A 5-year-old, neutered male mixed-breed dog was referred for necrotic skin resulting from bite wounds.
History. The patient had been treated for severe bite wounds (puncture wounds) over the right lateral flank one week earlier. The wounds extended over an 8 × 14 cm area but did not penetrate the abdominal muscular wall. Initial treatment consisted of copious lavage using a 0.9% saline solution and oral cephalexin.
Examination. The dog had normal vital signs and a large area of necrotic skin on the right flank region. The necrotic skin was separating from the healthy skin edges and was malodorous. Bacterial culture of exudate isolated Pseudomonas aeruginosa, which was sensitive to enrofloxacin. Initial complete blood count results revealed a mildly elevated number of white blood cells with neutrophilia. Serum chemistry profile results were unremarkable. Radiographs of the abdomen and abdominal ultrasonography revealed no evidence of penetration into the abdominal cavity.
ASK YOURSELF ...
How would you initially manage this wound?
A. Debride necrotic skin and apply a wet-to-dry bandage around the body.
B. Immediately debride the necrotic skin and close with a skin flap.
C. Debride the necrotic skin and apply a nonadherent dressing to the wound until a healthy granulation bed has developed; then close the wound with a skin flap.
D. Debride the necrotic skin and allow the wound to form a scab and heal by second intention.
Correct Answer: A.
Debride necrotic skin and apply a wet-to-dry bandage around the body.
Treatment. In this case, a wet-to-dry bandage was placed, as the wound had been freshly debrided of necrotic material and a healthy granulation tissue bed had not developed. In addition, because of the presence of the purulent exudate, this wound needed to have open wound management to eliminate infection. The bandage was changed every 24 hours for 10 days, until healthy granulation tissue developed.
The lateral flank is very difficult to bandage, especially in a male dog, as most bandages would cover the penis. To overcome this problem, a tie-over bandage-which involves placing suture eyelets around the perimeter of the wound; then packing it with bandaging material and lacing umbilical tape through the eyelets-can be used. A tie-over bandage can be effective for small to medium wounds, or wounds that are not gravity dependent (dorsum of back). In large wounds, the sponges and packing material usually will slide ventrally, exposing the wound. Thus, tie-over is not an effective technique in such cases.
New Method: Step by Step.
A novel, more effective bandaging method is the Ioban bandage (3M Health Care, www.3M.com), which is a thin, stretchy, water-repellent, antibacterial material that is sticky on one side (Figure 1). This bandage is applied in the following manner: