Wednesday, March 2, 2016
When collagen is an optionIn veterinary medicine there is a growing trend to select ‘biological’ dressings that create a physiological interface between the wound surface and the environment. Collagen dressings, such as Cyprofil (Pioneer Vet Products) are therefore a real option in the management of hard to heal wounds in dogs and cats See Case study 3.A 5-year-old male Lhasa Apso presented to our specialist veterinary hospital with a 4 cm diameter soft tissue sarcoma on his caudal elbow that required surgical excision. The surgery was initially successful however the wound dehisced and open wound management was started using wet-to-dry dressings, changed on a twicedaily basis. Cultures of the wound revealed a profuse growth of Streptococcus canis, sensitive to amoxicillin clavulanate, so open wound management was continued in combination with oral antibiotics. The wound, located over the olecranon, was in a difficult area to allow primary closure using the adjacent skin due to tension. It was therefore important that a healthy and clean granulation bed of tissue was obtained to enable a thoracodorsal flap placement. A Cyprofil collagen dressing was selected following control of the infection because of the known effects on inflammatory mediators and the proliferation phase of wound healing in addition to the structural support that it provides to the wound bed. The dressing was cut to the size of the wound, facilitating multiple uses of one dressing and applied directly onto the wound bed. The dressing was then secured with a secondary and tertially dressing layer. The collagen dressing was changed every 3 days. The wound was not inspected between these changes to allow integration of the dressing with the wound surface.Eight days later the wound bed had a healthy bed of granulation tissue that was free of infection. Surgery was performed at this point and a thoracodorsal axial pattern flap was elevated to close the wound. This is the first report of the use of a collagen dressing to support a wound prior to the transfer of an axial pattern flap in the dog. The flap healed successfully and at the last re-examination, a year following surgery, the patient was clinically well with no evidence of tumour recurrence or wound problems.Collagen was selected in this wound once the infection had resolved, as the function of collagen in infected wounds is unknown. However once infection had been controlled the benefits of the collagen in this particular case were: the integration with the wound surface, the non toxic and non-irritant properties and the promotion of a viable and healthy bed of granulation tissue that was suitable for flap transfer. The low frequency of bandage changes was also beneficial as it allowed the maintenance of a moist wound environment while reducing the risk of exposure to further infection. In this case the dressing selected was collagen type 1 of fish origin (Cyprofil, Pioneer Vet Products), a licensed product in dogs.1.The soft tissue sarcoma.2.The infected wound just after dehiscence.3.Day 3 of the collagen dressing.4.Day 8 just prior to skin flap.5.Following the thoracodorsal skin flap.6.4 weeks after surgery.
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