Wound dehiscence generally occurs
around day 3-5
• Factors: Infection, motion, fluid leakage,

tensionN.B, I. ANALGESIA –very
important: pre- and post operative
N.B,
I. ANALGESIA –very important:
pre- and post operative
ii. NSAID
iii. Tramadol
Reference
WASAVA
https://
www.cliniciansbrief.com/
Thank you
By :
Dr /Arsani Seidhom

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Management of

Decrease the tissue damage

Provide an ideal environment

Full clinical status of the patient

1st Aid at the beginning

Iv- fluid therapy

Heat pad _ oxygen therapy

• Lavage, debridement, dressing

Degree of tissue loss

Any expected complication of healing

Thermal / Radiation burns

B. Remove foreign debris and contamination.

C. Debride dead / dying tissue.

D. Promote viable vascular bed.

E. Choose appropriate method of closure.

• If a wound is not fresh when presented to you,

• MAKE IT FRESH! ( •Debridement •Lavage)

Injectable ivermectin topically to pockets where you suspect still maggots.

• Useful in human wounds with ANAEROBIC bacterial growth.

• Foaming action increases oxygen tension in a wound destroys anaerobic bacteria.

• Toxic for cells, especially for migrating fibroblasts.

• VERY harmful & VERY dangerous

2. Delayed Primary Closure

3. Secondary Intention Healing

Sometimes requires tension relieving techniques

• - Undermining / walking sutures

• Dissecting under each edge of

Phase Bleeding Inflamation Proliferation Remodling

• Anti-bacterial Granulation tissue

Tension balance most important

Cover damaged area then apply correct tension or

• Factors: Infection, motion, fluid leakage,

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