Changes

==Minimizing the potential problems of a wound==

==Minimizing the potential problems of a wound==

[[Image:Acute wound protocol.jpg|right|thumb|250px|<small><center>Veterinary protocol for management of the acute wound (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]

[[Image:Acute wound protocol.jpg|right|thumb|250px|<small><center>Veterinary protocol for management of the acute wound (Image courtesy of [http://drupal.thedonkeysanctuary.org.uk The Donkey Sanctuary])</center></small>]]

#* The use of suitably placed surgical drains - vacuum drains and Penrose (capillary) drains

#* The use of suitably placed surgical drains - vacuum drains and Penrose (capillary) drains

#* Minimizing dead space within the wound itself

#* Minimizing dead space within the wound itself

# The use of physiologically sound wound lavage mechanisms (see [[Wound Management Basics - Donkey#2. Initial cleaning|Initial cleaning below]] and [[Donkey - Factors that inhibit wound healing#Foreign body|Foreign body]]).

# The use of physiologically sound wound lavage mechanisms (see [[Wound Management Basics - Donkey#2. Initial cleaning|Initial cleaning below]] and [[Wound Healing Inhibition Factors - Donkey#Foreign body|Foreign body]]).

# [[Wound Management Basics - Donkey#5. Infection control|Reducing and controlling infection]]

# [[Wound Management Basics - Donkey#5. Infection control|Reducing and controlling infection]]

# [[Wound Management Basics - Donkey#4. Prevention of further injury and contamination|Eliminating and preventing contamination and continuing trauma]]

# [[Wound Management Basics - Donkey#4. Prevention of further injury and contamination|Eliminating and preventing contamination and continuing trauma]]

The choice of wound closure method is governed by the nature and site

The choice of wound closure method is governed by the nature and site

of the wound and is a matter of clinical preference. Wounds subjected to

of the wound and is a matter of clinical preference. Wounds subjected to

[[Donkey - Fundamentals of healing#Primary or first intention healing|primary wound closure]] or first intention healing will usually heal faster

[[Healing Fundamentals - Donkey#Primary or first intention healing|primary wound closure]] or first intention healing will usually heal faster

than those subjected to either [[Healing Fundamental - Donkey#Delayed primary healing|delayed primary healing]] or [[Healing Fundamental - Donkey#Secondary or second intention healing|second intention

than those subjected to either [[Healing Fundamentals - Donkey#Delayed primary healing|delayed primary healing]] or [[Healing Fundamentals - Donkey#Secondary or second intention healing|second intention healing]].

healing]].

Incised wounds frequently lend themselves to suturing. Suturing should

Incised wounds frequently lend themselves to suturing. Suturing should

'''Important note'''

'''Important note'''

* '''Delays in closure may result in contraction of the skin flaps and so preclude closure

* '''Delays in closure may result in contraction of the skin flaps and so preclude closure

* '''[[Healing Fundamental - Donkey#Primary or first intention healing|Primary closure]] will almost always fail when tissue necrosis and swelling disrupt the suture line

* '''[[Healing Fundamentals - Donkey#Primary or first intention healing|Primary closure]] will almost always fail when tissue necrosis and swelling disrupt the suture line

* '''Notwithstanding the presence of obvious complication factors, wounds involving the lower parts of the limbs usually present the greatest challenges. There is considerable controversy over the need/necessity to suture lower limb wounds. In general, a limb wound may be sutured if the wound is:

* '''Notwithstanding the presence of obvious complication factors, wounds involving the lower parts of the limbs usually present the greatest challenges. There is considerable controversy over the need/necessity to suture lower limb wounds. In general, a limb wound may be sutured if the wound is:

# '''In the longitudinal plane (i.e. running up/down the limb).

# '''In the longitudinal plane (i.e. running up/down the limb).

# '''In a suitable site that makes suturing without undue tension feasible.

# '''In a suitable site that makes suturing without undue tension feasible.

* '''Otherwise it is probably best to use [[Healing Fundamental - Donkey#Secondary or second intention healing|second intention

* '''Otherwise it is probably best to use [[Healing Fundamentals - Donkey#Secondary or second intention healing|second intention

healing]] or [[Healing Fundamental - Donkey#Delayed primary healing|delayed primary intention healing]]

healing]] or [[Healing Fundamentals - Donkey#Delayed primary healing|delayed primary intention healing]]

[[Healing Fundamental - Donkey#Delayed primary healing|Delayed primary closure]] may be applicable in relatively clean but

[[Healing Fundamentals - Donkey#Delayed primary healing|Delayed primary closure]] may be applicable in relatively clean but

contaminated wounds with extensive tissue damage. The wound is '''cleaned,

contaminated wounds with extensive tissue damage. The wound is '''cleaned,

debrided and dressed with a hydrogel and a polymeric foam dressing'''

debrided and dressed with a hydrogel and a polymeric foam dressing'''

incisions).

incisions).

[[Healing Fundamental - Donkey#Secondary or second intention healing|Second intention healing]] is applicable to the large majority of wounds in donkeys. The '''wound is left open''' after initial treatment and '''allowed to

[[Healing Fundamentals - Donkey#Secondary or second intention healing|Second intention healing]] is applicable to the large majority of wounds in donkeys. The '''wound is left open''' after initial treatment and '''allowed to

granulate'''. Once healthy granulation tissue fills the wound from its depth

granulate'''. Once healthy granulation tissue fills the wound from its depth

and has reached the wound margin, the epithelium should be able to migrate

and has reached the wound margin, the epithelium should be able to migrate

|linkpage =Wound Management - Donkey

|linkpage =Wound Management - Donkey

|linktext =Wound Management - Donkey

|linktext =Wound Management - Donkey

|pagetype=Donkey

|pagetype=Donkey

}}

}}