List of Contributors xv
Foreword xvii
Preface xix
About the Companion Website xxi
1 The Skin 1
M.S. Amarendhra Kumar
Cutaneus Immune Barrier 3
Pigmentation 5
The Normal Keratinization Process 11
The Abnormal Keratinization Process 12
Dermis 15
The Hypodermis (Subdermis or Subcutis or Superficial Fascia) 17
Connective Tissue and Fascia 23
Skeletal Muscle 26
Skeletal Muscle Trauma and Regeneration 28
References 30
2 Physiology of Wound Healing and Clinical Considerations 37
Daniel J. Lopez
Stages of Wound Healing 37
Proliferative Stage 41
Inherent Detriments to Wound Healing 46
Conclusion 49
References 49
3 Postoperative Complications 53
Ryan P. Cavanaugh
Introduction 53
Seromas 54
Wound Dehiscence (Indolent Pockets, Pseudo Healing) 57
Biofilms 65
References 68
4 Wound Types and Terminology 73
Desiree D. Rosselli
Classifications of Veterinary Wounds 73
Wound Closure 80
References 82
5 Patient Presentation and Evaluation of Wound 85
Colin Chik
Initial Stabilization of the Wound Patient 85
Acute Critical Wound Patients 85
Stable and/or Chronic Wound Patients 89
Evaluation of Patient Factors 90
Evaluation of Wound Factors 92
Initial Treatment 93
Decision-Making for Primary Closure 95
Debridement 95
Drain and Bandage Placement 98
References 101
6 Cleansing Solutions 103
Julia P. Sumner
Cleansing Solutions 103
Tap Water 106
Isotonic Intravenous Crystalloid Fluid Preparations (e.g., 0.9% Saline, Lactated Ringer’s Solution, Hartman’s Solution, Plasmalyte, Normosol) 106
Antiseptic Solutions 106
References 109
7 Topicals 111
Nicole J. Buote
Hydrogels 111
Zinc-Oxide Hydrophilic Pastes 113
Honey/Sugar 114
Antimicrobials (Nitrofurazone, Triple Antibiotic, Silver Sulfadiazine) 117
Triple Antibiotic (Neomycin, Polymixin B, and Bacitracin) 118
Silver Sulfasalazine 119
Oxygen 120
Nitrous Oxide 120
Miscellaneous Topicals 121
References 123
8 Wound Dressings 127
Nicole J. Buote
Moist Wound Healing 127
Characterization of Dressings 127
Adherent Dressings – Woven Gauze and Lap Sponges 131
Non-adherent Semiocclusive (Porous-Dry or Petrolatum-Impregnated) 132
Absorbent 133
Moisture Retentive Dressings 135
Antimicrobial 138
Bioelectric Dressings 141
Xenograft Dressings 143
Miscellaneous 149
References 150
9 Drains: How and When to Place Them 155
Angela C. Banz
Passive Drains 155
Closed-Suction/Active Drains 158
References 163
10 Vacuum-Assisted Bandages (Negative Pressure Wound Therapy) 165
Kathryn A. Pitt and Bryden J. Stanley
Physiology 165
Increased Granulation Tissue 165
Reduced Bacterial Load 166
Increased Blood Flow 167
Decreased Hematoma and Seroma Formation 168
Increased Cytokines/Growth Factors 168
Microdeformation with In-Vitro Modeling 168
Indications of NPWT 168
Description of Technique 169
Postoperative Care 173
Outcomes/Complications 173
References 174
11 Biologic Treatments 177
Subsection A: Medicinal Leech Therapy 177
Celine S. Kermanian and Nicole J. Buote
Anatomy and Physiology 177
Indications 179
Description of Technique 181
Postoperative Care 185
Outcomes/Complications 186
References 188
Subsection B: Maggot Therapy 191
Megan Mickelson
Background/Physiology 191
Indications 192
Description of Technique 193
Post-Procedural Care 195
Outcomes/Complications 196
References 200
12 Bandages 205
Kristin A. Coleman and Nicole J. Buote
Introduction 205
Light or Modified Robert Jones Bandage 205
Wet-to-Dry or Dry-to-Dry Bandages 208
Tie-Over Bandages 210
References 214
13 Hyperbaric Oxygen Therapy 215
Cheryl Braswell
Introduction 215
Physiology 215
References 224
14 Low Level Laser, Photobiomodulation and Electromagnetics for Wound Therapy 225
Nicole J. Buote
Low Level Laser Therapy 225
Photobiomodulation 226
Pulsed Electromagnetic Field Therapy 228
References 231
15 Platelet Rich Plasma and Stem Cell Therapy 233
Aarthi Rajesh, Rebecca M. Harman, and Gerlinde R. Van de Walle
Platelet Rich Plasma (PRP) Therapy 233
Stem Cell Therapy 241
Combinational Therapy Using PRP and Stem Cell Therapy 246
References 247
16 Reconstructive Techniques for Wounds 253
Jill K. Luther and Nicole J. Buote
Equipment 253
Basic Tissue Handling Tenants 256
Skin Tension 257
Tension-Relieving Techniques 258
Triangular, Square, Rectangle Wounds 264
Circular and Crescentic Wounds 266
Skin Flaps 267
Specific Axial Pattern Flaps 272
Skin Grafting 281
References 285
17 Specific Wounds 289
Subsection A: Bite Wounds – A Case Study 289
Nicole J. Buote
Presenting Signs 289
Examination and Initial Wound Characteristics 289
Diagnostics 289
Initial Therapy and Procedure 289
Follow-up Bandage Care 290
Surgical Procedure 292
Outcome 292
Prognosis 292
Clinical Lessons 293
Subsection B: Penetrating Wounds 295
Galina Hayes
Clinical Presentation 295
Triage and Imaging 297
Management Plans 298
Prognosis 301
References 301
Subsection C: Abscess Case Study 303
James D. Crowley and Julia P. Sumner
Presenting Signs 303
Outcome 305
Prognosis 305
Subsection D: Burns 309
Galina Hayes
Clinical Presentation 309
Anatomy and Physiology of Burns 309
Comparative Aspects of Burn Physiology 309
Acute Management Plan 310
Bandage Management 312
Split Thickness Grafts 312
Possible Complications 313
Future Directions 313
Prognosis 313
References 314
Subsection E: Wounds Over Joints 315
Galina Hayes
Clinical Presentation 315
Specific Challenges 315
Management Plans 316
Prognosis 317
References 319
Subsection F: Shearing Wounds – Case Study 321
James D. Crowley
Presenting Signs 321
Outcome 323
Prognosis 323
Subsection G: Necrotizing Fasciitis (Necrotizing Soft Tissue Infections) 327
Nathan Peterson
Presenting Signs 327
Wound Characteristics 327
Physiologic Effects 328
Shock/Sepsis 329
Prognosis 332
References 332
Subsection H: Snakebites 335
Nathan Peterson
Presenting Signs 335
Wound Characteristics 335
Physiologic Effects 337
Treatment 339
Possible Complications 340
Prognosis 340
References 342
Subsection I: Pythiosis 343
Kristin A. Coleman
Introduction 343
Presenting Signs 343
Diagnosis 344
Wound Characteristics 344
Physiologic Effects 345
Treatment 345
Possible Complications 349
Prognosis 349
References 349
Subsection J: Eyelid Wounds 351
Brian Marchione
Introduction 351
Presenting Signs 352
Physiologic Effects 354
Treatment 354
Possible Complications 356
Prognosis 359
References 359
Subsection K: Lip Wounds 361
Nicole J. Buote
Introduction 361
Anatomic Considerations 361
Wound Characteristics 362
Surgical Treatments 362
Avulsion Injuries 365
Primary Repair 365
Wedge Resection Techniques 365
Full-Thickness Advancement Flaps Full-Thickness 365
Postoperative Care 367
Complications 369
Prognosis 369
References 369
Subsection L: Pinna Wounds 371
Nicole J. Buote
Anatomic Considerations 371
Wound Characteristics 371
Surgical Treatments 372
Postoperative Care 374
Complications 376
Prognosis 377
References 377
Subsection M: Circumferential Wounds – A Case Study 379
Nicole J. Buote
Introduction 379
Case 1 379
Other Examples of Circumferential Injuries 383
Case 2 383
Case 3 383
Clinical Lessons 384
References 385
Subsection N: Preputial Reconstruction – Hypospadia Case Study 387
Galina Hayes
Presenting Signs 387
Examination and Wound Characteristics 387
Diagnostics 387
Surgical Procedure 387
Outcome 388
Prognosis 388
Clinical Lessons 388
Index 393