- In nearly all cases, open wounds should be bandaged to protect the wound from contamination and support the wound while it heals. In most cases, mechanical debridement is desired (i.e., in most wounds after initial management has been performed, with varying degrees of contamination or infection), so use an adherent dressing. Once a healthy granulation bed has formed, convert to a non-adherent dressing.
- The most common adherent dressing is a wet-to-dry bandage, consisting of sterile gauze sponges that are saturated with sterile saline, gently wrung to eliminate excessive moisture, and the applied directly to the wound. Over the wet dressing, several dry gauze sponges are applied. In large wounds, laparotomy sponges may be optimal to cover more wound bed.
- The most common non-adherent dressing is a semi-occlusive cotton pad (e.g., Telfa®) that retains moisture against the wound bed and ‘wicks‘ exudate from the surface of the wound.
- Use topical silver sulfadiazine ointment or triple-antibiotic ointment on most wounds.
- Apply a secondary layer over the primary layer. Most commonly, rolled cast padding or roll cotton is used to provide support. Splints can be included in the secondary layer, if used.
- Apply a tertiary layer, typically consisting of non-adherent conforming bandage, adhesive bandage, or both. This layer holds the dressing and secondary layer in place, provides additional support, and provides more durable protection of the underlying layers. In most cases, the tertiary layer is applied just tight enough to hold the bandage in place, and without compression.
- Change bandages at least once daily. More frequent bandage changes may be necessary if the wound has a heavy discharge or the bandage becomes soiled or partially removed by the MWD. Once wound discharge is reduced and a healthy granulation bed has formed, bandage changes become less frequent, generally every 2-3 days.
- Any MWD with a bandage applied must be prevented from chewing at the bandage. A plastic bucket with the bottom cut out can be used to prevent self-trauma can be attached to the dog‘s collar as an effective prevention practice (See Figure 21 and Figure 22).
- Negative pressure wound therapy (NPWT; e.g., WoundVac®) has proven a viable treatment modality for wounds in dogs, but requires proper training to apply properly to dogs and frequently heavy sedation of the MWD to prevent disruption of the dressing. HCPs with experience with NPWT are encouraged to consult with supporting veterinary personnel if this treatment modality is considered necessary before the MWD is evacuated to a veterinary facility. In most cases, application of NPWT can be delayed until the MWD is evacuated to a veterinary facility for long-term care.
- A “tie-over” bandage should be used in locations that are difficult to place a bandage, such as the inguinal area, dorsum, hip, and flank. Routine bandages placed in these areas typically slip off, and fail to protect the wound. A tie-over bandage consists of the same layers of bandage material, whether adherent or non-adherent, placed within and over the wound in a packing fashion. Multiple suture loops are placed around the periphery of the wound in the skin, evenly spaced around the wound, using large (2-0 or larger) monofilament suture material. The wound is then covered with a portion of impermeable drape or similar material. The bandage is then secured using umbilical tape or similar material laced through the suture loops (see Figure 44). Ties of surgical masks are a good substitute if umbilical tape is not available. The ties should be sufficiently tight to hold the bandage in place, with mild tension on the suture loops. The covering layer should be snug over the top of the underlying layers. A tie-over bandage will not have a compression layer.
Figure 44. Tie-Over Bandage