Howard Seim, DVM, Diplomate ACVS

Monday, January 19 • 4:35-4:50, Marriott
This article emphasizes the importance of debridement and lavage when treating open wounds and outlines how to manage open wounds with modifications to the tie-over bandage technique. Surgical excision of necrotic debris allows for proper open-wound management, but the use of wet-to-dry, dry-to-dry, or wet-to-wet bandages can also aid in removal of embedded foreign matter. Second-intention healing occurs when wounds contract with formation of granulation tissue and epithelialization. When large surface-area wounds are not amenable to surgery or if they are in areas that cannot be easily bandaged, the tie-over bandage may be indicated. This technique involves the use of loop sutures placed around the edges of the wound. Laparotomy pads are placed over the wound, and an umbilical tape is passed through the loops to secure the bandage. Another technique, called "split-shot" wound management, allows for local skin to undergo "intussusceptive growth." It is performed under general anesthesia and involves placement of monofilament nonabsorbable suture through rubber bumpers at the commissures of a wound. Metallic split shots are placed to provide gentle tension as the wound contracts over a period of 7 to 10 days.

COMMENTARY: As noted in this presentation, a tie-over bandage provides an excellent means for wound coverage, particularly in areas where circumferential bandage placement is difficult. An added benefit is its skin-stretching capability. Maximal stretching is usually achieved 2 to 3 days after placement. Although wet-to-dry bandages and dry-to-dry bandages have been recommended for debridement, we prefer wet-to-wet dressings or use of topical agents, foams, or other dressings that keep the wound bed moist without causing local skin maceration.
Tie-over bandages can be covered with an adherent, antimicrobial impregnated material (eg, Loban; to reduce local contamination. When the split-shot technique is used to close incisions, skin under the bumpers should be inspected daily for evidence of ischemia. In some patients, excessive tension may damage local tissue, necessitating premature removal of the devices.