What You Should and Should Not Put In or On
a Wound
Dean A. Hendrickson, DVM, MS, DACVS
There are many different dressings and potions marketed for treating equine wounds. Not all of
them have evidence of safety or efficacy. It is prudent to understand what effect the dressing will
have on the wound before using it. Author’s address: Colorado State University, Fort Collins, CO
80523; e-mail: dean.hendrickson@colostate.edu. © 2015 AAEP.
1. Introduction
The main concept in wound cleaning is to remove the necrotic tissue and other debris from the wound,
while also reducing the bacterial load. The reduc-
tion in necrotic debris and bacteria will help the
wound to heal more effectively, both functionally
and cosmetically. Consequently, it is important to
choose a technique that does not cause more necrosis
and subsequent bacterial growth. Every cleaning
agent and technique will cause some trauma to the
wound. It is therefore important to weigh the cost
to benefit of the technique prior to starting. In
essence, the benefit of a clean wound must be
weighed against the trauma that the agent will
cause. Cleaning agents will generally cause some type of
chemical trauma leading to cellular toxicity. The
most biocompatible cleaning agent should always be
chosen to limit the toxicity to the wound bed. Var-
ious cleaning agents will be discussed further in this
section. Human chronic wound healing groups
have a saying: you should not put something in a
wound that you would not be willing to put in your
eye. It is a great way to consider limiting the
trauma associated with most of our wound-cleaning agents. I think this is especially true in the field of
veterinary medicine where we are often entrenched
in historical use of cleaning agents and techniques. Cleaning techniques also have the potential to
cause trauma to the wound bed. Most techniques
will cause some type of mechanical trauma to the
wound. This is especially true when mechanical
forces such as scrubbing or high-pressure lavage are
used. The trauma to the tissue left behind must be
considered when choosing a cleaning technique. The hope is that the veterinarian will choose wisely
when selecting wound-cleaning agents and tech-
niques so that wounds will heal quickly and
effectively.
2. Saline (Isotonic and Hypertonic)
Isotonic saline has been shown to be as effective as
1% povidone-iodine (PI) in reducing infection rates
in the human emergency room.
1 Although the iso-
tonic nature is gentle to the wound bed and unlikely
to cause necrosis of the surrounding tissue, isotonic
saline is somewhat acidic and it may be better to use
a polyionic replacement fluid. Hypertonic saline
(20%) is very effective in reducing bacterial numbers
in the wound. However, it can be traumatic to nor-
AAEP PROCEEDINGSfiVol. 61fi2015 9
IN-DEPTH: TRAUMA/WOUND MANAGEMENT
NOTES