A clinical audit to identify factors contributing to surgical wound healing complications
Abstract
This clinical audit investigated the potential effect of a range of factors on wound healing success in a mixed sample of 285 cats and dogs post ovariohysterectomy in a practice that had noticed healing complications in some patients. Patient records over 18 months from 2008-2009 were included in the study. Factors investigated included skin, muscle and subcutaneous suture material, differences between species and age, the use of an Elizabethan collar, post-operative antibiotics and whether the individual veterinary surgeon performing the surgery affected the incidence of healing complications. Statistical testing included risk-ratio analysis, Chi Square test and Fisher's exact test. The use of catgut in muscle and subcutaneous tissue was found to significantly increase the risk of healing complications (
Wound management forms an important part of small animal practice and is an area that is continually reassessed in light of new techniques and recommendations. Regardless of the dynamic approaches to managing wounds, the aims of such management are to repair the wound, relieve pain and distress, use financially viable procedures that are time efficient and to recognize delayed healing and take prompt action (Anderson, 1996). These aims apply whether the wound was caused by a surgical incision or trauma, and whether primary or secondary healing is deemed appropriate. In addition to pre-operative preparation, veterinary nurses also play a fundamental role in the post-surgical management of the wound, both of which contribute greatly to reducing wound infection rates. Veterinary nurses should also extend their role by educating and supporting owners in managing the wound appropriately at home.
Primary closure should theoretically only be used where the wound has been created in an aseptic manner (Anderson, 1997) and this technique is therefore appropriate for clean surgical wounds, such as those involved in routine neutering. Depending on the degree of initial contamination, primary closure may also be deemed appropriate in certain cases, such as a recently lacerated pad. However, in this study, only routine ovariohysterectomy cases were used to assist in controlling variables. Three suture materials were involved: Polyglactin 910 (Vicryl, Ethicon, Livingston, Scotland); AK Catgut (Animus Surgical Ltd, Suffolk) and Nylon (Nylon, Ethilon, Ethicon). Polyglactin 910 and AK Catgut are both absorbable suture materials; polyglactin 910 is degraded by hydrolysis, whereas enzymes and phagocytosis degrade catgut (Niles and Williams, 1999). Nylon is non-absorbable although it is affected by slow hydrolysis (Niles and Williams, 1999). Therefore polyglactin and catgut can be used for subcutaneous and muscle suture while nylon is suitable only for skin closure.
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