A wound can be covered temporarily with bandage until specialized veterinary care is received to avoid gross contamination and mutilation of the area. Generally the area of wound is cleaned, lavaged and hair around the wound should be clipped and shaved, followed be some antiseptic dressing. The dirty or contaminated wounds should not be closed and open drainage is required. In some cases, dressing is done but a drain is kept to allow escape of fluid coming out if the gap is too big, suturing is required, but in some cases with, tissue heals by itself whereas some wounds require delayed suturing. Sometimes necrosed (dead) tissue is present which has to be removed and the edges are freshened (debridement) for healthy healing.
In haemorrhagic wounds the first step is to arrest the bleeding. Similarly in fracture wounds (open fractures), anatomical reconstruction and reduction of fracture and then wound closure should be done. In case of maggoted wounds, which occur by attack of blow flies or by eggs laid by flies on any open wound has to be treated accordingly i.e. removal of maggots. This can be done by applying tincture turpentine locally, which will irritate the maggots and they will come out or apply any spray or ointment containing insecticidal compounds (BHC). In case of burn wounds, the fluid therapy of the patient is of utmost importance as many electrolytes are lost from weeping burn surface along with local application of emollient and antiseptic dressing (e.g. sulphacetamide ointments). Dog bite wounds should be attended with special precaution. Wearing of gloves is essential by anyone who handles the dog. First of all antirabies vaccination (post bite, Day 0, 3, 7, 14, 21, 30 and 60) should be done. A thorough washing of area should be done followed by antiseptic dressing. It should not be sutured as is generally contaminated. Similarly, in all contaminated wounds, suturing is delayed. In case of gunshot wounds, the cartridge has to be removed the position of which can be ascertained by taking radiograph. In case of severe tissue loss, tissue grafting is needed and is a really helpful.
*The line of treatment wounds varies with the cause, type and duration of wound.
In spite of a lot of available options, many a times there is delay in the wound healing or there is formation of an ulcerating wound. Many of the systemic/endogenous and exogenous/environmental factors are involved which can affect the rate of wound healing and strength of the healed tissue.
- Anaemia: In anaemia the haemoglobin is less so the oxygen carrying capacity of the blood is reduced. Oxygen is required for the cells for respiration the reduction of which leads to delayed wound healing.
- Hypoproteinaemia: Wound healing is a process of protein synthesis; less of the protein may lead to delayed wound healing and decreased strength. Methionine and cysteine prevents delayed wound healing and thus be incorporated in diet.
- Uraemia: increased blood urea nitrogen delays wound healing. Uraemia causes slow granulation tissue formation and poor quality collagen, the tissue so formed is thus not so strong.
- Dehydration and odema: These two factors are involved in wound healing and excess of any of these two can cause a delayed healing.
- Diabetes/blood sugar: More of the sugar in the blood has been seen in the humans have seen to delay the wound healing and may be involved in dogs also.
- Thyroid: Imbalances in the normal values of thyroid hormone affects wound healing and should be ruled out in case of delayed wound healing.
- Infection: Infection local or systemic will delay the wound healing. A good antiseptic dressing should be applied and changed regularly. A systemic antibiotic should be selected based on the type of infection for whichantibiotic sensitivity test is helpful. *A complete blood testing is thus recommended in cases of long standing wounds or ulcerated wounds like blood haemoglobin, total protein, urea nitrogen fasting blood sugar, thyroid and antibiotic sensitivity test (ABST).
- Oxygen tension: Oxygen is required for every cell and sometimes a very tight bandage will reduce blood flow to the affected area. So while applying bandage, just observe that your finger can go between skin and bandage but at the same time it should not be too loose.
- Temperature: Maximum strength of the healed tissue is attained at 30o C. so it is not good to keep your dog at very less temperature (in Air conditioner) or very high temperature (very hot environment) otherwise the collagen formed will be not very strong.
- Cleaning agent: Owners should keep in their mind that the skin of dogs and human are different. The floors at which the dogs are kept are occasionally cleaned with phenol (Phenyl) which is irritating to the dogs and many a times allergic. In addition to this many a times dog owners apply Dettol or Savlon or Human Shampoos to clean their dogs, it is to inform them that you are actually harming your dog. Don’t apply it on your dog as its skin is different from human skin. Apply betadine or just normal saline to clean the wound. You are actually causing harm to your dog. One more thing that I want to tell is about the shampoos being used on the dogs; please use only dog shampoos and not the human ones.
- Vitamin E and Zinc: If present in excess, vitamin E will delay wound healing, by slowing collagen formation so should not be given in excess to the dogs. Zinc is required in moderate amount for normal wound healing as it helps in cellular proliferation however, in excess zinc delays wound healing by inhibiting macrophage function (cells involved in combating infection).
- Corticosteroid: Dogs are given corticosteroid for their anti inflammatory action but they markedly inhibit growth of the blood vessels and epithelial cells of the affected area. They can thus complicate the wound healing instead of helping. For anti-inflammatory action other suitable drugs can be used, if required (e.g. Serratiopeptidase).
- Anticancer drugs: These drugs are cytotoxic (toxic to the cells) and directly affecting all the developing and growing cells of the body and should not be given, until very necessary.
- Vitamin C: It is required for the formation of collagen. God quality collagen provides strength to the healing tissue. Vitamin C can be given easily through oral route as palatable tablets are available.
- Drugs: Some of the dogs are allergic to some drugs like amino glycosides group of antibiotics and a delay in wound healing is observed, a change of antibiotic may help. In addition drugs like Aspirin, phenyl-butazone have also been reported to decrease healing. *History is very important as it can help in identification and removal of involved agent.
- Self mutilation: Many a times the dog licks the wounds. They damage the bandage and remove dressing. Here neck collar and Elizabethian collars (http://innovationindia.weebly.com, http://innovationindia.webs.com) can be very useful as they will restrict the head movement and prevent licking and self mutilation of the area.
- Constant irritation: Decubital ulcers or pressure sores develop and do not heal in cases of recumbency in certain diseases (Paralysis, Hind quarter weakness) due to which the wound cannot heal. The pet should be encouraged to stand and if not possible rehabilitation aid should be provided to the animal. Slings can be very useful and may help dog to stand whereas in long standing cases wheel chair/wheel cart (http://innovationindia.weebly.com, http://innovationindia.webs.com) should be provided as animal can stand and move and the wound dressing can be done very easily. In addition, it will remove constant pressure of dogs own body weight and irritation due to recumbency.
- Immobility: Sometimes the wound is near or at the joint which causes constant movement and thus healed tissue will rupture again and again. For this the area should be immobilized, at the same time dressing of the area is also very important, so a splint with a window can be applied for better outcome. Various fore leg and hind leg splints are available which can be beneficial for the pet (http://innovationindia.weebly.com, http://innovationindia.webs.com).
*Rehabilitation of animal should be instituted as early as possible as it enhances the rate of recovery, wound healing and animal well being.