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Hard to heal wounds: dealing with the problematic wound
Abstract
Wounds are encountered on a daily basis when working within veterinary practice, with the vast majority going on to heal without any issue. Some wounds however, may have issues in healing and these can pose a challenge for clinicians. There are numerous reasons for wounds not to heal; these can include patient factors, such as underlying disease, aetiology, and poor nutrition, but also surgical factors, such as haemotoma formation and infection. This article looks at the underlying causes of delayed wound healing and what action can be taken in terms of both prevention, and treatment.
In order to deal with wounds effectively it is essential that veterinary staff have a good understanding of the normal processes involved in wound healing. In all wounds, irrespective of their aetiology, the healing process will generally be the same.
There are three main phases to wound healing: haemostasis and inflammation, proliferation, and maturation and remodeling.
Whenever dealing with a wound consideration should always be given to the fact that normal wound healing phases are interlinked and can be affected by a variety of patient, environmental and surgeon factors, e.g. the systemic health of the patient, wound environment. Also when dealing with feline wounds the clinician should be reminded that they will heal differently to canine wounds as they have different cutaneous vascular supply, and their granulation tissue production, epithelialisation and overall healing times will be decreased (Demetriou and Stein, 2011).
When considering the closure of wounds, the timing of closure can be assigned to various categories. First either primary closure or first intention, whereby the wound is immediately sutured closed at the time of creation, e.g. following mass removal, or where a clean wound or clean-contaminated wound has been debrided and is deemed suitable for immediate closure without tension. The classification for open wound healing includes:
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