Initial Wound Management Recommendations

Provide effective analgesia or anesthesia (see K9 Analgesia and Anesthesia) based on wound severity, location and other factors. See Table 1.1-7

1. The goal of initial lavage is to remove gross contaminants and reduce bacterial burden.

- Apply sterile water-soluble lubricant liberally on the wound bed and then clip the hair with wide margins around the wound.
- Gently cleanse the skin around the wound, but not the wound bed, with surgical scrub (such as chlorhexidine gluconate or povidone-iodine).
- Gently lavage the lubricant and gross contaminants from the wound using a sterile isotonic solution (such as normal saline or Lactated Ringer’s Solution). Tap water can also be used in austere conditions for wound lavage to remove debris when saline or LRS is not available, as studies have shown no increase in wound infection rate when compared to saline.8

2. Debride grossly necrotic tissue and non-viable tissue (see Figure 1) carefully using aseptic technique and sharp dissection with a scalpel blade or scissors. Do not mass ligate tissues or use excessive cautery – this leads to necrosis. Use caution not to damage, transect, or ligate major blood vessels (unless active hemorrhage) or nerves.

Figure 1. Example of appearance of non-viable skin tissue in a dog following a bite wound injury.

3. Lavage of the wound is necessary to remove debris and reduce bacterial contamination. The solution to pollution is dilution.

- Low pressure, high-volume irrigation with bulb and syringe or gravity irrigation with large bore tubing are common options for wound irrigation.
  - 7 – 8 psi is recommended for wound irrigation and can be achieved by placing a 1-liter bag of fluids in a pressure cuff at 300 mmHg and attaching a hypodermic needle (16 to 22 gauge) to an extension line.5
- High pressure irrigation with pulsatile jet lavage irrigation may be available and can reduce bacterial contamination but can also result in tissue damage.9
- A standard volume for irrigation is not reported, but a general guideline reported in literature is 50 to 100 mL per centimeter of wound length.10
  - For wounds involving open fractures, common volumes include approximately 3 liters for Type I fractures, and 3-6 liters for Type II and III fractures, sometimes using as much as 9 liters for Type III fractures.11

4. Generally, contaminated and dirty/infected wounds should not be sutured until healthy granulation tissue is established, in about 3 to 5 days. This is especially true for bite wounds.

Table 1. Management of open or necrotic wounds in MWDs.