Principles of wound healing

Wound healing can be divided into immediate (zero to 1 hour), early (1 to 24 hours), intermediate (1 to 7 days), and late (greater than 7 days) stages. Many physical and physiologic events occur simultaneously and sequentially during these stages to produce the final wound scar. The processes of skin retraction, scab formation, would debridement, wound contraction, epithelial migration and proliferation, fibroplasia, and collagen maturation all must occur for healing to be successful. Many factors affect the size and shape of the resulting scar, including anatomic location and skin tension forces, systemic condition of the patient, blood supply to the wound, nutritional factors, environmental temperature, the presence of systemic drugs, wound infection, motion, wound oxygen gradient, wound moisture, and bandaging. Ideally, each of the factors would occur at a level compatible with optimal healing, but, in many clinical cases, one or more factors compromise normal, rapid healing. When we intervene with therapy, we probably adversely affect another factor in healing, while trying to correct the factor that is out of balance. In these decisions, the effects of our treatment on wound healing should be considered. The trade-off should be weighed and the treatment pursued only as long as necessary to allow healing to progress; then it should be discontinued or changed. With these considerations, it is hoped that we can attain healing at the most rapid physiologic rate.     

Wound healing after mulesing and other options for controlling breech flystrike in Merino lambs: quantitative and semiquantitative analysis of wound healing and wound bed contraction

Background A two‐part study examined wound healing and contraction occurring after mulesing and two alternative methods of preventing breech flystrike in sheep. Objective To quantify wound healing using a scoring system and to assess the contractility of the wound bed of the breech after mulesing, cetrimide‐intradermal treatment and application of clips. Method The study group of 30 mulesed, 30 cetrimide‐intradermal treated, 30 control and 10 clip‐treated sheep were humanely killed at six time points from 3 to 47 days after each treatment. Wound healing post treatment was assessed using a scoring system, and contractility was assessed by the quantification of myofibroblast expression. Statistical analyses allowed comparisons of temporal wound healing and contraction between treatment groups. Results Mulesing wounds healed faster in the first 11 days, but by 19 days wound healing was similar between the mulesing and cetrimide‐intradermal groups. By 32 days, all three treatment groups had similar wound healing scores. There was greater myofibroblast expression in the mulesing group in the first 11 days after treatment, but by 19 days expression was similar in both the mulesing and cetrimide‐intradermal groups. The clip group had significantly less myofibroblast expression from 32 days after treatment. Conclusion Wound healing is initially most rapid after mulesing, but there are similar wound healing scores in the mulesing and cetrimide‐intradermal treatment groups by 19 days. Both mulesing and the cetrimide‐intradermal treatment induce a similar amount of wound bed contraction, with less contraction observed after application of clips.     

Broiler responses to feeds formulated with or without minimum crude protein restrictions and using supplementall-valine andl-isoleucine

Comparisons of corn-soy-feeding programs formulated using different protein constraints were done in the present study. A total of 1,800 one-day-old, slow-feathering Cobb × Cobb 500 male broiler chicks were placed in 72 floor pens of 25 birds each with 9 birds/m². Feeding programs (PRG) were composed of prestarter (PST,1–7 d), starter (ST, 8–21 d), grower (GR, 22–35 d), and finisher (FN, 36–43 d) diets formulated as: PRG 1 = CP restricted to a minimum (22.4, 21.1, 19.8, and 18.4% for PST, ST, GR, and FN, respectively) with amino acid-to-Lys ratios only set for TSAA (0.72) and Thr (0.65); PRG 2 = CP not restricted, whereas ratios of amino acids to Lys were also extended to Val (0.77) and Ile (0.67); PRG 3 and PRG 4 were the same as PRG 2, but withl-Val added in PRG 3 andl-Val andl-Ile in PRG 4. Feeds were formulated to have digestible Lys of 1.324, 1.217, 1.095, and 1.006% for PST, ST, GR, and FN, respectively, or 5% higher. A completely randomized design was used with a 4 × 2 factorial (4 PRG and 2 digestible Lys) design with 9 replications per treatment. Overall, no interactions between PRG and digestible Lys were observed, with 1 exception observed for BW gain and FCR from 36 to 43 d. Birds fed PRG 2 showed improvements in BW gain and FCR when fed the diet 5% higher in digestible Lys. Cumulative BW gain and FCR results at 35 and 43 d, as well as in each individual feeding phase, showed broilers from PRG 2 having the best results, but without mean separation significant differences when compared with PRG 3 and 4. Feeding a dietary program with a 5% increase in digestible Lys resulted in improved cumulative FCR only when cumulatively measured from placement to 43 d. Abdominal fat, as a percentage of the eviscerated carcass at 43 d, was lowest for birds fed PRG 2 diets. Formulation of diets having traditional recommendations of digestible Lys with Val- and Ile-to-Lys ratios of 0.77 and 0.67, without restricting CP, led to the best results overall in performance and fat pad deposition; therefore, if the goal is to reduce CP, similar results should be achieved by addingl-Ile with further reductions in protein ifl-Val is also added. Data obtained in this study support the applicability of supplementation withl-Val andl-Ile when ideal AA ratios are followed.     

一种新型伤口处理剂对仔猪去势伤口处理的效果实证

在猪场中,正确的伤口处理对于伤口的恢复具有重要的意义。为了研究新型伤口处理剂对仔猪去势伤口的效果,特选取5～7日龄533头公仔猪,分为两组。试验组利用常规碘酊消毒去势后喷洒新型伤口处理剂,对照组则按常规操作单纯碘酊消毒。而后分别记录每天伤口恢复情况以及去势后15 d内表现关节肿的去势公仔猪比例。结果表明:新型伤口处理剂可以减少伤口出血,促进去势伤口的愈合,减少细菌通过伤口感染猪只的几率。     

A review of research into second intention equine wound healing using manuka honey: Current recommendations and future applications

In addition to the generic properties of honey, manuka honey has a nonperoxide antimicrobial activity largely attributed to methylglyoxal. Commercially, manuka honey is graded against a standard antiseptic, phenol, to provide a measure of antimicrobial activity referred to as the unique manuka factor (UMF). The higher the UMF, the greater the antimicrobial activity. However, more recently, there is evidence that manuka honey can also modulate the initial inflammatory response through activation of toll‐like receptor 4 on monocytes to enhance production of cytokines important in tissue repair and regeneration. Recent studies investigating the effects of manuka honey on second intention healing of lower limb wounds in horses have shown that wounds treated with UMF 20 manuka honey retracted less and healed faster than untreated wounds. Using this wound healing model, the primary effects of manuka honey appeared to be associated with the modulation of the initial inflammatory reaction rather than its antimicrobial effects. Based on the current knowledge, treatment with manuka honey should be instituted as soon as possible after injury. Where bacterial contamination is substantial, manuka honey with a UMF ≥15 should be used. While bandages will improve the contact between the honey and the wound and may be indicated in the early stages of wound healing, prolonged bandaging may lead to the production of excessive granulation tissue. If topical treatment without a bandage is to be used, more honey is not necessarily better. Using a thin film combined with regular application, contact times may be optimised. Application 2–3 times daily to open wounds may improve efficacy. Manuka honey should be applied for at least 21 days after wounding but there may be beneficial effects if it is applied until wound healing is almost complete.     

Principles of wound management of small mammals: hedgehogs, prairie dogs, and sugar gliders.

The management of wounds is a common scenario for the exotic animal practitioner. When presented with such cases, the practitioner must first adhere to the firmly established principles of wound healing, and then modify available treatment modalities to fit the needs of the species at hand. Practicing wound management on exotic patients can be challenging due to their small size, unusual anatomy, difficult behaviors, and tendency for developing secondary stress-related health problems. A review of the stages of wound healing as well as traditional wound management techniques is provided here. This review is followed by a summary of typical wounds encountered in hedgehogs, prairie dogs, and sugar gliders, as well anatomic, physiologic, and behavioral characteristics that should be taken into consideration when managing wounds on such species.     

Evaluation of LHP? (1% hydrogen peroxide) cream versus petrolatum and untreated controls in open wounds in healthy horses: a randomized,blinded control study

Background

Treatment and protection of wounds in horses can be challenging; protecting bandages may be difficult to apply on the proximal extremities and the body. Unprotected wounds carry an increased risk of bacterial contamination and subsequent infection which can lead to delayed wound healing. Topical treatment with antimicrobials is one possibility to prevent bacterial colonization or infection, but the frequent use of antimicrobials ultimately leads to development of bacterial resistance which is an increasing concern in both human and veterinary medicine.

Methods

Standardized wounds were created in 10 Standardbred mares. Three wounds were made in each horse. Two wounds were randomly treated with LHP^® or petrolatum and the third wound served as untreated control. All wounds were assessed daily until complete epithelization. Protocol data were recorded on day 2, 6, 11, 16, 21 and 28. Data included clinical scores for inflammation and healing, photoplanimetry for calculating wound areas and swab cytology to assess bacterial colonization and inflammation. Bacterial cultures were obtained on day 2, 6 and 16.

Results

Mean time to complete healing for LHP^® treated wounds was 32 days (95%CI = 26.9-37.7). Mean time to complete healing for petrolatum and untreated control wounds were 41.6 days (95%CI = 36.2-47.0) and 44.0 days (95%CI = 38.6-49.4) respectively. Wound healing occurred significantly faster in LHP^® wounds compared to both petrolatum (p = 0.0004) and untreated controls (p < 0.0001). There was no significant difference in time for healing between petrolatum and untreated controls. Total scores for bacteria and neutrophils were significantly (p < 0.0001) lower for LHP^® treated wounds compared to petrolatum from day 16 and onwards. Staphylococcus aureus and Streptococcus zooepidemicus were only found in cultures from petrolatum treated wounds and untreated controls.

Conclusions

Treatment with LHP^® reduced bacterial colonization and was associated with earlier complete wound healing. LHP^® cream appears to be safe and effective for topical wound treatment or wound protection.     

CLINICAL TECHNIQUE: Negative Pressure Wound Therapy-General Principles and Use in Avian Species

Negative pressure wound therapy (NPWT) is an adjunctive wound management modality that has been shown to augment the treatment of acute and chronic dermal and subdermal wounds in human and veterinary medicine. The proposed effects of NPWT are multifactorial and include improvement of wound perfusion, reduction of interstitial edema and substances inhibitory to wound healing, enhancement of granulation tissue formation, and reduction in bacterial contamination from a wound bed. Together, the proposed benefits of NWPT can lead to enhanced efficiency of wound healing when this treatment modality is applied to a wound. In this article, the authors provide an overview of the mechanism of action of NPWT. Case selection, system application and management, as well as contraindications to NPWT therapy are presented. Potential uses, practical application, and limitations of use of NPWT in avian species are discussed.     

Effects of topical application of taurolidine on second intention healing of experimentally induced wounds in rats

OBJECTIVE: To determine the macroscopic effects of topical application of taurolidine on second intention healing of experimentally induced wounds in rats. ANIMALS: 32 adult Sprague-Dawley female rats. PROCEDURES: In each rat, 2 skin wounds were created in the lumbar area. Groups of 7 rats were assigned to have 1 wound treated topically with hydroxycellulose gel (HDCG), 2% taurolidine in HDCG (T-HDCG), 2% taurolidine-sodium citrate solution, or bacitracin-neomycin-polymyxin B ointment; the other wound was not treated. Four control rats (8 untreated wounds) were used. Wounds were monitored for contraction, epithelialization, and complete healing at 4, 8, and 14 days after wound creation. The number of days to complete healing was also recorded for each wound. RESULTS: Compared with other treatments or untreated wounds, wounds treated with T-HDCG had decreased total healing at day 8 and decreased epithelialization and decreased total healing at day 14. Wounds treated with T-HDCG required approximately 3 days longer to completely heal than all other treated and untreated wounds. Application of bacitracinneomycin-polymyxin B ointment did not enhance wound healing. Mean time to complete healing of untreated wounds in all treatment and control groups was 10.00 to 10.14 days. CONCLUSIONS AND CLINICAL RELEVANCE: In rats, topical application of T-HDCG to wounds had a negative effect on second intention healing by delaying the epithelialization process. In mammals, generally, wounds treated topically with taurolidine may need to be treated and monitored for a longer period than other wounds treated with other common woundhealing compounds or untreated wounds.     

Effects of a proprietary topical medication on wound healing and collagen deposition in horses

Full-thickness skin wounds were created on the dorsum of both metacarpi in 8 horses. Three topical treatment regimens were studied. All wounds were bandaged with a nonadherent dressing, which was held in place with a snug elastic wrap. Group-A wounds were treated with a proprietary topical wound medication that consisted of a spray and an ointment. Group-B wounds were treated with the same regimen, except the putative active ingredients in the ointment were omitted. Group-C wounds were treated with a dry nonadherent bandage only. Wound dressings were changed every day and the limbs were photographed every other day until the wounds were healed. Specimens of normal skin and biopsy specimens of healed wounds were examined histologically and were assayed for hydroxyproline content. Wound healing measurements quantitated for each wound were number of days to healing, maximal wound size attained, day wound contraction commenced, day epithelium first noticed, rate of wound contraction, final wound size, and fraction of the wound that healed by contraction. The cosmetic appearance of the healed wounds was also graded. Significant differences were not noticed in hydroxyproline content, histologic appearance, or any of the wound healing measurements between treatment groups. The cosmetic appearance of healed group-A and -B wounds was significantly better than the appearance of group-C wounds. The topical treatment regimens studied neither enhanced nor inhibited wound healing in this study.     

The effectiveness of the haemodialysate Solcoseryl for second-intention wound healing in horses and ponies

Second-intention healing of limb wounds in horses is often problematic. Solcoseryl is a protein-free, standardized dialysate/ultrafiltrate (HD) derived from calf blood, which has been shown to improve healing in both animals and humans. The efficacy of HD in the healing of deep wounds in horses and ponies was investigated. Deep wounds of 20 by 35 mm were created on both metatarsi (skin, subcutis, periosteum) and on both femoral biceps muscles (skin, subcutis, muscle) of five horses and five ponies. The wounds on one side were treated with HD, four times a week during the period that the wounds were bandaged and once daily thereafter. The wounds on the other side were left untreated. In the first 4 weeks of the healing period HD stimulated healing but inhibited healing thereafter. This pattern was significant for all wound groups (P < 0.001). Because of this change in effect, the overall effect on wound healing over the entire period was not significant (P = 0.77). HD stimulated healing initially by provoking a greater initial inflammatory response, faster contraction and faster formation of granulation tissue. Subsequently, HD inhibited healing because it significantly delayed epithelialization and caused protracted inflammation. The effects of HD were most pronounced in the horses. Because this study distinguished between contraction and epithelialization, it could be shown that HD stimulated contraction but inhibited epithelialization. Therefore, HD is useful in horses for the treatment of deep wounds during the initial phase of healing by second intention, i.e. during the first weeks when wound contraction can be expected. Treatment should be ceased when epithelialization becomes predominant.     

Principles of early wound management

The unique personality of horses, combined with their environmental surroundings and the way they are used, makes them prone to a variety of injuries. As such, large animal practitioners are frequently called to examine and treat wounds on horses. Effective and proper treatment is predicated upon a reasonable knowledge of wound healing and how wound healing can be manipulated in a favorable fashion. The optimal end result includes return of full function, cosmetic healing, a short recovery period, and minimal cost to the owner. Not all of these goals are achievable in every case, but they should be kept in mind when treating all cases.     

Evaluation of dressings to aid healing of mulesing wounds on sheep

Five proprietary and one experimental dressing were compared with no treatment in their ability to aid healing of mulesing wounds in over 1900 young lambs. Healing was judged as the completeness of shrinkage of the mulesing cuts and the condition of scabs on the new skin surface. When assessed at 21 d it was found that treatment with Heriots Crown Wound Powder or Coopers Mulesing Powder offered a significant advantage over leaving the wounds untreated. Neither aqueous organophosphate washes, Defiance nor Defiance containing 0.08% chlorfenvinphos offered any healing advantage over controls. However, washing the wounds with an aqueous organophosphate solution aided healing more than the Defiance-based dressings. It was considered that the powders or the washes encouraged quick scab formation either by creating a dry covering (powders) or by washing away blood and allowing fast drying of the wound. The Defiance-type dressings slowed healing by keeping the wound moist for up to 10 d, but healing was not significantly different to the untreated group by 21 d.     

生物敷料对大鼠深Ⅱ度烧伤创面愈合的作用

为了评价生物敷料对烧伤创面的治疗效果，将SPF猪皮细化处理后制成软膏制剂，以其作为生物敷料对大鼠深Ⅱ度烧伤进行了治疗试验，对照组采用普遍油纱布敷料处理，观察烧伤大鼠创面愈合程度，记录愈合时间，并测定了大鼠在烧伤前后的血液学指标。结果显示，试验组比对照组创面愈合时问短，愈合率高，血液学指标恢复较快。     

The effects of topical oxygen therapy on equine distal limb dermal wound healing

Topical oxygen therapy (TOT) has been used in human medicine to promote healing in chronic wounds. To test the efficacy and safety of TOT in horses, an experimental wound model was created by making 1 standardized dermal wound on each limb of 4 healthy horses (n = 16). Each wound was fitted with an oxygen delivery cannula and covered with a bandage. One limb of each front and hind pair was randomly assigned to the treatment group (fitted with an oxygen concentrator device), with the contralateral limb assigned to the control group (no device). Wound area, epithelial area, and contraction were measured every 3 to 4 d. Biopsy samples and culture swabs were taken on days 16 and 32 to evaluate angiogenesis, fibroplasia, epithelial hyperplasia, inflammation and bacterial growth. Mean healing time in treated wounds (45 d, range: 38 to 52 d) was not significantly different from that in the paired control wounds (50 d, range: 38 to 62 d). Topical oxygen therapy had little effect on dermal wound healing in this experimental wound model in healthy horses.     

Healing of dehorning wounds

Open wound healing following dehorning using a wire saw was observed in 25 cattle aged between 1 and 5 years. Initially, there was a marked thickening of the scab over the wound as a ridge near the skin margin. A pale yellow to pink membrane then developed from the sides of the frontal sinus opening. Granulation tissue formed to fill the frontal sinus opening before healing by epithelization, followed by wound contraction. In some animals a bony horn stump projecting about 2-3 mm above the wound surface appeared which underwent osteosis; the dead bone gradually loosened and fell off during the healing process; histological sections revealed the presence of numerous osteoclasts lining the bone spicules. The presence of the frontal sinus and the stump of the horn processes left after dehorning are factors that make the healing of an open dehorning wound unique compared with other wounds.     

Surgical correction of ear curling caused by scar tissue formation in a horse

An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses.     

Effect of a single acupuncture treatment on surgical wound healing in dogs: a randomized,single blinded,controlled pilot study

Background

The aim of the study was to investigate the effect of acupuncture on wound healing after soft tissue or orthopaedic surgery in dogs.

Methods

29 dogs were submitted to soft tissue and/or orthopaedic surgeries. Five dogs had two surgical wounds each, so there were totally 34 wounds in the study. All owners received instructions for post operative care as well as antibiotic and pain treatment. The dogs were randomly assigned to treatment or control groups. Treated dogs received one dry needle acupuncture treatment right after surgery and the control group received no such treatment. A veterinary surgeon that was blinded to the treatment, evaluated the wounds at three and seven days after surgery in regard to oedema (scale 0-3), scabs (yes/no), exudate (yes/no), hematoma (yes/no), dermatitis (yes/no), and aspect of the wound (dry/humid).

Results

There was no significant difference between the treatment and control groups in the variables evaluated three and seven days after surgery. However, oedema reduced significantly in the group treated with acupuncture at seven days compared to three days after surgery, possibly due the fact that there was more oedema in the treatment group at day three (although this difference was nor significant between groups).

Conclusions

The use of a single acupuncture treatment right after surgery in dogs did not appear to have any beneficial effects in surgical wound healing.     

Comparison of the effects of the CO2 surgical laser and conventional surgical techniques on healing and wound tensile strength of skin flaps in the dog

OBJECTIVE: To determine if CO(2) laser was superior to conventional surgical techniques (CST) for creation of skin flaps in dogs as determined by hemostasis, wound healing, and wound tensile strength. STUDY DESIGN: In-vivo model ANIMALS: Six large, mixed-breed dogs. METHODS: On each dog's trunk, 3 pairs of identical, dorsally based, pedicled skin flaps were created and sutured back into position. Based on a Latin Square design, flaps on one side were created with a CO(2) laser and on the other side by CST. Intraoperative hemorrhage was measured by weighing sponges used to absorb blood. On days 7, 10, and 14, specimens from the flap-skin junction and the central portion of each pair of flaps were collected. Specimens were subjected to tensile strength testing and histologic examination to evaluate wound healing. RESULTS: Mean (+/- standard error of mean [SEM]) hemorrhage was significantly less (P =.02) with CO(2) laser (4.70 +/- 1.37 g) than CST (10.82 +/- 1.37 g). Wound tensile strength (N/m(2)) after CST (0.49 +/- 0.049) was significantly greater (P =.01) than with CO(2) laser (0.17 +/- 0.049). Laser incisions had partial necrosis of the wound edges and a more extensive inflammatory response; however, healing of the wound beds were similar regardless of technique. CONCLUSIONS: The CO(2) laser provided better intraoperative hemostasis than CST. However, overall healing and increase in tensile strength of the skin-flap junction of the flaps created by the laser may be delayed during the first few weeks of wound healing. CLINICAL RELEVANCE: Skin flaps used to repair large skin defects in dogs can be created and elevated with a CO(2) laser. In areas of increased skin mobility or tension, skin flaps created with CO(2) laser may be more susceptible to complications such as dehiscence, and care should be taken to minimize these complications.     

Effects of 4-chloro-2,6-bis-(2-hydroxyl-benzyl)-phenol on healing of skin wounds and growth of bacteria

In this investigation, the effects of synthesized 4-chloro-2,6-bis-(2-hydroxyl-benzyl)-phenol (CBHBP) on cutaneous wound healing and growth of some of the wound contaminating microorganisms were studied. The antibacterial effects of this compound were then evaluated on Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli) and Klebsiella spp., using solid dilution method. It was demonstrated that CBHBP has a significant antimicrobial activity against S. aureus but it is not effective in the case of other microorganisms studied in this experiment. The effect of local administration of CBHBP on healing of a standard full-thickness 2 cm skin incision of skeletally mature rats was evaluated. Histological changes together with mechanical properties and dry weight content of the healing tissues at the site of the lesions were assessed in treated and untreated animals. It was observed that the injured area of the treated animals was more organized and showed more fibroblasts and less inflammatory cells. Much better maturation criteria in treated tissues were observed in comparison with those of the untreated ones which contained numerous polymorphonuclear inflammatory cells after 14 days post-injury. Many infiltrated macrophages and lymphocytes were present even 28 days after injury induction in the haphazardly organized dermis and also in subcutaneous tissues of the untreated animals. The percentage dry weight content of the treated lesions at 14 days post-injury was remarkably higher than those of the untreated animals. The results of biomechanical tensile testing showed that the ultimate tensile strength and stress of the injured skin of the treated animals were higher than those of the untreated ones. From these results, it could be concluded that CBHBP can be effective on wound healing and may be considered as a treatment regimen after evaluating its mechanism of action as well as testing its contraindications.