Episode 12 - The Return of the Wound Queen

In this episode John, Sue and Paul welcome Georgie Hollis back to the platform for the second half of their discussion of all things wound-related.

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SHOW NOTES

Intro

(00:14) John re-introduces the ‘Queen of Wounds’ conversation from last episode’s part one.

Chapter 1 – Debridement or indeed 'debridement' in French

(01:00) Sue asks about biofilms and how she would suggest dealing with this slime over the wound. Georgie touches on diabetic foot ulcers and uses a pepper analogy for bacteria, saying a sprinkling of bacteria like pepper on the chips is where you can shake the chips and the pepper comes off. Colonisation is where the pepper is sticking to the chips and isn’t going to move, and biofilm is where the pepper has now forming its own protein coat around it and the vinegar is not going to penetrate it.

So, biofilm formation is an important consideration as the body can’t remove them – it is hard to see them and know when you have them and so it is hard to know if you have removed them. You can use some antiseptic solutions to help remove these such as hypochlorous or PHMVs.

(03:35) Sue asks about honey and whether this is helpful. Georgie says honey is useful for wounds with yellow debris, as this has some properties to remove dead tissue and so is a debriding agent as well as an antiseptic. So using the yellow stuff on the yellow wounds, which gets rid of the bioburden and then the antiseptic gets rid of the contamination.

(05:27) John asks about debridement and when you would do this. Georgie says debridement gets rid of non viable tissue, where it had been damaged and the blood supply has been cut off – this is protein rich material and the bacteria will eat this and therefore you don’t want it in the wound. Manual removal of as much as possible using a scalpel under anaesthetic or with products such as honey, called autolytic debridement which uses osmosis by using sugar to draw out the dead stuff much like a poultice

(07:24) Sue asks about medical maggots and Georgie says these rather than autolytic debridement magots use enzymatic debridement where you use enzymes to break down dead tissue. So the maggots vomit the enzyme protease into the wound and this makes a protein soup which they then eat and then they poo into the wound which has been shown to have beneficial effects on granulation tissue.

(08:41) John asks then whether this pushes the owners again to go to the vet to make the decision as to whether debridement is necessary. Georgie agrees and says this goes further, where there may be different times when this is necessary, talking about a process of demarcation; so it may not be that you can tell which part of the wound is going to die and need debridement straight away.

This is an important consideration, because you don’t want to cut off skin which may still be viable, meaning that it still has a blood supply and could play an important role in reducing the size of the wound.

Chapter 2 - Dressings

(10:03) Sue asks about what considerations there are with selection of wound dressings and Georgie says you need three boxes in the cupboard.

1) dressings that help you debride, and clean the wound up and help it granulate.

2) dressings that donate moisture, to stop the wound drying out – citing a study from 1962 be George Winter which showed from pigs with wounds left open to the air that they healed 30-50% slower that wounds kept moist and covered. All of our modern selection of dressings is based upon this principle of keeping the wound moist as a result of this understanding, and it is important that these dressings are left in place long enough for the wound to heal, as changing the dressing too regularly can remove cells regenerated on the wound.

3) dressings that absorb moisture absorb exudate and hold moisture to the wound as long as possible to aid healing, such as super absorbent foam dressings for large wounds. So, this is a balancing act and an art, selecting the dressing according to the type of wound and what any given wound is doing at any given time. For example, in the inflammatory, early stage there is a lot of exudate as the white blood cells work on the wound and then as the wound begins to granulate it starts to dry and a different dressing would be needed. There are many factors which will affect when and how a wound will be at each stage and Georgie lists some of these in context of areas and breeds and species.

(15:07) John asks if there are any tips on bandaging difficult areas and Georgie says there are and cites an example, a good product is a fingertip gauze you can tape on to protect the tail and John mentioned dog ends as a product on the veterinary market for this. Georgie stresses the important of anchoring this to the tail and describes this.

Chapter 3 – Georgie’s 10 Top Tips

(17:44) John asks for Georgie’s top ten hints for caring for wounds.

1. Nominate a wound nurse, to look after dressings and help people in the practice.
2. Be sure to lavage a wound and as soon as possible.
3. Don’t use toxic antimicrobials in wounds as discussed.
4. Organise the dressing cupboard in ways as discussed.
5. Chuck out sudocreme! Georgie feels there are better products out there.
6. Review bandaging techniques as this might not be the best.
7. Don’t use honey out of a jar, medical grade honey should be used, as there could be contamination in a jar of honey for food.
8. First aid kit, having a salt solution in a water bottle and hypochlorous and get your pet to the vet as soon as possible.
9. Puncture wounds can be serious.
10. Sue says if it isn’t working ask for help, whether an owner, nurse or vet. As muddling on isn’t on the animal’s best interest, and Georgie wholeheartedly agrees.

(24:51) Sue asks about sustainability and how sustainable wound care is and Georgie has been thinking about this recently. Wound dressing manufacture for example is a factor, citing that manuka honey being derived from New Zealand, shipped to the UK for manufacture and then shipped back to New Zealand. She also talks about the repeat use of a Robert Jones bandaging as a huge use of recourses and sustainability gives a good reason to use a cast for this bandage type.

Outro

(29:39) John wraps up the conversation with a final-off-the-wall question and Georgie plugs a friend’s company which sustainably repairs surgical equipment Fix Your Kit