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Although wounds are given specific classifications, most have properties of
several types. Indeed, there are seldom any classical wounds that affect nothing
but the skin and are without any significant anatomical complications, apart
from those afflicted in the course of elective or other surgical procedures.
'''[[Graze/abrasion/erosion - Donkey|Graze/abrasion/erosion]]
'''[[Bruise - Donkey|Bruise]]
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'''Definition: bruising is the result of bleeding and tissue destruction
within and under the intact skin that causes damage to capillary
beds or larger blood vessels.'''
Bruising commonly complicates skin lacerations and other injuries.
It may be difficult to detect skin bruising because of the skin colour and
dense hair coat.
Treatment is seldom required but in some sites, such as eyelids or
penis, ice packs or possibly cold-hosing can be used to reduce the local
inflammation and control swelling and further damage to the skin. Healing
is usually uneventful and with minimal scarring.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Haematoma - Donkey|Haematoma]]
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'''Definition: the accumulation of free blood under the skin.'''
Haematomas are quite common as a result of a direct blow such as
a kick. In the early stages the swelling may seem to be firm, but it soon
becomes apparent that it is fluid-filled. Pain may be only slight and even
palpation may not be resented.
Haematoma can be differentiated from oedema or inflammatory fluid
by the '''finger press test''' (In the case of oedema, a finger pressed onto the swelling and then removed will leave
an indent that remains visible for some minutes. If the swelling is inflammatory there
will probably be no pitting with pressure and in the case of haematoma the indentation
will disappear immediately the finger is removed). Recurrent haematoma following minor trauma
should alert the clinician to the possibility of blood-clotting disorders.
Diagnosis can also be confirmed by a combination of ultrasonography,
when the fluid nature of the swelling will be appreciated, and by aspiration.
Haematomas that have been present for some days to weeks show separation
of plasma/serum and clotted blood. The clot will tend to organize and
become ultrasonographically denser. At this stage the overlying skin may
crinkle slightly or may simply be ‘baggy’.
Management of haematoma is simple according to clinical preference.
A haematoma can be '''drained''', although there are risks associated with this,
such as continued haemorrhage or infection. Alternatively, it can be '''left to
organize'''. There are no definitive rules, but attempts to drain a haematoma
should not be made too early because the risk of continued haemorrhage
is higher.
In the early stages, direct pressure via a firm bandage may limit the size and
speed up the organization phase, but in some locations it can be difficult or
even impossible. A stent applied over the site may be sufficient to limit the size.
Avoidance of any further trauma is important. Direct pressure to the drained
area is sometimes helpful, but can also be difficult in some locations.
A scar may be visible as distorted skin, firmly bound down to the
underlying tissues. Organizing haematomas in some sites, for example a
penile haematoma, can result in penile deviations, while a haematoma within
the semimembranosus-semitendinosus region may cause fibrotic myopathy.
Haematomas that occur within the muscle sheath are particularly painful
and can result in long-term fibrous metaplasia of the muscle belly with
consequent loss of function.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Contusion - Donkey|Contusion]]
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'''Definition: a contusion is in effect a severe bruise with some skin injury.'''
Contusions are common and often occur around the head (periorbital
region) during severe colic. They are rarely a problem except where
structures other than skin are involved. Secondary effects may be far more
significant than the skin damage, although in the case of the eyelid there
may be long-term consequences.
Contusions are usually managed by a combination of '''ice packs and
prophylactic [[Antibiotics|antibiotics]]'''.
Healing is usually uneventful but some permanent scarring can occur.
Damage to underlying structures such as the eye or the bony orbit may be
more serious than the wound itself.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Puncture Wound - Donkey|Puncture wound]]
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[[Image:Puncture wound.jpg|left|thumb|250px|<small><center>A fresh puncture wound in a donkey - the wound is likely to heal rapidly but the risks of tetanus are more significant. Is the donkey vaccinated and, if not, can suitable protection be provided with antiserum and penicillin? (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
[[Image:Puncture wound 2.jpg|right|thumb|250px|<small><center>Close up of the puncture wound (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
'''Definition: a puncture wound is a wound that has depth rather than size.'''
Puncture wounds in the skin and hoof etc., from sharp objects (e.g. nails,
glass shards, bullets or other foreign bodies) are common and potentially
very serious, although they are easily overlooked or trivialized. The size of
the wound often belies the potential severity of the injury. The skin defect is
usually trivial by comparison to the deeper damage. Even apparently minor
wounds can be fatal if they involve synovial structures, the cranium or the
body cavities. There is a high risk also from infection and anaerobes are
particularly dangerous. The wounds may be difficult to explore effectively; this applies particularly to the sole of the foot. Infections of the interstitial tissues and the lymphatic vessels are termed cellulitis and lymphangitis
respectively. In either case, infection can spread extensively from the site
of the injury. This type of wound proves the ideal anaerobic environment
for [[Clostridium species|Clostridial organisms]] to flourish. [[Clostridium species#Clostridium tetani|''Clostridium tetani'']] is possibly the most dangerous of these.
Management of puncture wounds requires a detailed knowledge of the
regional anatomy and some information on the cause and the direction of
the penetration. Puncture wounds must be treated by scrupulous cleaning
and, if necessary, widening of the injury to ensure full cleaning and avoidance
of anaerobic conditions. [[Antibiotics]] and [[NSAIDs|non-steroidal anti-inflammatory
drugs]] are usually used. Controlled movement is usually considered to be an
important aid to treatment. Tetanus prophylaxis is a major issue.
Healing of the skin wound is incidental in all cases.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Incised Wound - Donkey|Incised wound]]
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'''Definition: an incised wound is one in which the skin is cut cleanly with minimal tearing and bruising of the wound margins.'''
An incised wound (including a surgical wound) has a sharply defined
margin and is caused by sharp metal or glass, flint or occasionally the leading
edge of a shoe. In accidental wounds concurrent injury to non-cutaneous
structures is common.
The reflex arterial constriction that occurs when skin is cut means that
there is usually remarkably little haemorrhage in the immediate post-injury
stage. Thereafter, there may be considerable haemorrhage associated with
vasodilation, especially if arteries/arterioles are involved. '''Haemorrhage'''
may be controlled by '''pressure bandaging or clamping/ligation''' of significant
vessels.
Incised wounds are often amenable to first intention healing and, with the
possible exception of the distal limb where there is some controversy over
the need to or benefit from suturing, healing is correspondingly rapid.
'''Important note'''
'''As nerves and arteries often run in close proximity, blindly feeling for the vessel with a pair of haemostats in the conscious donkey can be very dangerous!'''
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Laceration - Donkey|Laceration]]
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[[Image:Eyelid laceration.jpg|right|thumb|250px|<small><center>Lacerations are common at almost every site on the body! Here an eyelid laceration in a middle-aged donkey before and after cleaning is shown. The injury was two days old when it was first seen. (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
[[Image:Eyelid laceration 2.jpg|right|thumb|250px|<small><center>Injuries involving the eyelids have particular significance for the future function of the eye and so early attention is essential. (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
'''Definition: a laceration is a traumatic tearing of the skin in an uncontrolled fashion.'''
Lacerations are the commonest skin injuries in donkeys. Multiple tears
in the skin may be accompanied by bruising but haemorrhage is rarely a
problem.
Management of lacerations usually involves careful wound preparation
and restoration of anatomical integrity by means of sutures or staples.
[[Antibiotics|Antibiotic therapy]] is usually applied for a period of four to six days.
The absence of ‘spare’ (loose) skin on limbs means that large deficits
in these sites require particular care. There is seldom any spare skin that
can be mobilized and so a prolonged recovery and/or expensive surgical
procedures may be expected.
'''Degloving injuries''' are commonest on the upper limb regions. The skin
on the lower limb is probably more firmly attached and seldom ‘degloves’
in the same way as the upper limb and body trunk. These injuries should
be promptly treated to restore as much of the skin as possible to its
original position (even if it is probably non-viable). Degloving of limbs
usually involves at least some horizontal skin laceration and is usually in a
downward direction so that the skin hangs around the limb. The exposed
subcutaneous tissues rapidly become dry and infected but remarkably little
bleeding occurs in most such cases. The blood supply to the upper margin
of the wound is usually intact and so this is less of a problem than the
distal wound margin, which is invariably compromised, especially at the
most central part of the wound margin. Sloughing of the skin along this
margin is common.
The wound should be irrigated with '''copious warm sterile saline''' and
protected from further contamination by application of a '''hydrogel''' to the
exposed tissues. This will minimize dehydration and infection. '''Restoration
of the flap to its normal position''' as far as possible maintains warmth,
prevents further contamination and devitalisation and covers the exposed
tissues with a biological dressing. If feasible, a bandage should be applied
to limit further damage until a detailed examination can be performed.
Movement of the limb should be minimized so that tension on the wound
is reduced as far as possible. Shear forces will be maximal during movement
of the underlying muscles relative to the skin.
The wound should be carefully examined (possibly even under general
anaesthesia) and, after superficial irrigation, all obvious foreign matter
and devitalised subcutaneous tissues are scrupulously removed. Deeper
injuries are treated by lavage and, if indicated, by suturing the defects with
an absorbable suture material of suitable diameter and pattern. Skin should
not be removed unless it is totally devitalised and shredded; this applies
particularly to the eyelids.
Once the deep tissues have been repaired (possibly with drain placement),
the skin is restored to its normal position. Excessive tension on the wound
site will almost always result in wound dehiscence and further complications.
Carefully placed and securely knotted sub-cutaneous ‘walking’ sutures of a
fine absorbable material may allow the wound to be closed without undue
tension and will provide support for the flap of skin. However, if the injury
is more than one or two hours old, the skin will have shrunk significantly and it may be difficult to
restore it to its natural position. Undermining the adjacent attached skin and making small
1 cm long overlapping relieving incisions (running parallel to the wound margins) may permit the
skin to be restored fully to the normal site without any undue tension on the wound margin.
Alternatively, it is sometimes wise not to attempt to restore the skin fully to its position and simply
suture the skin to the underlying tissues, as near as possible to the wound margin without excessive
tension. The uncovered area will then heal by [[Donkey - Fundamentals of healing#Secondary or second intention healing|second intention]] but will of course be much smaller than the original wound and may be amenable to skin grafting in
due course.
The skin wound is closed using '''interrupted horizontal or vertical mattress sutures''' with '''monofilament nylon''' (4 or 5
metric/1 or 2 USP). Tension across the wound site can also be relieved by using supported quill sutures or a stent.
Suitable dressings and bandages and antibiotic therapy are useful in all cases. '''Movement should be restricted''' depending on the extent and type of wound, and dressings should be changed as and when indicated.
Variable necrosis of at least part of the skin margin is commonly present.
In any case the necrotic tissue will eventually need to be removed and the
wound allowed to heal by [[Donkey - Fundamentals of healing#Secondary or second intention healing|second intention]] or by some form of '''grafting'''.
Uneventful healing should take place regardless of the anatomical
location of the wound but can be problematic, especially on the limbs.
Complications may be present such as skin loss or degloving and such
wounds are best regarded as ‘complicated’. The prognosis is less favourable
than for incised wounds because tissue necrosis and sloughing are frequent
complications.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Complicated Wound - Donkey|Complicated wound]]
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[[Image:Facial injury.jpg|left|thumb|250px|<small><center>This facial injury was complicated by severe damage to the facial nerve resulting in facial paralysis and an oro-cutaneous-nasal fistula (direct communication between the skin wound and the mouth and nasal cavity). The wound had been in existence for some 10 days before presentation and the bone underlying the wound was necrotic. There were therefore significant complications and reasons why the wound was likely to heal slowly, if at all. (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
[[Image:Facial injury 2.jpg|right|thumb|250px|<small><center>Oro-cutaneous-nasal fistula (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
'''Definition: a wound that has components of one or more of the other types that is complicated by factors that either preclude simple [[Donkey - Fundamentals of healing#Primary or first intention healing|primary union]] or are likely to result in serious delays in healing.'''
Complicated wounds are commonly seen in equine practice. The
management of complicated wounds is always problematic. Some require
careful anatomical reconstruction and others require various other
techniques. In all cases the wound management procedure must be followed
carefully.
Initially the wound must be protected from further damage until
a detailed exploration can be performed. For this reason it is common
practice to apply a hydrogel and a dressing while the animal is moved to a
suitable facility. Involvement of other organs or structures may be more
significant than the skin injury itself. One of the most critical factors is a
full exploration of the wound. In some cases this can be performed with
the sedated standing animal but in others a general anaesthetic is advisable.
The extent of the injuries may mean that the skin wounds are insignificant
(e.g. compound fractures of the limb bone, open body cavities, etc).
Healing depends on the extent of damage and ability of the structures
involved to heal.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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'''[[Burns - Donkey|Burns]]
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[[Image:Rope burn.jpg|right|thumb|250px|<small><center>Injury caused by rope burn (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
'''Definition: a burn is an injury that results from the application of harmful abnormally high (or low) temperatures.'''
Fortunately burns are rare in donkeys but there are several different types, and each has its own complications:
* Thermal burns
* Scalding
* Friction burns (rope galls or grass grazes)
* Chemical/caustic and exudate ‘burns’
* Freeze ‘burns’
* Actinic sunburn
The face, eyes, breast, back and legs are most often involved as a result of stable or grass fires. While flash
burns from explosions usually affect the head, breast and neck, barn or stable fires often result in smoke inhalation
that can be at least as serious for the donkey as the most extensive burns.
Burns are described by extent (percentage of body surface) and depth of tissue damage (first, second and
third degree).
Rope or focal burns from other causes are simply minor forms of skin
necrosis resulting from friction rather than flames. The true extent of the
damage may not be apparent immediately and so management must be
directed at general supportive measures and focused wound management.
Small burns benefit from being covered with a '''hydrogel immediately''' and
then left to slough. There is no advantage in bursting blisters. Extensive
fresh burns should be cooled with '''cold running water''' as fast as possible
– this is known to limit the severity to some extent. Thereafter hydrogel
application and possibly antibacterial creams are advised because '''burns
appear to have an increased tendency to infection'''.
==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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==References==
* Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) ''The Professional Handbook of the Donkey'', 4th edition, Whittet Books, Chapter 9
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