Advanced veterinary wound care
An introduction to veterinary wound management Animal wounds are a common occurrence in veterinary practice and are most likely traumatic or resulting from surgical procedure. Clinical management aims to provide a rapid return to function while eliminating risks of delay. A moist environment encourages essential cellular activity, collagen formation and vital contraction processes. Wound dressings have subsequently developed to manage the wound environment more actively, by managing the factors associated with delayed healing.
Common causes of delayed healing in animal wounds:
The need for specific properties varies according to the wound and different wounds will require different dressings at different stages to get the best results. Advanced dressings are principally designed to actively re-hydrate or to absorb and retain excess wound fluid as well as protecting against further trauma. They may also be required to manage infection, contamination and inflammation.
Compromised blood flow
There are several key principles to adopt when using advanced dressings which will maximise the outcome and make for easy application and removal.
Early traumatic wounds (less than 4 hours old)
Dehydration of the wound environment Maceration of the wound environment Contamination or infection within the wound Foreign material, devitalised tissue and wound debris Physical interference, friction and movement Dehydration (Physiological) Poor nutrition Lack of immune response
Wound
General guide to preparation prior to dressing: Wounds that are treated within 4 hours of occurring have a good chance of uneventful
Preparing the wound to heal In all cases a full animal history should be attained to establish related or unrelated conditions that may affect healing, management or recovery. Prior to examination the area around the wound should be clipped with a generous margin so that the extent of injury is visible and to allow the dressing to overlap the wound by at least 2cm.
material. Anaesthesia may be required to do this effectively. Closure may be achieved by surgical means if the wound is sufficiently clean and enough viable tissue is available.
Long-standing traumatic wounds
Wounds that are over a day old may begin to show signs of deterioration in the form of contamination, infection and dead or devitalised tissue. The wound should be explored thoroughly and non-viable tissue removed. Anaesthesia is likely to be required to examine the extent of injury thoroughly. Thorough lavage with normal saline is recommended.
Surgical wounds
Surgical wounds, following closure should be simply cleansed with normal saline and patted dry with woven gauze prior to dressing.
Dressing selection guide Product
direct closure. The wound should be generously lavaged using saline and explored to establish the extent of trauma and any presence of foreign
Necrotic
Sloughy
Contaminated/ Infected
Granulating
Epithelialising
Exuding
secondary dressing
secondary dressing
secondary dressing
secondary dressing
secondary dressing
Eclypse can be used as a primary or secondary dressing on highly exuding wounds
secondary dressing
Advazorb can be used as a primary or secondary dressing on lowmedium exuding wounds
Delicate tissue/ grafts
Activon® Tube Algivon® Algivon® Plus* Actilite® Activon® Tulle Yes
Eclypse range ®
Yes
Advazorb® range
secondary dressing
SilÁex® *Algivon® Plus is also available as a ribbon
secondary dressing
secondary dressing
secondary dressing
Yes
Eclypse Adherent, Border & Border Oval have soft silicone wound contact layers
Yes Advazorb 6ilÀx & Border have soft silicone wound contact layers
Activon® Manuka Honey 100% pure Manuka honey Antimicrobial
3-4 14 ,2+ ® Tulle in an equine limb wound Applying Activon® Tulle or Algivon®
Effectively fights infection
j4 '- 42*-4/"-33+ 04' ,(4 12-"42*-4 % /4
Osmotic effect
has been cleansed and examined.
Draws fluid from the wound bed, promoting healing j4 '')!42*-4/"-33+ 04/+"-,2)!42 42*-4 % /4
Enhanced healing
allowing the dressing to overlap the wound edge by a minimum of 2cm.
Promote granulation and epithelialisation
Odour elimination Rapid reduction and elimination of wound odours
j4 "4) "0-4 % /34# "-42* 4 -4 dressing may be required to ensure the wound area is fully covered.
Activon® Tube 100% Manuka honey tube, suitable for application into wounds.
j4 "43# ))-"4 % /342*-4/"-33+ 04# !4 be cut to size using sharp scissors or folded to fit.
Actilite® An inexpensive and highly effective broad spectrum antimicrobial dressing containing 99% Manuka honey and 1% Manuka oil for use on low to moderate exuding wounds.
Dressing Changes j4 -# -42*-4/"-33+ 04&!40- 2)!4)+12+ 041" #4 -4 142*-4, " -"35
The dressing is designed to protect a wound, promote healing and allow the passage of exudate. It is an ideal choice for epithelialising wounds that are perceived to be at risk of re-infection.
j4 *-4'" '-"2+-34 14* -!4 +))4)+(-)!4, %3-42*-4 % /42 4 ''- "4 moist and ‘gooey’. The beneficial osmotic action of the honey will have drawn exudate and debris from the wound and should be removed using saline.
Activon® Tulle
j4 342*-4 % /4"-/%,-34+ 43+M-4- %/ 2-4)- -)343* %)/4 decrease and the dressing can be left in place for longer between changes.
Activon® dressings are designed to retain Activon® Manuka Honey at a wound site, protect a wound, create a moist healing environment and form a barrier which effectively reduce or eliminate wound odour. ®
Activon Tulle is a triple layer primary wound dressing gauze and can be unfolded to wrap around a limb. Additional layers should be applied to maintain osmotic pressure.
Algivon®
j4 -!4/"-33+ 034 "-4% )+(-)!42 4 /*-"-42 42*-4 % /4/%-42 4 their osmotic properties. However, should this occur gently irrigate the dressing area with saline and consider applying a layer of Activon® Tube Honey to the wound prior to redressing. Secondary dressings:
An alginate, absorbent, sterile, non-adherent wound contact dressing impregnated with 100% Manuka honey, comprising calcium alginate (High M) fibres impregnated with Activon® Medical Grade Manuka honey. Algivon® dressing has absorbent properties ideal for use on wounds that are exuding, which is common with bacterial contamination or infection. Algivon® Plus version with strengthened alginate fibres, ideal for wetter wounds. Also available in a Algivon® Plus Ribbon version, which features the same strengthened alginate fibres but shaped for easy application within cavities and sinuses.
j4 3-4 4 &3 "&- 243-, / "!4/"-33+ 042 4 )) 41 "4 4+ ,"- 3-4 in initial exudate level. This is due to the osmotic effect of the Manuka honey and is beneficial in nature. Advazorb® plus or Eclypse® Adherent are suitable for use over the Activon honey range. j4 24+34"-, ##- /-/42* 24/"-33+ 034 "-4"- +- -/4 24 -42 4 two days initially to observe wound progression and ensure adequate exudate management. j4 342*-4 % /4&-0+ 342 4*- )42*-4/"-33+ 034# !4&-4)-124+ 4 place for up to five days. Appearance after cleansing and loose tissue debridement at 1st dressing change.
Ordering information Product
Size
No. per box
Stock code
Activon® Tube
25g
12
CR3830
Activon Tulle
5cm x 5cm
5
CR3761
Activon® Tulle
10cm x 10cm
5
CR3658
5cm x 5cm
5
CR3831
10cm x 10cm
5
CR3659
®
Algivon
®
Algivon® Actilite®
5cm x 5cm
10
CR4281
Actilite®
10cm x 10cm
10
CR3849
Actilite®
10cm x 20cm
10
CR3852
Algivon® Plus
5cm x 5cm
5
CR4230
Algivon® Plus
10cm x 10cm
5
CR4225
Algivon® Plus Ribbon
2.5cm x 20cm
5
CR4231
Wound at third dressing change (seven days). Wound is clean and contracting. Further debridement between dressing changes is not required. Appearance at first dressing change.
Acknowledgements: Professor Derek Knottenbelt OBE, BVM&S, DVMS, DipECEIM, MRCVS Philip - -"*%)#-4 3'+2 )B4 + -"3+2!4 of Liverpool.
Advazorb®
Silflex®
Moist wound management
Soft silicone wound contact layer
Product description
Product description
Advazorb® is a comprehensive range of patient friendly, absorbent foam dressings presented in non-adhesive and atraumatic silicone adhesive format. The range is designed to overcome the complex challenges of managing exudate whilst protecting ‘at risk’ fragile skin, a combination of excellent fluid handling capabilities of Advazorb® with a layer of atraumatic soft silicone adhesive.
A wound contact non-adherent dressing made from polyester mesh coated with Silfix® soft silicone.
Advazorb®, Advazorb® Silfix and Advazorb® Border are available in both a regular thickness for moderate to high exudate and ‘Lite’ versions for low to moderately exuding wounds.
Silflex® is designed to gently adhere to the skin surrounding a wound and not to the wound bed. This is an atraumatic dressing which means it is designed to minimise the pain and trauma associated with dressing change. The dressing allows the passage of exudate.
Indications
Benefits
Surgical wounds Second degree burns Skin Grafts Any delicate tissue
Reduces excess fluid at the wound site Helps maintain a moist environment Gentle and conformable Protects wound Advazorb® Border
Benefits
The silicone wound contact layer has large pores which enable the passage of exudate into the absorbent foam whilst protecting the fragile wound bed.
Advazorb® Silfix Combination of the excellent fluid handling capabilities of Advazorb® with a layer of atraumatic soft silicone adhesive.
Adheres only to dry skin not to a moist wound Atraumatic soft silicone, reduced pain on dressing change Allows passage of exudate Hydrophobic Silfix® soft silicone coating Soft and conformable Ordering information
Ordering information Product
®
Advazorb
Advazorb® Silfix
Advazorb® Border
Product
Size
Stock code
No. per box
Silflex®
5cm x 7cm
CR3922
10
8cm x 10cm
CR3923
10
12cm x 15cm
CR3924
10
20cm x 30cm
CR3925
10
35cm x 60cm
CR4006
5
Size
No. per box
Stock code
5cm x 5cm
10
CR4221
®
Silflex
7.5cm x 7.5cm
10
CR4165
Silflex®
10cm x 10cm
10
CR4166
®
Silflex
Silflex®
12.5cm x 12.5cm
10
CR4167
15cm x 15cm
10
CR4168
10cm x 20cm
10
CR4169
20cm x 20cm
10
CR4170
7.5cm x 7.5cm
10
CR4177
10cm x 10cm
10
CR4178
12.5cm x 12.5cm
10
CR4179
15cm x 15cm
10
CR4180
10cm x 20cm
10
CR4181
20cm x 20cm
10
CR4182
7.5cm x 7.5cm
10
CR4190
10cm x 10cm
10
CR4191
12.5cm x 12.5cm
10
CR4192
15cm x 15cm
10
CR4193
10cm x 20cm
10
CR4194
20cm x 20cm
10
CR4195
10cm x 30cm
10
CR4196
What is special about Silfix® soft silicone? Many traditional dressings and adhesive products contribute to increased pain and trauma on dressing change. As dressing technology advances the issue of painful dressing changes that were once associated with wounds can now be largely alleviated with proper dressing selection. Soft silicone is hydrophobic and does not stick to a moist wound only to the surrounding dry area. Silfix® helps to maintain a moist wound healing environment and makes it ideal technology for non-adherent wound contact dressings. Silfix® dressings will not damage newly formed granulating tissue or epithelial cells. Silfix® dressings will not lose their adhesion after initial application. This can help achieve optimum dressing positioning without wastage.
Eclypse® High exudate management Product description
Ordering information
®
Eclypse is a highly absorbent, high capacity wound exudate management product designed to help reduce potential fluid leaks and reduce risk of maceration. The dressing has a rapid wicking action combined with a secondary highly absorbent layer. The dressing provides a large capacity with an ability to take on fluid quickly. The backing is a fluid repellent film designed to prevent strikethrough and resist abrasion.
Product
Size
No. per box
®
10cm x 10cm
20
CR3818
Eclypse®
15cm x 15cm
20
CR3769
Eclypse®
20cm x 30cm
20
CR3743
Eclypse®
60cm x 40cm
10
CR3808
Eclypse® Adherent
10cm x 10cm
10
CR3881
Eclypse® Adherent
10cm x 20cm
10
CR3883
Eclypse® Adherent
15cm x 15cm
10
CR3863
Eclypse® Adherent
20cm x 30cm
10
CR3864
Eclypse® Border
15cm x 15cm
10
CR4296
Eclypse® Border
22cm x 23cm
10
CR4297
Eclypse Border Oval
10cm x 20cm
10
CR4300
Eclypse® Border Oval
15cm x 20cm
10
CR4299
20cm x 30cm
10
CR4298
Eclypse
®
Eclypse® Adherent The soft silicone layer provides convenient gentle adherence and will not stick to a wound or damage the surrounding skin or hair. Particularly suited to equine limb wounds, Eclypse® and Eclypse® Adherent are designed to absorb and retain fluid from medium to highly exuding wounds. Eclypse® Adherent gently but effectively adheres to clipped fur preventing slippage and movement after bandaging. Eclypse® can be used for highly exuding wounds in small and large animals.
®
Eclypse Border Oval
Stock code
Additional Products
Siltape® Soft silicone perforated tape
Benefits Rapid absorption High capacity Fluid repellent backing Strength and durability Thin and conforming Eclypse® Border and Eclypse® Border Oval The soft silicone layer provides gentle adherence that will facilitate atraumatic removal. The hypo-allergenic, dual adhesive border, provides additional dressing security.
Benefits Increased absorbency capacity Atraumatic and hypo-allergenic Breathable, fluid-repellent backing Provides moist wound healing environment Additional wicking and moisture locking central core Combination silicone and acrylic adhesive border
Product description Siltape® is made from soft silicone which is gentle on the skin, this is particularly useful in patients with very thin, friable skin which is vulnerable to damage. Silicone does not cell strip in the same way that other adhesives may damage tissue.
Dressing features Atraumatic soft silicone, reduced pain on change, adjustment or removal Soft and conformable Adheres only to dry skin, not to a moist wound Easily adjustable with no loss of adherence Ordering information Product
Size
No. per box
Stock Code
Siltape®
2cm x 3m
1
CR3938
4cm x 1.5m
1
CR3939
®
Siltape
3-4 14 ,2+ ®, Eclypse® & Advazorb® on canine bite wounds
3-4 14 ,2+ ® & Algivon® following a canine RTA
Presentation
Presentation
The patient (12 year old female Lurcher) presented with a four day
The male patient (Crossbreed) presented with a wound to its left
old bite wound that the owner had previously been treating themselves at home.
fore following an RTA (Fig 1) Management
Management
Initially the wound was debrided and cleaned with the patient under general anaesthetic and then dressed with Activon®
The initial clip and clean revealed 2 bite wounds, the larger measuring 2.5cm x 1cm and 0.5cm deep. The smaller more
Medical Grade Manuka Honey. (Fig 2)
superficial wound measured 1cm x 1cm. Both wounds were inflamed with necrotic areas and debris present. (Fig 1)
After 2 days the wound was looking clean and healthy. (Fig 3) The
with warm Hartmanns. The wound was then dressed with Activon
digit was then filleted out and the remainder of the wound closed with a pad flap. (Fig 4) 5 days after surgery the flap was holding
Medical Grade Manuka Honey and covered with a layer of sterile
well, although after a further 2 days a small area of the wound
swab. An Eclypse Adherent was used as a secondary dressing to absorb exudate and to hold the whole dressing in place. (Fig 2) Elastoplast was used to provide additional security. The dressing remained in place for 36 hours but had come off prior to its planned removal. The wound was again lavaged and it was then showing signs of granulation and contraction. (Fig 3)
had begun to break down. (Fig 5) The dog was again examined under general anaesthetic, the wound edges were freshened up and extra sutures placed on the flap. The wound was then dressed with Algivon®, Activon® impregnated alginate dressing to support the healing environment.
The necrotic tissue was debrided and the wound thoroughly lavaged ®
®
Outcome It was then redressed with Activon® and this time Advazorb® hydrophilic foam dressing was used as a secondary layer due to the lower levels of exudate that were present. Dressing change was planned for 4-5 days and the owner was advised to bathe the wounds in warm water and dress with Activon® should the dressings come off. The second dressing remained in place for 2 days, unfortunately the dog returned from the garden without it on the second day. The owners followed the advice to lavage and apply Activon® twice daily and the wounds continued to improve. After 6 days of further Activon® treatment the smaller wound was completely reepithelialised and the larger wound was partially healed. (Fig 4) Outcome The wound went onto fully heal despite having spent a considerable time without a dressing in place. The wound was at significant risk of infection but the Activon® Medical Grade Manuka Honey helped to prevent infection developing. Dressing summary The Activon® Medical Grade Manuka Honey was used to help manage the local infection risk within the wound due to its antibacterial properties transferred from the nectar of the Manuka Bush. Autolytic debridement was also aided by the Activon® as the high sugar level of 80% has an osmotic action of drawing fluid from the wound and softening and lifting necrotic tissue. The Eclypse® Adherent dressing absorbed and helped to lock away the exudate initially and the Advazorb® foam dressings helped to protect the wound later on. Alison King RVN, Animal Medical Centre www.vetwoundlibrary.co.uk Dog #60
Following dressing with the alginate dressing 100% of the pad flap survived (Fig 6). Within 16 days from the initial date of injury the dressings had been removed and the dog was sent home with a buster collar. The wound healed with good cosmetic and functional results. Dressing summary The Activon® Medical Grade Manuka Honey was used to help manage the local infection risk within the wound due to its antibacterial properties transferred from the nectar of the Manuka Bush. Autolytic debridement was also aided by the Activon® as the high sugar level of 80% has an osmotic action of drawing fluid from the wound and softening and lifting necrotic tissue. www.vetwoundlibrary.com - Dog #43
Advanced wound care solutions With an established international reputation in the advanced wound care field, the Advancis brand is able to bring quality dressings into the Veterinary market. 24 %"432 2-E 1E2*-E "24# %1 ,2%"+ 041 ,+)+2!4+ 42*-4 B4 Advancis Veterinary is constantly investing in the research and development of advanced wound care products. This allows not only innovation, but ensures the production of high quality products at a relatively inexpensive cost. Advancis are pleased to work with a wide range of veterinary professionals to design and manufacture innovative products, that will help budgets and improve animal health while receiving treatment. At Advancis we pride ourselves on our reputation for customer service and commitment to ensuring a first class service42 4 ))4 14 %"4,%32 #-"3B4+ 42*-4 4 /4 -"3- 35 A60
M1 Teversal
A6
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Kirkby in Ashfield
Pinxton
61 1
A60
Ve t e rin ary
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South Normanton
Sutton Rd
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Alfreton R
M1 Somercotes
Annesley
Selston
27
1
Notts Golf Club
Newstead Village
Rd
17
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Hilcote
gh
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No
Sutton in Ashfield Huthwaite
M1 Blackwell
Mansfield
Stanton Skegby Hill
Tibshelf
Advancis Veterinary has provided this brochure for general information only. It is intended for a health care professional and not for public use. Please note that: 1. Not all products are available in all regions or from all wholesalers. 2. Indications for use and contra-indications may vary from time to time depending on current clinical information. Always read the package insert prior to use. 3. Advancis Medical makes no representations, or warranties regarding the accuracy or completeness of this brochure. 4. Customer Service is available to help with product information or questions during normal office hours. Copyright Brightwake Ltd (Trading as Advancis Veterinary) 2016
DLC Australia Pty Ltd 17-19 Horne Street, Hoppers Crossing, VIC, 3029 Phone: (03) 9360 9700 | Fax: (03) 9360 9994 Toll Free: 1300 785 405 | Email: sales@dlc.com.au
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