Techniques in Small Animal Wound Management E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Techniques in Small Animal Wound Management A thorough and practical guide to the surgical and non-surgical treatment of small animal wounds Techniques in Small Animal Wound Management focuses on surgical and non-surgical management techniques for the wide variety of wounds that clinicians in any stage of training or clinical practice treat in veterinary medicine. A comprehensive but accessible guide to wound management in small animal patients, this textbook covers all important wound management modalities and available products. This book includes detailed information on currently available products, including specific indications and instructions for use, and step-by-step descriptions of techniques used to treat wounds, making it an indispensable resource for small animal veterinary practitioners. Topics discussed range from the anatomy of wounded tissues, phases of healing, and classification of wounds to initial treatments, dressings, vacuum-assisted bandages, and surgical reconstructions. In Techniques in Small Animal Wound Management, readers will also find: * Step-by-step instructions for using innovative wound management tools such as hyperbaric oxygen therapy, laser therapy, stem cell/platelet-derived treatments, leeches, and maggots. * Detailed discussions of specific uses and indications for topicals, dressings, drains, bandages, and many other tools and techniques. * Clinically oriented chapters offering tips for specific wounds such as burns, bite wounds, eyelid, lip, and ear wounds, and necrotizing fasciitis. Techniques in Small Animal Wound Management is an ideal practical reference for all veterinary students, small animal veterinary practitioners, and veterinary surgeons looking for a comprehensive guide to the wounds we treat.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
List of Contributors
Foreword
Preface
About the Companion Website
1 The Skin
Cutaneus Immune Barrier
Pigmentation
The Normal Keratinization Process
The Abnormal Keratinization Process
Dermis
The Hypodermis (Subdermis or Subcutis or Superficial Fascia)
Connective Tissue and Fascia
Skeletal Muscle
Skeletal Muscle Trauma and Regeneration
References
2 Physiology of Wound Healing and Clinical Considerations
Stages of Wound Healing
Proliferative Stage
Inherent Detriments to Wound Healing
Conclusion
References
3 Postoperative Complications
Introduction
Seromas
Wound Dehiscence (Indolent Pockets, Pseudo Healing)
Biofilms
References
4 Wound Types and Terminology
Classifications of Veterinary Wounds
Wound Closure
References
5 Patient Presentation and Evaluation of Wound
Initial Stabilization of the Wound Patient
Acute Critical Wound Patients
Stable and/or Chronic Wound Patients
Evaluation of Patient Factors
Evaluation of Wound Factors
Initial Treatment
Decision‐Making for Primary Closure
Debridement
Drain and Bandage Placement
References
6 Cleansing Solutions
Cleansing Solutions
Tap Water
Isotonic Intravenous Crystalloid Fluid Preparations (e.g., 0.9% Saline, Lactated Ringer's Solution, Hartman's Solution, Plasmalyte, Normosol)
Antiseptic Solutions
References
7 Topicals
Hydrogels
Zinc‐Oxide Hydrophilic Pastes
Honey/Sugar
Antimicrobials (Nitrofurazone, Triple Antibiotic, Silver Sulfadiazine)
Triple Antibiotic (Neomycin, Polymixin B, and Bacitracin)
Silver Sulfasalazine
Oxygen
Nitrous Oxide
Miscellaneous Topicals
References
8 Wound Dressings
Moist Wound Healing
Characterization of Dressings
Adherent Dressings – Woven Gauze and Lap Sponges
Non‐adherent Semiocclusive (Porous‐Dry or Petrolatum‐Impregnated)
Absorbent
Moisture Retentive Dressings
Antimicrobial
Bioelectric Dressings
Xenograft Dressings
Miscellaneous
References
9 Drains
Passive Drains
Closed‐Suction/Active Drains
References
10 Vacuum‐Assisted Bandages (Negative Pressure Wound Therapy)
Physiology
Increased Granulation Tissue
Reduced Bacterial Load
Increased Blood Flow
Decreased Hematoma and Seroma Formation
Increased Cytokines/Growth Factors
Microdeformation with
In‐Vitro
Modeling
Indications of NPWT
Description of Technique
Postoperative Care
Outcomes/Complications
References
11 Biologic Treatments
Anatomy and Physiology
Indications
Description of Technique
Postoperative Care
Outcomes/Complications
References
11 Biologic Treatments
Background/Physiology
Indications
Description of Technique
Post‐Procedural Care
Outcomes/Complications
References
12 Bandages
Introduction
Light or Modified Robert Jones Bandage
Wet‐to‐Dry or Dry‐to‐Dry Bandages
Tie‐Over Bandages
References
13 Hyperbaric Oxygen Therapy
Introduction
Physiology
References
14 Low Level Laser, Photobiomodulation and Electromagnetics for Wound Therapy
Low Level Laser Therapy
Photobiomodulation
Pulsed Electromagnetic Field Therapy
References
15 Platelet Rich Plasma and Stem Cell Therapy
Platelet Rich Plasma (PRP) Therapy
Stem Cell Therapy
Combinational Therapy Using PRP and Stem Cell Therapy
References
16 Reconstructive Techniques for Wounds
Equipment
Basic Tissue Handling Tenants
Skin Tension
Tension‐Relieving Techniques
Triangular, Square, Rectangle Wounds
Circular and Crescentic Wounds
Skin Flaps
Specific Axial Pattern Flaps
Skin Grafting
References
17 Specific Wounds
Presenting Signs
Examination and Initial Wound Characteristics
Diagnostics
Initial Therapy and Procedure
Follow‐up Bandage Care
Surgical Procedure
Outcome
Prognosis
Clinical Lessons
17 Specific Wounds
Clinical Presentation
Triage and Imaging
Management Plans
Prognosis
References
17 Specific Wounds
Presenting Signs
Outcome
Prognosis
17 Specific Wounds
Clinical Presentation
Anatomy and Physiology of Burns
Comparative Aspects of Burn Physiology
Acute Management Plan
Bandage Management
Split Thickness Grafts
Possible Complications
Future Directions
Prognosis
References
17 Specific Wounds
Clinical Presentation
Specific Challenges
Management Plans
Prognosis
References
17 Specific Wounds
Presenting Signs
Outcome
Prognosis
17 Specific Wounds
Presenting Signs
Wound Characteristics
Physiologic Effects
Shock/Sepsis
Prognosis
References
17 Specific Wounds
Presenting Signs
Wound Characteristics
Physiologic Effects
Treatment
Possible Complications
Prognosis
References
17 Specific Wounds
Introduction
Presenting Signs
Diagnosis
Wound Characteristics
Physiologic Effects
Treatment
Possible Complications
Prognosis
References
17 Specific Wounds
Introduction
Presenting Signs
Physiologic Effects
Treatment
Possible Complications
Prognosis
References
17 Specific Wounds
Introduction
Anatomic Considerations
Wound Characteristics
Surgical Treatments
Avulsion Injuries
Primary Repair
Wedge Resection Techniques
Full‐Thickness Advancement Flaps Full‐Thickness
Postoperative Care
Complications
Prognosis
References
17 Specific Wounds
Anatomic Considerations
Wound Characteristics
Surgical Treatments
Postoperative Care
Complications
Prognosis
References
17 Specific Wounds
Introduction
Case 1
Other Examples of Circumferential Injuries (see Chapter 11A)
Case 2
Case 3
Clinical Lessons
References
17 Specific Wounds
Presenting Signs
Examination and Wound Characteristics
Diagnostics
Surgical Procedure
Outcome
Prognosis
Clinical Lessons
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Summary of skin differences between dogs and cats.
Chapter 2
Table 2.1 Summary of stages of wound healing.
Table 2.2 Summary of factors acting as inherent detriments to wound healing...
Table 2.3 Species differences.
Chapter 3
Table 3.1 Surgical hand preparation methods.
Table 3.2 Variables associated with surgical wound dehiscence and factors a...
Table 3.3 Risk factors for surgical site infection.
Table 3.4 Recommended antibiotics for antimicrobial prophylaxis based on su...
Table 3.5 Antibiotics effective against biofilms.
Chapter 4
Table 4.1 Wound closure classifications.
Chapter 5
Table 5.1 Patient factors resulting in decreased wound healing.
Table 5.2 Wound debridement instrumentation and techniques.
Chapter 6
Table 6.1 Cleansing solutions.
Chapter 7
Table 7.1 Commonly used topicals in veterinary medicine.
Table 7.2 Mechanism of action of honey.
Table 7.3 Summary of miscellaneous topical treatments for wounds.
Chapter 8
Table 8.1 Characteristics of primary wound dressings.
Table 8.2 Sterilization and storage for Tilapia skin grafts.
Table 8.3 Application of Tilapia skin grafts to wounds.
Chapter 9
Table 9.1 Advantages and disadvantages to passive drains.
Table 9.2 Advantages and disadvantages to active drains.
Chapter 10
Table 10.1 Mechanisms to ameliorate wound healing attributed to NPWT.
Table 10.2 Indications for NPWT.
Table 10.3 Contraindications for NPWT.
Chapter 11A
Table 11.A.1 Indications for MLT in veterinary medicine.
Table 11.A.2 Table summarizing preoperative diagnostic tests, MLT technique...
Chapter 12
Table 12.1 Home care instructions.
Table 12.2 Disadvantage of wet‐to‐dry and dry‐to‐dry bandages.
Chapter 13
Table 13.1 HBOT action during phases of healing.
Table 13.2 Author's recommendations.
Table 13.3 Daily and weekly checklist.
Chapter 14
Table 14.1 Proposed mechanisms of action of PMBT.
Table 14.2 Treatment regimens for chronic wounds [14].
Chapter 15
Table 15.1 Platelet‐rich plasma (PRP) applications for healing of naturally...
Table 15.2 Platelet‐rich plasma (PRP) applications for healing of experimen...
Table 15.3 Classification of platelet‐rich plasma formulations.
Table 15.4 Summary of platelet‐rich plasma (PRP) protocols used in wound he...
Table 15.5 Summary of platelet‐rich plasma (PRP) protocols used in wound he...
Chapter 16
Table 16.1 Useful axial pattern flaps for wound reconstruction.
a
Chapter 17K
Table 17.K.1 Lip wound characteristics and recommended treatments.
List of Illustrations
Chapter 1
Figure 1.1 (a) Lateral approach to the shaft of the femur is shown. The fasc...
Figure 1.2 Layers of epidermis. (a) Basement membrane. (b) Stratum basale. (...
Figure 1.3 Keratinocytes and nonkeratinocytes of the epidermis. (a) Epidermi...
Figure 1.4 Schematic diagram of skin showing hairs and associated structures...
Figure 1.5 Histological features of hair. (a) Hair in the anagen stage (note...
Figure 1.6 Schematic diagram of the epidermis depicting the differentiation ...
Figure 1.7 Examples of thick and thin skin. (a,b) Thick epidermis, palmar sk...
Figure 1.8 Different types of hairs in animals. (a,f,g) Tactile (or sinus) h...
Figure 1.9 Structure of skin, schematic. (a) Keratinocyte stem cells are pre...
Figure 1.10 Transverse sections of
regio abdominis lateralis
of the dog. (a)...
Figure 1.11 Cells and other components of loose connective tissue (superfici...
Figure 1.12 Sections of dog limbs. (a) Superficial adipose tissue is present...
Figure 1.13 Organization of superficial and deep fascia. 1, Skin; 2, Superfi...
Figure 1.14 (a) Sensory structures of the skin. Various types of receptors a...
Figure 1.15 Cutaneus circulation in the dog and cat (schematic from neck reg...
Figure 1.16 Cutaneus blood vessels are important for surgical repositioning ...
Figure 1.17 Skin tension lines in the dog. (a) Skin has a natural tendency t...
Figure 1.18 Cutaneus muscles of the dog. (a) Lateral view of a dog showing v...
Figure 1.19 Muscle damage and repair. (a) Injury resulting in muscle fiber d...
Figure 1.20 Schematic illustration of skeletal muscle fiber regeneration aft...
Chapter 2
Figure 2.1 Hemostasis. (a) A sharp traumatic laceration presenting within ap...
Figure 2.2 Early inflammation. This image depicts a wound localized on the c...
Figure 2.3 Late inflammation. These images are of the same patient, with the...
Figure 2.4
Hallmarks of the proliferative stage
. These illustrations depict ...
Figure 2.5 (a,b)
Granulation tissue
. These images are from a patient who suf...
Figure 2.6 (a,b)
Epithelialization
. These images are from a severe degloving...
Figure 2.7 (a,b)
Contraction
. These images are from a patient who suffered a...
Figure 2.8 (a–c)
Wound maturation
. These pictures are serially taken from a ...
Chapter 3
Figure 3.1 Visual depiction of the components of the TIME assessment system....
Figure 3.2 (a,b) Typical appearance of incisional seromas affecting the late...
Figure 3.3 Incisional seroma affecting the ventral cervical region in a dog ...
Figure 3.4 (a,b) Extensive dead space in the left lateral flank area of a Si...
Figure 3.5 SWD of a single pedicle advancement flap used for reconstruction ...
Figure 3.6 SWD of a ventral midline abdominal skin incision at the “T” junct...
Figure 3.7 Left‐sided perianal incision with SWD after removal of an anal sa...
Figure 3.8 Postoperative SWD in a dog after digit amputation was performed t...
Figure 3.9 SWD of a left‐sided maxillectomy reconstruction after wide excisi...
Figure 3.10 SWD of a wound centered over the olecranon of the left thoracic ...
Figure 3.11 Postoperative image of a dog with a large wound centered over th...
Figure 3.12 Postoperative image of a dog suffering SWD after surgical recons...
Figure 3.13 SWD of an extremity wound located over the tarsus of a dog. The ...
Figure 3.14 Postoperative SWD in a dog with a multidrug resistant
Staphyloco
...
Figure 3.15 Image of an infected wound that has stalled out as it attempts t...
Figure 3.16 (a) Preoperative image of the lateral thorax of a dog that suffe...
Figure 3.17 Chronic, left caudal thigh and perianal wound in a cat undergoin...
Figure 3.18 (a) Full thickness thoracic limb extremity wound in a dog after ...
Chapter 4
Figure 4.1 An abrasion injury to the right flank of a dog, caused by being d...
Figure 4.2 A burn wound to the dorsum of a small breed dog, with extension o...
Figure 4.3 A degloving injury to the manus of a dog. Note the exposure of li...
Figure 4.4 (a) Depicts bone exposure of a tibial fracture treated with exter...
Figure 4.5 A laceration sustained to the caudal aspect of the carpus of a sh...
Figure 4.6 (a) Is a pressure sore on the lateral aspect of the hock of a dog...
Figure 4.7 Bite wounds to the ventral cervical region of a Dachshund, sustai...
Figure 4.8 (a) Depicts a draining tract on the medial tibia, overlying a met...
Figure 4.9 (a) Is a chronic wound on the inguinal region of a dog, in an are...
Figure 4.10 A contaminated wound on the ventral thorax of a dog, sustained b...
Figure 4.11 An infected wound on the flank of a dog, with evidence of the pr...
Figure 4.12 These images depict second intention healing of a dog bite wound...
Figure 4.13 A wound healed with contracture on the right flank of a terrier....
Figure 4.14 An example of delayed primary closure where a bite wound of the ...
Chapter 5
Chart 5.1 General flowchart for initial stabilization of the wound patient....
Figure 5.1 Photographs of patients being provided supplemental oxygen. (a) P...
Figure 5.2 Photographs of point‐of‐care ultrasounds. (a,b) Photographs of a ...
Figure 5.3 Photographs of a patient with a gunshot wound. (a) Photograph of ...
Figure 5.4 (a–c) Photographs of a thoracocentesis. Note the set‐up including...
Figure 5.5 Photograph of a patient sustained severe trauma to the chest cavi...
Figure 5.6 Photographs of incisional dehiscence. (a) Photograph of a patient...
Figure 5.7 (a) Photograph of a patient with a modified Robert‐Jones bandage ...
Figure 5.8 Photographs of wound explore. The hemostat is being used to probe...
Figure 5.9 Examples of en‐bloc debridement. (a,b) Patient with a lateral thi...
Figure 5.10 Photograph of a patient with distal necrosis of an axial pattern...
Figure 5.11 Photographs of serial wound debridement and bandaging over seven...
Figure 5.12 Photographs of common bandaging techniques. (a) Photograph of a ...
Figure 5.13 Photograph of lap sponge and blue drape commonly used to cover t...
Chapter 6
Figure 6.1 Photographs of wound flush setups using a needle or catheter and ...
Figure 6.2 Photograph of a wound being flushed with a sterile saline bottle ...
Figure 6.3 Photograph of chlorhexidine bottles. The solution (blue) on the l...
Figure 6.4 Chlorhexidine for lavage should be diluted by 1 part 2% solution ...
Figure 6.5 Iodine is also used most commonly as a dilution (one part 10% pov...
Chapter 7
Figure 7.1 (a) Photograph of different hydrogel formulations (A‐Kendall Woun...
Figure 7.2 (a,b) Photographs of Medihoney
®
topical ointment. (c,d) Phot...
Figure 7.3 Photograph of nitrofurazone ointment.
Figure 7.4 Photograph of triple antibiotics ointment.
Figure 7.5 Photograph of silver sulfadiazine cream.
Figure 7.6 Photograph of Nitric Oxide gel kit (Restore, Noxsano).
Chapter 8
Figure 8.1 Photograph of a commonly used 3 × 3 in woven gauze. Some brands h...
Figure 8.2 Photograph of lap sponges used in many highly exudative wounds as...
Figure 8.3 Photographs of a non‐adherent Telfa pad. (a Note the shine on t...
Figure 8.4 Photographs of a 5 × 9‐in double‐layer non‐adherent Adaptic
®
Figure 8.5 Photographs of a calcium alginate dressing. (a) Note the soft fel...
Figure 8.6 Photographs of a hydrocellular foam dressing. (a) This foam was o...
Figure 8.7 Photograph of a polyurethane film dressing (Tegaderm) with a non‐...
Figure 8.8 Photographs of a thin hydrocolloid dressing. (a) This dressing ha...
Figure 8.9 Photographs of a Mepilex Ag polyurethane foam impregnated with si...
Figure 8.10 Photographs of a MediHoney
®
honey + calcium alginate dressi...
Figure 8.11 Photographs of a bioelectric dressing (Procellera). (a) The dres...
Figure 8.12 Photographs of porcine small intestinal submucosa (PSIS) dressin...
Figure 8.13 Photographs of novel Whart’n's jelly (WJ) dressing (Sanatela™ Ma...
Figure 8.14 Photographs of tilapia graft being applied after full‐thickness ...
Figure 8.15 Photographs of a 7 × 10 cm North Atlantic cod skin graft (Kereci...
Figure 8.16 Photographs of cod skin graft (Kerecis Omega‐3 VET) being used i...
Figure 8.17 Photographs of a 5 × 7 cm nitric oxide dressing (Restore by Noxs...
Chapter 9
Figure 9.1 Penrose drains of various sizes‐from left to right ¼
″
, ½
″
...
Figure 9.2 Placement of a Penrose drain blindly. (a) Grasping the Penrose dr...
Figure 9.3 Severe bite wounds on the abdomen and right flank of a dog. Patie...
Figure 9.4 Umbilical tape used for drainage. (a) Umbilical tape. (b) Umbilic...
Figure 9.5 Components of a closed suction (JP) drain. (a) A 7 mm wide fenest...
Figure 9.6 Photographs of a Jackson Pratt drain in place on the caudal thigh...
Figure 9.7 Photographs of a trocar‐style closed suction drain placement. (a)...
Figure 9.8 Components of a butterfly needle drain. (a) Photograph of a 21gau...
Figure 9.9 Example of a closed suction drain made from butterfly catheter an...
Figure 9.10 A dog with a butterfly drain placed in a wound on the left later...
Figure 9.11 Patient with partial necrosis of wound and evidence of infection...
Chapter 10
Figure 10.1 NPWT applied to the wound. An open‐cell foam is conformed to the...
Figure 10.2 Prior to anesthetizing the patient and applying the NPWT dressin...
Figure 10.3 Liquid skin adhesive Mastisol
®
(Eloquest Healthcare
®
, ...
Figure 10.4 (a) The periwound skin is clipped and cleaned and liquid skin ad...
Figure 10.5 (a) Seal the wound area with the impermeable, adhesive drapes. (...
Figure 10.6 A 2 cm round hole is cut in the sheet exposing a similarly sized...
Figure 10.7 Adhesive fenestrated disc with associated evacuation tubing is p...
Figure 10.8 When the NPWT is activated, the foam dressing is suctioned down ...
Figure 10.9 NPWT has been applied to the right hindlimb. The adhesive dressi...
Figure 10.10 (a) Continued removal of an adhesive drape will cause recurrent...
Chapter 11A
Figure 11.A.1 Photograph of a leech,
Hirudo medicinalis
.
Figure 11.A.2 Photograph of a leech suctioned to side of plastic mobile home...
Figure 11.A.3 Photographs of cat who suffered a constrictive wound due to a ...
Figure 11.A.4 Photographs of patients undergoing MLT for venous congestion f...
Figure 11.A.5 Data collection form created for use by veterinarians during m...
Figure 11.A.6 Patient with extensive skin loss over left lateral face and ve...
Figure 11.A.7 Patient underwent a superficial temporal flap for closure of w...
Figure 11.A.8 Cat undergoing MLT for venous congestion after an angularis or...
Figure 11.A.9 Photograph of MLT for venous congestion of a rotation flap on ...
Chapter 11B
Figure 11.B.1
Lucilia sericata
fly sitting on top of a cluster of eggs.
Figure 11.B.2
Lucilia sericata
sizes shown with a scale for reference. Pictu...
Figure 11.B.3
Lucilia sericata
sizes shown with a scale and penny for refere...
Figure 11.B.4 Human patient with IV extravasation of medication causing a wo...
Figure 11.B.5 Human patient with a wound on the distal leg before treatment ...
Figure 11.B.6 Human patient treated with MDT for a decubital ulcer located a...
Figure 11.B.7 Vials of medical maggots as shipped from Monarch Labs in Irvin...
Figure 11.B.8 Pictured is the BB100 4 × 5 cm Biobag® containing larvae withi...
Figure 11.B.9 A close‐up cross‐sectional image of the opened BB100 Biobag co...
Figure 11.B.10 A close‐up image of the smallest size Biobag on a scalpel bla...
Figure 11.B.11 LeFlap™ primary dressing for confinement of medical maggots d...
Figure 11.B.12 LeSoc™ primary dressing for confinement of medical maggots du...
Figure 11.B.13 MDT dressing pictured covering a wound on the hip of a human ...
Figure 11.B.14 MDT dressing using nylon stocking to confine the medical magg...
Figure 11.B.15
Lucilia sericata
third instar larvae pictured with the promin...
Figure 11.B.16 Close‐up view of maggots demonstrating engorgement at the tim...
Figure 11.B.17 Wound appearance prior to MDT in a canine patient with severe...
Figure 11.B.18 Wound appearance post‐MDT two days following initial applicat...
Chapter 12
Figure 12.1 Photographs of common bandage material. (a) non‐adherent dressin...
Figure 12.2 (a) A modified Robert jones bandage; (b) A cross‐your‐heart soft...
Figure 12.3 Photographs of a modified Robert Jones bandage being placed over...
Figure 12.4 Photograph of an IV bag that can be used for bandage protection....
Figure 12.5 Photograph of a bandage‐associated wound with full‐thickness dis...
Figure 12.6 These sutures (0‐Prolene for dogs, 2‐0 nylon for cats) are examp...
Figure 12.7 Stay sutures should be placed at least 1 cm from the wound or in...
Figure 12.8 Stay sutures are ideally placed in even numbers with each pair d...
Figure 12.9 The primary contact layer is placed into the wound. In this case...
Figure 12.10 The umbilical tape is threaded through the 2 stay sutures acros...
Figure 12.11 After creating half of a square knot with a single throw and an...
Figure 12.12 The next two stay sutures across from each other have umbilical...
Chapter 13
Figure 13.1 (a,b) Photographs of two 8‐week‐old puppies presented one week p...
Figure 13.2 Photographs of an eight‐year‐old MN German Shepherd who underwen...
Figure 13.3 Photographs of a 10‐year‐old MN mix breed presented for traumati...
Figure 13.4 Photographs of a one‐year‐old MI Labrador presented after having...
Chapter 14
Figure 14.1 Photograph of a K laser
®
, a class 4 therapeutic laser.
Figure 14.2 (a,b) Photographs of the commercially available Phovia device (K...
Figure 14.3 Photographs of a four‐year‐old male neutered Pitt bull with a se...
Figure 14.4 Photograph of the Assisi Loop (Assisi Animal Health, Northvale, ...
Chapter 15
Figure 15.1 General methodology for the preparation of platelet rich plasma ...
Figure 15.2 Photographs of different PRP preparation methods. (a) Gravity‐de...
Figure 15.3 Photographs of PRP‐treated wounds. (a) Linear wound on the palma...
Figure 15.4 Overview of the isolation and culture of mesenchymal stromal cel...
Figure 15.5 Overview of the molecular mechanisms facilitating each step of M...
Figure 15.6 MSC mechanism of action and immunomodulatory capabilities. (a). ...
Figure 15.7 (a) Canine mesenchymal stem cells in cell culture; (b) Canine me...
Figure 15.8 Peripheral blood‐derived MSCs from dogs (a) and adipose‐derived ...
Figure 15.9 (a) Photograph of a Wharton's jelly novel matrix in place in sur...
Chapter 16
Figure 16.1 A standard instrument set used for soft tissue surgery. (a) Pene...
Figure 16.2 (a) Martin cartilage scissors are very sharp and cut skin smooth...
Figure 16.3 (a) Photograph of a monopolar electrosurgery pen with a flat tip...
Figure 16.4 Photograph of CO
2
laser handles with straight (a) and right‐angl...
Figure 16.5 (a) Skin hooks, (b) close‐up of hooks – note they have rounded e...
Figure 16.6 Skin sutures being used for elevation and manipulation. 3‐0 PDS ...
Figure 16.7 Self‐retaining retractors. (a) Ring‐retractor (Lonestar retracto...
Figure 16.8 Photographs of subjective “pinch testing” of patient's skin elas...
Figure 16.9 This photograph shows blunt dissection by advancing closed Mayo ...
Figure 16.10 (a) Looser subcutaneous layer being grasped by Brown‐Adson forc...
Figure 16.11 Walking sutures. (a) Grasping deep subcutaneous tissue under th...
Figure 16.12 Far‐far‐near‐near patterns. (a) Line drawing, (b) photograph of...
Figure 16.13 Photograph of a far‐far‐near near suture with the knot to the s...
Figure 16.14 (a) Penrose drains as stents under tension‐relieving vertical m...
Figure 16.15 Photograph of a very large mammary mass on a canine patient. Th...
Figure 16.16 Photograph of an 11‐year‐old MC Boston terrier with a MCT on ta...
Figure 16.17 (a) Photograph of a feline patient after a large facial sarcoma...
Figure 16.18 Photograph of extensive releasing incisions on the thoracic lim...
Figure 16.19 Photographs of a triangular wound being closed with a three‐sid...
Figure 16.20 Photographs of a triangular wound being closed with a rotationa...
Figure 16.21 Square or rectangular defects can be closed using a variety of ...
Figure 16.22 Closure of a rectangular wound by advancement flap. (a) H‐plast...
Figure 16.23 Photographs of a linear closure for a circular wound. (a) Circu...
Figure 16.24 “Bow tie” technique to close larger circular wounds. (a,b) Equi...
Figure 16.25 Photographs of a crescentic wound closure. (a) Crescentic wound...
Figure 16.26 Photographs of “V‐Y” plasty for a circular wound. (a) “V” incis...
Figure 16.27 Line drawings of “Z” plasty. A Z‐plasty can be used for redistr...
Figure 16.28 Photographs of a transposition/rotation flap to close a large f...
Figure 16.29 Postoperative photograph of an axillary (elbow) fold flap used ...
Figure 16.30 Postoperative photographs of a caudal auricular flap. (a) Later...
Figure 16.31 Superficial temporal flap. (a) Tumor on dorsomedial aspect of c...
Figure 16.32 Postoperative photograph of an angularis oris flap for closure ...
Figure 16.33 Photographs of a thoracodorsal flap used in a golden retriever ...
Figure 16.34 Photographs of a Caudal Superficial Epigastric flap used in a L...
Figure 16.35 Photographs of genicular flaps. (a) Flap raised in patient afte...
Figure 16.36 Photographs of a flank fold flap used to close a wound in the i...
Figure 16.37 Photographs of a meshed full‐thickness free skin graft. (a) Pat...
Figure 16.38 Photographs of a Negative Pressure Wound Bandage on a paw‐free ...
Figure 16.39 Photograph of full thickness free mesh graft six days post‐plac...
Chapter 17A
Figure 17.A.1 Photograph of patient on the night of presentation after wound...
Figure 17.A.2 Photograph of necrosis of skin at previous wound sites when pa...
Figure 17.A.3 Photograph of caudal thigh wound after two days of honey‐impre...
Figures 17.A.4, 17.A.5, 17.A.6 Photographs of the wounds after one day of ca...
Figures 17.A.7, 17.A.8 Photographs of the negative pressure wound bandage (N...
Figure 17.A.9 Photograph of wounds on Day 7 of hospitalization. The granulat...
Figures 17.A.10, 17.A.11 Photographs of primary closure over a Jackson Pratt...
Figure 17.A.12 Photograph of minor dehiscence and venous congestion at the d...
Chapter 17B
Figure 17.B.1 Bite wounds following a dog‐on‐dog attack‐ despite the relativ...
Figure 17.B.2 Progressive necrosis requiring serial debridement and open man...
Figure 17.B.3 Dehiscence of a dog‐on‐dog bite wound treated six days prior w...
Figure 17.B.4 Accidental gunshot wound from a hunting rifle in a 3‐year‐old ...
Figure 17.B.5 Image of a patient shortly after a quilling. This German sheph...
Figure 17.B.6 This substantial wood fragment was removed from a dog with a s...
Figure 17.B.7 Dog presenting with an intra‐gastric barbecue skewer which sub...
Figure 17.B.8 (a and b) This dog impaled itself on a branch while running in...
Figure 17.B.9 (a and b) Images from a patient with a known penetrating injur...
Chapter 17C
Figure 17.C.1 Open wound (~10 × 10 mm) with serosanguinous discharge on the ...
Figure 17.C.2 Orthogonal mediolateral and craniocaudal radiographic projecti...
Figure 17.C.3 (a) Persistent draining tracts on the medial aspect of the pro...
Figure 17.C.4 Communication between the draining tracts was confirmed by ins...
Figure 17.C.5 (a) Targeted surgical approach to the Kirschner wire (anti‐rot...
Figure 17.C.6 Surgical approach to the proxomedial right tibial region for w...
Figure 17.C.7 Swab used to collect sample of deep tissue within the explored...
Figure 17.C.8 (a) Draining sinus tract in the popliteal region of the right ...
Figure 17.C.9 Intravenous contrast computed tomography images in the dorsal ...
Figure 17.C.10 (a) Surgical swab identified and retrieved in the popliteal r...
Chapter 17D
Figure 17.D.1 Patient with declaring wounds following a heating pad burn sus...
Figure 17.D.2 (a and b) Large area burn over the dorsum and right flank befo...
Figure 17.D.3 Patient with VAC and NG tubes in place over a large burn wound...
Figure 17.D.4 (a and b) Patient with an extremity wound following a chemical...
Figure 17.D.5 Dermatome in use with appropriate width plate and depth set. A...
Figure 17.D.6 Donor sites immediately following split graft harvest. Sites o...
Figure 17.D.7 Meshing of a split‐thickness graft using a graft expander. Cou...
Figure 17.D.8 (a) Burn wounds seven days after grafting with partial loss of...
Chapter 17E
Figure 17.E.1 (a–c) This challenging wound in a 6 yo FS Labrador developed f...
Figure 17.E.2 Chronic ulcer over the caudal aspect of the olecranon resultin...
Figure 17.E.3 Releasing incision placed over the medial aspect of the elbow ...
Figure 17.E.4 Thoracodorsal flap used to close a large wound over the elbow ...
Figure 17.E.5 (a and b) Full‐thickness meshed autograft used to close a larg...
Figure 17.E.6 A carpal wound on a 60 kg mastiff. The dog tolerated bandaging...
Chapter 17F
Figure 17.F.1 (a–c) Day 0 – Full thickness shearing wound over the dorsal as...
Figure 17.F.2 (a and b) Day 4 – Appearance of the dorsal metatarsal wound fo...
Figure 17.F.3 Day 16 – Healthy, hyperemic granulation bed on the dorsal meta...
Figure 17.F.4 A sterile piece of paper is used to template the size of the d...
Figure 17.F.5 The free skin graft is harvested from the right lateral thorax...
Figure 17.F.6 (a) The full‐thickness skin graft is tacked to a sterile roll ...
Figure 17.F.7 The meshed free skin graft is placed into the recipient wound ...
Figure 17.F.8 Appearance of the grafted wound seven days post‐operative. The...
Figure 17.F.9 (a–c) Appearance of the grafted wound two years post‐operative...
Chapter 17G
Figure 17.G.1 Photograph of a German shepherd with NSTI of the distal right ...
Figure 17.G.2 Photograph of a mixed breed dog with severe NSTI of the axilla...
Figure 17.G.3 Photographs of a patient with diagnosed NSTI of the medial asp...
Figure 17.G.4 Photographs of a three‐year‐old MN German Shepherd diagnosed w...
Chapter 17H
Figure 17.H.1 Photograph of a Weimeraner on presentation after a rattlesnake...
Figure 17.H.2 Photograph of the patient in Figure 17.H.1. (a) Appearance of ...
Figure 17.H.3 Photomicrographs of a blood smear of a dog after envenomation....
Figure 17.H.4 Photographs of dogs after snake bite wounds. (a and b) Full‐th...
Figure 17.H.5 West Highland Terrier in the hours and days after a rattlesnak...
Figure 17.H.6 Photographs of a patient with necrosis of the right temporal r...
Chapter 17I
Figure 17.I.1 Dorsal lumbar cutaneous/subcutaneous pythiosis lesion on a dog...
Figure 17.I.2 Cutaneous/subcutaneous pythiosis lesion on 6‐year‐old mixed br...
Figure 17.I.3 Large ulcerative crusting invasive cutaneous/subcutaneous
P. i
...
Figure 17.I.4 Anesthetized canine patient being prepared for wide surgical e...
Figure 17.I.5 Surgical marker is used to adequately outline the wide surgi...
Figure 17.I.6 If the lesion to be resected is on the truncal region, an axia...
Figure 17.I.7 The patient's head is on the right in this image, and in...
Figure 17.I.8 The patient's head is on the right in this image, and af...
Figure 17.I.9 The patient's head is on the right in this image, and aft...
Figure 17.I.10 The patient's head is on the left in this image, and aft...
Figure 17.I.11 A closed suction drain was placed and kept indwelling for fi...
Figure 17.I.12 The patient was presented for suture removal three weeks foll...
Chapter 17J
Figure 17.J.1 Noteworthy anatomical landmarks. a – medial canthus, b – Dorsa...
Figure 17.J.2 Note the meibomian glands within the eyelid and their openings...
Figure 17.J.3 Full‐thickness laceration to the upper eyelid running perpendi...
Figure 17.J.4 Full‐thickness laceration to the lateral cornea. Note the fibr...
Figure 17.J.5 Medial canthal ulcerative blepharitis.
Figure 17.J.6 Squamous cell carcinoma infiltrating the lower eyelid and peri...
Figure 17.J.7 Previous eyelid laceration allowed to heal by secondary intent...
Figure 17.J.8 Cicatricial ectropion secondary to a previous facial wound. Th...
Figure 17.J.9 V to Y Plasty can be performed to correct an eyelid that is ro...
Figure 17.J.10 Cicatricial entropion secondary to previous injury to the eye...
Figure 17.J.11 Y to V Plasty can be performed to correct cicatricial entropi...
Figure 17.J.12 The figure of 8 suture pattern allows for exact apposition of...
Figure 17.J.13 (a) Two full‐thickness eyelid lacerations affecting the media...
Figure 17.J.14 A four‐sided resection may be used to excise eyelid masses in...
Figure 17.J.15 (a) Meibomian gland adenoma affecting the central portion of ...
Figure 17.J.16 (a) Histiocytic neoplasia affecting ½ of the left upper eyeli...
Chapter 17K
Figure 17.K.1 Photographs of adult West Highland terrier after a big‐dog‐lit...
Figure 17.K.2 Photographs of a canine patient after a dog attack. (a) The ro...
Figure 17.K.3 Photographs of a 7‐year‐old male neutered, mixed breed, presen...
Figure 17.K.4 Photographs of a two‐year‐old Labrador retriever presenting af...
Figure 17.K.5 Photographs of a labial advancement flap performed after soft ...
Figure 17.K.6 Photographs of an adult Boxer after resection of a grade two m...
Figure 17.K.7 Photographs of patient seen in Figure 17.K.3 after a caudal au...
Figure 17.K.8 Photographs of a lip‐to‐lid flap performed for eyelid agenesis...
Figure 17.K.9 Photograph of a canine patient with evidence of dehiscence of ...
Chapter 17L
Figure 17.L.1 Photographs of a feline patient after sustaining wounds from b...
Figure 17.L.2 Photographs of a patient sustaining bilateral injuries to the p....
Figure 17.L.3 Intraoperative photographs of a feline partial pinnectomy. Whil...
Figure 17.L.4 Postoperative photograph of a feline patient with bilateral ne...
Figure 17.L.5 Photographs of a canine patient who underwent a caudal auricul...
Figure 17.L.6 Photographs of a canine patient postoperatively. (a) He sustai...
Chapter 17M
Figure 17.M.1 Orthogonal view radiographs of tarsometatarsal fracture luxati...
Figure 17.M.2 Orthogonal view radiographs of patient 1's postoperative tarso...
Figure 17.M.3 (a) (lateral) and (b) (craniocaudal) photographs of patient 1'...
Figure 17.M.4 (a) (lateral) and (b) (craniocaudal) photographs of patient 1'...
Figure 17.M.5 Image of multiple craniocaudal photographs of patient 1's paw ...
Figure 17.M.6 (a) (lateral) and (b) (craniocaudal) photographs of patient 1'...
Figure 17.M.7 (a–e) Photographs of patient with muzzle injuries due to a rub...
Figure 17.M.8 Photographs of a patient who sustained circumferential injury ...
Chapter 17N
Figure 17.N.1 (a and b) Ventral abdomen showing the abnormal penis and prepu...
Figure 17.N.2 Island of preputial mucosa circumferentially incised while mai...
Figure 17.N.3 Right testicle being exteriorized from the inguinal canal – th...
Figure 17.N.4 The penis is now in a more normal orientation, and the preputi...
Figure 17.N.5 Completed closure of the preputial mucosa to achieve penile co...
Figure 17.N.6 The skin of the abdominal wall was then closed in two layers c...
Figure 17.N.7 (a and b) Following partial closure of the cranial aspect of t...
Figure 17.N.8 (a and b) The flank fold flap was progressively mobilized from...
Figure 17.N.9 (a and b) Placement of the flap and closure in the new positio...
Figure 17.N.10 Clinical appearance at suture removal 14 days postoperatively...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
List of Contributors
Foreword
Preface
About the Companion Website
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Techniques in Small Animal Wound Management
Edited by
Nicole J. Buote DVM, DACVS‐SA
ACVS Founding Fellow Minimally Invasive Surgery (Soft Tissue)Associate ProfessorDepartment of Clinical SciencesSmall Animal Surgery SectionSoft Tissue ServiceCornell University School of Veterinary MedicineIthaca, NY, USA
Copyright © 2024 by John Wiley & Sons Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.
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Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
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Library of Congress Cataloging‐in‐Publication Data Applied for:
Hardback ISBN: 9781119933823Cover Design: Wiley
Cover Design: WileyCover Image: Nicole J. Buote
This textbook is dedicated to my family, whom I love the most and the best. Thank you for pushing me, for supporting me, and understanding me.
To my parents, Robert and Sharon, thank you for always urging me to think big and work hard. I have not and will not “settle.”
Nathan, thank you for all your support during the creation of this book. I know it has been hard, and I couldn't have done it without you.
To my boys, William and Nicholas, thank you for all the hugs and support and for making me take a break occasionally. I hope you see the value in all this hard work. Love you best.
List of Contributors
Angela C. Banz, DVM, DACVSVCA Northwest Veterinary SpecialistsClackamas, OR, USA
Cheryl Braswell, DACVECC, CHT‐C, CVPP, CHPVSpring City, TN, USA
Nicole J. Buote, DVM, DACVS‐SAACVS Founding Fellow, Minimally InvasiveSurgery (Soft Tissue)Department of Clinical SciencesCornell UniversityIthaca, NY, USA
Ryan P. Cavanaugh, DVM, DACVS‐SAACVS Founding Fellow, Surgical OncologyAssociate Professor of Small Animal SurgeryRoss University School of Veterinary MedicineSt. Kitts, West Indies
Colin Chik, DVMDepartment of Clinical SciencesCornell UniversityIthaca, NY, USA
Kristin A. Coleman, DVM, MS, DACVS‐SAGulf Coast Veterinary SpecialistsHouston, TX, USA
James D. Crowley, BVScSmall Animal Specialist HospitalSydney, Australia
Rebecca M. Harman, PhDDepartment of Microbiology and ImmunologyBaker Institute for Animal HealthCornell UniversityIthaca, NY, USA
Galina Hayes, BVSc, PhD, DACVECC, DACVSDepartment of Clinical SciencesCornell UniversityIthaca, NY, USA
Celine S. Kermanian, DVMVCA West Los Angeles Animal HospitalLos Angeles, CA, USA
M.S. Amarendhra Kumar, BVSc., MVSc., MS, PhDDepartment of Medical EducationTufts University Schools of Medicineand Dental MedicineBoston, MA, USA
Daniel J. Lopez, DVM, DACVS‐SADepartment of Clinical SciencesCornell UniversityIthaca, NY, USA
Jill K. Luther, DVM, MS, DACVS‐SAHeartland Veterinary Surgery, LLCColumbia, MO, USA
Brian Marchione, DVM, DACVOOcuvet Inc., Los Angeles, CA, USA
Megan Mickelson, DVM, DACVS‐SAACVS Fellow of Surgical OncologyCollege of Veterinary MedicineUniversity of MissouriColumbia, MO, USA
Nathan Peterson, DVM, MS, DACVECCDepartment of Clinical SciencesCornell UniversityIthaca, NY, USA
Kathryn A. Pitt, DVM, MS, DACVS‐SAACVS Fellow, Surgical OncologyWanderlust Veterinary ServicesAcademic and Private Practice Locum
Aarthi Rajesh, PhDDepartment of Microbiology and ImmunologyBaker Institute for Animal HealthCornell UniversityIthaca, NY, USA
Desiree D. Rosselli, DVM, DACVS‐SAVCA West Los Angeles Animal HospitalLos Angeles, CA, USA
Bryden J. Stanley, BVMS, MANZCVS, MVetSc, MRCVS, Diplomate ACVSAnimal Surgical Center of MichiganFlint, MI, USA
Julia P. Sumner, BVSc, DACVS‐SASmall Animal Specialist HospitalSydney, Australia
Gerlinde R. Van de Walle, DVM, PhDDepartment of Microbiology and ImmunologyBaker Institute for Animal HealthCornell UniversityIthaca, NY, USA
Foreword
It is with great pleasure that I write this foreword for the outstanding textbook, Techniques in Small Animal Wound Management, edited by Dr. Nicole J. Buote. I am acutely aware of the impact full‐thickness wounding has on our small animal patients as well as how profoundly devastating and overwhelming it is for owners to be faced with the seemingly monumental task of restoring pain‐free function to their much‐loved family member. Our competence and confidence in effectively managing a challenging open wound play an essential role for the health and well‐being of both patients and owners.
Wound management is both science and art, and as veterinarians, we are often faced with many complex issues, commonly requiring a multidisciplinary approach. Appropriate management of the wound and periwound until both are healthy is the first crucial step. Only then can clinicians choose the optimal reconstructive technique which is critical to successful healing. The choices we face at each step can at times appear too numerous and bewildering. The field is constantly evolving, requiring the unwavering commitment of wound care practitioners to maintaining an open mind, and researching newer therapies and modalities. Each wound is different, and each patient presents a unique set of challenges and complications. Every owner is different, and communication becomes a vital part of the journey. This remarkable compendium offers a comprehensive and insightful guide that will undoubtedly become a cornerstone in the education of veterinary students, veterinarians, and specialists alike, instilling knowledge and confidence. Dr. Buote, with her vision and dedication, has brought together a formidable assembly of experts who have collectively amassed and generously shared their knowledge.
“Techniques in Small Animal Wound Management” is well‐structured, beginning with a solid foundation in anatomical considerations, principles of wound healing, and factors influencing this intricate and fascinating progression. Understanding how a wound heals is essential, as it forms the bedrock upon which successful wound management strategies are built. Wound complications are, unfortunately, a reality, and this textbook equips readers with the knowledge and skills to recognize and address them appropriately – a necessary reminder for us to maintain adaptability and critical thinking. Wound terminology is nuanced, and this textbook clearly outlines how we classify wounds, how we describe wounds, and the language of wound closure. Effective communication among veterinary professionals is indispensable, and understanding the terminology is the bridge that connects us in our pursuit of excellence.
The journey through this book continues with a comprehensive exploration of the initial evaluation of the patient and the wound, emphasizing the all‐important basic tenets of initial wound management, which are so critical for laying the groundwork for effective wound care. The book progresses to discussing a plethora of topical treatments, dressings, and bandages, providing insights into the latest advancements in wound care. The chapters on topical treatments and dressings, ranging from traditional to cutting‐edge biologic and regenerative therapies, exemplify the evolving nature of wound management in veterinary medicine. These exciting newer therapies hold the promise of not only accelerating healing but also improving the overall quality of the repaired tissues.
The art of reconstructing wounds is an intricate endeavor full of decision‐making, and the latter part of the textbook offers a solid guide to mastering variously shaped wounds, tension‐relieving techniques, skin flaps, and free grafting. These skills are critical in the pursuit of a robust wound closure with excellent functional outcomes, and becoming familiar with such procedures greatly improves our competence. The inclusion of a chapter covering specific wound types, including several case studies, serves as a valuable tool, guiding readers through real‐life scenarios and underscoring the unique nature of every wound and the necessity of individualized care.
Each wound, each patient, each owner, is a journey to be undertaken and a family story waiting to be told. It is our responsibility to guide that journey safely to the best possible outcome so that the story can be told well. Dr. Buote's Techniques in Small Animal Wound Management will facilitate veterinarians’ ability to be successful in this responsibility. In closing, I extend my heartfelt gratitude to Dr. Nicole Buote and the contributors of this extraordinary textbook. Your dedication to the advancement of small animal wound management is evident on every page, and your commitment to spreading knowledge and improving care is inspiring.
8 October 2023
Bryden J. Stanley, BVMS, MANZCVS, MVetSc, MRCVS, Diplomate ACVS
Preface
Since the origin of medical practice, wound management has been critical to human and animal survival. Beginning with the Barber Surgeons of Henry V through the robotic surgeons of today, the treatment of wounds has captivated students, clinicians, and researchers. Whether you are a general practitioner, an emergency doctor, or a specialist, wounds will likely comprise a consistent part of your practice. The ability to assess and successfully treat wounds is therefore one of the most important skills you as a veterinarian can possess. The treatments available for wounds are as varied as their causes, and the complexity of their management is often challenging, leaving clinicians either elated or frustrated. These cases test a doctor's examination skills, clinical decision‐making, and client communication. Clinicians of all experience levels require up‐to‐date information to ensure the best outcomes for their patients.
Even if wound management is a daily occurrence in your practice, the volume of new information published on a yearly basis can be overwhelming. There are already amazing resources on the biology of wounds and reconstruction techniques. We hope to complement these texts with the most current information in clinically relevant, easy‐to‐read sections. This textbook offers a depth of anatomy and physiology knowledge that is emphasized with clinical case examples and specific treatment recommendations in an effort to provide “something for everyone.” Some information, such as the stages of wound healing, wound terminology, and initial evaluation, is a requirement for any text on wounds and can be found within; but we have added in‐depth chapters on the anatomy of tissues most often affected by wounds and common complications that clinicians are likely to encounter to provide important clinical context. Many authors in this book are leaders in the field, publishing ground‐breaking research on the treatments they discuss and providing insight from years of experience. On a specific note, this textbook includes 14 chapters on specific wound types, delivering detailed information about unique wound characteristics, treatment recommendations, and prognosis. While some chapters necessarily delve into advanced techniques (e.g. hyperbaric oxygen therapy, negative pressure wound therapy, stem cells, etc.), this text also includes hundreds of photographs and illustrations describing the basics of bandaging, drain placement, and the reconstructive techniques a recent graduate may need.
As wound treatments continue to evolve, so will this book, and we hope the online resources and videos add value for our readers. It is my intent to add updated references and product lists on a yearly basis to supplement the information contained in this textbook in between editions since wound management changes rapidly. I believe that giving back to the veterinary community is important; therefore, a portion of the proceeds from the sale of this book will be donated to the Association of Women Veterinary Surgeons (AWVS, www.awvs.org), an organization intent on supporting female surgeons and house officers to ensure they succeed and thrive. A textbook of this type is not produced solely by the editor, and I want to extend my deepest gratitude to every contributor for their tireless work as well as many of my colleagues at Cornell University who provided chapters, pictures, drawings, and encouragement. The time and energy spent to better prepare students, residents, and our colleagues is well worth it, and we hope this textbook helps you care for your patients and clients for years to come.
Knowing what must be done does away with fear.
−Rosa Parks
Nicole J. Buote, DVM, DACVS‐SA
ACVS Founding Fellow Minimally Invasive Surgery (Soft Tissue)Associate ProfessorDepartment of Clinical Sciences,Small Animal Surgery Section,Soft Tissue Service,Cornell University School of Veterinary Medicine,930 Campus Road,Ithaca, NY 14853, USAE‐mail address:[email protected]
About the Companion Website
This book is accompanied by a companion website:
www.wiley.com/go/buote/wounds
The website includes:
Videos that are supplementary to the script.
1The Skin
M.S. Amarendhra Kumar
Department of Medical Education, Tufts University Schools of Medicine and Dental Medicine, Boston, MA, USA
The integument comprises the skin and its appendages (referred to as the adnexa), including structures such as hair, glands, digital pads, and claws [1–3]. The adnexal structures are of epidermal origin; they are continuous with the epidermal layer of the skin, supported by the underlying connective tissue.
Skin: The skin (cutis) is one of the body's largest and most important organs, for it forms a protective layer against the external environment and plays a crucial role in homeostasis. It is composed of three layers [4], the epidermis, dermis, and hypodermis (or subcutis), all firmly attached to each other. Important differences between cats and dogs exist (Table 1.1) and effect the healing properties and treatment options available when managing injuries. Skin transmits various stimuli from the external environment to the central nervous system (CNS). The nerve fibers carrying these stimuli penetrate the tissues (muscles and fascia) underlying the hypodermis and travel to the CNS, often within the fascial planes that ultimately merge with the periosteum of the appendicular and axial skeletal elements (Figure 1.1). Fascial planes form distinct compartments for individual muscles in many regions of the body. The skin's vascular components travel by similar routes and are responsible for maintaining body temperature within physiologic limits and regulating systemic blood pressure.
Epidermis: The epidermis of the skin is avascular and serves as the outermost protective layer of the body (Figure 1.2). It minimizes trans‐epidermal water loss, prevents invasion by infectious agents and other harmful substances, absorbs ultraviolet radiation by the melanocytes, and aids in Vitamin D biosynthesis. The basic structure of the epidermis is similar in all domesticated mammals with some minor regional and species differences. The thickness of the epidermis is inversely proportional to the density of the hair coat. In dogs and cats, since most of the skin surface is covered with hair, the epidermis is relatively thin. In the dog, the epidermis consists of two to three layers of living cells increasing to 10 layers [5–7] while in the cat, the epidermis is slightly thinner. The average time for epidermal turnover is 22 days in carnivores regardless of the thickness of the epidermis [8, 9]. Dermal papillae are small fingerlike extensions into the epidermis, surrounded by rete ridges of the epidermis. These two structures interlock with each other, anchoring the epidermis. Epidermal rete ridges are absent in most of the skin in carnivore skin due to the dense haircoat [10, 11]. The hair follicles extend into the dermis, firmly anchoring the epidermis. In sparsely haired regions such as the scrotum, inguinal, and axillary areas, the epidermis is slightly thicker and epidermal rete ridges may be observed. The term glabrous skin is applied to areas devoid of hairs, such as the nasal plane, lips, and genitals as well as parts of the limb extremities such as digital pads. These regions may have several layers of living keratinocytes, prominent basement membranes, and form epidermal rete ridges [10].
The epidermal layer rests upon a meshwork of extracellular fibers (dermal–epidermal junction) upon which the keratinocytes rest, called the basement membrane (or basal lamina), which is acellular and avascular (Figure 1.2). If the basement membrane is disrupted, as with a skin wound, other cells (such as activated fibroblasts and neutrophils) will pass through it from beneath to participate in healing processes, forming scars, extending capillary loops, and developing granulation beds. Otherwise, the basal lamina remains impassable. Beneath it is the dermis, the vascularized second layer of the skin.
Nonkeratinocytes: Several cell types are contained in these two major layers of the skin (the epidermis and dermis). The most common cells within the epidermis are keratinocytes, making up 85% of all epidermal cells. The nonkeratinocytes account for approximately 15% of the epidermis and include the melanocytes, tactile epithelioid cells (Merkel cells), and intraepidermal macrophages (or Langerhans cells). Melanocytes are derived from neural crest cells. Dendritic cells (DCs) are a heterogeneous group of antigen‐presenting leukocytes with a common origin that play an important role in the activation of the immune system. These cells have potent antigen‐presenting capabilities with characteristic dendritic morphology. Three main cutaneus DC populations have been described: intraepidermal Langerhans cells (LCs), dermal myeloid DCs, and dermal plasmacytoid DCs (pDCs). The intraepidermal macrophages (Langerhans cells) are interspersed among the much more numerous keratinocytes (Figure 1.3) and act as antigen‐presenting cells [13]. The LCs are one type of antigen‐presenting DCs involved in cutaneus hypersensitivity reactions. They are capable of inducing antiviral‐specific immune responses in vivo[14]. The LCs survey the epithelium constantly for pathogens and migrate to the lymph nodes where they present microbial antigens to T‐cells. This results in developing tolerance and maintaining tissue homeostasis [15]. Langerhans cells in the skin are continuously replenished from circulating bone marrow precursors [16, 17]. There is steady‐state migration of LCs to skin‐draining lymph nodes, perhaps to induce and maintain tolerance to cutaneus antigens. Their number in the epidermis is small compared to keratinocytes, and they are largely present in the upper stratum spinosum.
Figure 1.1
