Difference between revisions of "Healing Fundamentals - Donkey"

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In clinical practice healing can be achieved in one of three ways:
 
* Primary or first intention healing.
 
* Secondary or second intention healing.
 
* Delayed primary healing.
 
 
==Primary or first intention healing==
 
 
This is the mechanism that occurs when the edges of a wound can be closely
 
apposed. Most surgical wounds rely upon this mechanism. In a non-infected
 
surgical wound, healing is reliably accomplished in a predictably short time
 
(usually 7 to 14 days).
 
 
Elective surgical wounds are probably the current ‘gold standard’ of
 
wound management, but there are major differences between surgical
 
wounds and accidental injuries (see Table 1 and Table 2 below) and so there are
 
almost inevitable differences in healing between the surgical situation and
 
the accidental wound.
 
[[Image:Wounds table.jpg|center|thumb|450px|<small><center>(Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
 
[[Image:Table healing.jpg|center|thumb|450px|<small><center>(Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]
 
 
In primary wound healing, the various tissue structures involved are
 
managed by suturing to restore very close normal anatomical relations. The
 
underlying tissues are closed carefully to minimize dead space, provide good
 
support for the skin wound itself and to restore function as far as possible.
 
Although in most cases this will involve closure of the wound by sutures
 
or staples, this is not a prerequisite. Close apposition of the margins of the
 
wound using adhesive tabs or even simply by bandaging in a suitable fashion
 
may have the same effect and may indeed be considered to be advantageous
 
in that there is no foreign matter in the wound. Minimal granulation tissue
 
formation and epithelial migration are required and so the wound heals
 
rapidly. Usually within seven to ten days the wound margin is sufficiently
 
strong to permit removal of skin sutures.
 
 
Few accidental/ traumatic wounds are amenable to this approach because
 
there are almost always some complicating factors. Where it is possible
 
however to create a ‘surgical’ situation from a traumatic injury, wounds will
 
heal with an excellent result both functionally and cosmetically.
 
 
==Secondary or second intention healing==
 
 
Second intention healing is the natural way for a wound to heal. Wounds
 
too extensive or contaminated to suture, or those in which primary closure
 
has failed, must heal in this way.
 
 
In second intention healing, a '''healthy bed of granulation tissue is
 
required before epithelialisation can proceed'''. The quality of the granulation
 
tissue bed and the anatomical site has a strong influence on the rate of
 
healing of the wound. Because there is a necessary delay in the development
 
of the granulation tissue bed, there is an inevitable delay in healing.
 
 
Major factors in the process of second intention healing are the size of
 
the wound, the anatomical location and the extent of '''complicating factors''':
 
* Over 70% of donkey wounds are complicated by failure to heal and chronic inflammation
 
* Second intention healing relies upon the inflammatory response; the longer the wound takes to heal, the greater will be the scar and the possible cosmetic and functional deficits
 
* The anticipated problems associated with second intention healing may encourage clinicians to try to close wounds by primary union, although this can be ill-advised
 
 
<u>Most traumatic wounds create circumstances that preclude primary
 
closure</u> and so second intention healing is a major clinical aspect of wound
 
management in donkeys. Factors that disturb normal corrective processes
 
inevitably complicate and delay wound healing. Early recognition of healing
 
difficulties allows prompt correction; ideally factors that will result in
 
non-healing should be recognized pre-emptively at the time of wounding,
 
but inevitably some will not be apparent until later and possibly when the
 
wound has failed to heal.
 
 
The owner of a donkey with one or more of these factors can be given
 
rational advice on the likely prognosis and the time-scale for healing. Most
 
non-healing wounds are preventable by suitable management in the early
 
stages after injury and others are understandable or predictable. Failure
 
to recognize potential reasons for failure of healing in a fresh wound, or
 
delayed presentation, mean that the wound will become chronically inflamed
 
and so the healing process will be unnecessarily prolonged.
 
 
==Delayed primary healing==
 
 
This is a useful procedure that combines the early stages of second intention
 
healing with a primary intention healing after a few days. It is applicable to
 
a few wounds but it is a very rewarding process. If closure is delayed for
 
72 to 96 hours, only a minimal risk of infection exists. The method allows
 
contaminated wounds in which immediate closure may lead to infection to
 
heal faster than would be the case for second intention healing.
 
The wound is '''initially cleaned and debrided, but is not closed'''. After a
 
variable time (usually two to four days), the wound is '''surgically debrided to
 
remove any demarcated tissues and closed by suture as for first intention'''
 
healing. There is an inevitable delay in the healing process but, where it
 
is applicable, the healing time is usually shorter than second intention
 
healing.
 
 
The '''clinical advantages'' of delayed primary healing are considerable:
 
* The wound can be assessed for causes of failure of healing at various stages, allowing the best time for closure to be chosen
 
* Acute inflammatory responses and natural debridement can take place before it is ‘driven’ towards healing without the development of a difficult and prolonged chronic inflammatory process
 
 
The '''disadvantages''' include the need for repeated procedures and an inevitable increase in scarring when compared to first intention healing, even when the time delay is relatively insignificant.
 
 
==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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|Maintitle = [[Sponsors#The Donkey Sanctuary|This section was sponsored and content provided by '''THE DONKEY SANCTUARY''']]
 
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[[Category:Donkey]]
 
[[Category:Wound_Management_-_Donkey]]
 

Revision as of 11:18, 20 February 2010



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