Wound healing is a complex, multi-phase process, influenced by the local wound environment, wound type and the patient’s general health. The success of each phase depends on the completion of the preceding stages, so early, proactive intervention is crucial to prevent complications. However, wound healing is rarely a strictly linear process, with phases often overlapping as the wound progresses. Broadly, the physiological stages include:
Clotting phase: Haemostasis initiates with blood vessel constriction and the formation of a fibrin clot.
Inflammatory phase: Characterised by leucocyte influx to the injury site, lasting about 72 hours in healthy wounds (longer if the wound is contaminated).
Proliferative phase: Angiogenesis occurs, with granulation tissue forming, followed by epithelialization.
Maturation phase: Tissue remodelling takes place as fibroblasts re-organize along lines of tension.
While most wounds heal uneventfully and are rarely life-threatening, complications such as infection, wound breakdown, and pressure sores can pose significant challenges. These complications not only cause discomfort for pets but also increase costs and client dissatisfaction. Wound healing is complex, and complications can arise even with diligent care.
Causes of wound complications
The wound healing process - and therefore the risk of complications such as infection, wound breakdown, or delayed healing - can be affected by both systemic and local factors. Patients with compromised health, such as those who are diabetic, hypothyroid, or immunocompromised, may have a reduced ability to heal. Additionally, patient interference with wounds is a common challenge, particularly in active or anxious animals. Using suitable dressings, secure bandaging techniques, and close monitoring can help minimize these risks and support a smoother healing process.
However, while bandages are invaluable in preventing patient interference and protecting wounds, if not applied correctly, they can also cause significant issues including circulation compromise, pressure sores and delayed wound healing.
Role of dressings in wound healing1
- Prevent patient interference
- Protect the wound
- Control haemorrhage
- Prevent further trauma
- Prevent wound desiccation
- Absorb exudate
- Control infection
- Mechanical debridement
Patient selection
Different approaches to wound management may be required depending on the breed, species or underlying medical conditions. Cats, for instance, have fewer cutaneous perforating vessels compared to dogs, resulting in slower wound healing and around 50% less skin suture breaking strength in the first week after injury.2 In cats, granulation tissue also forms more slowly than in dogs and it often progresses circumferentially rather than across the wound bed.3 These species differences may make cats more susceptible to delayed wound healing. A further point to note is that second intention healing occurs by contraction of the wound edges in cats, whereas in dogs, wounds close from central pull and epithelialisation.
Thin-skinned breeds, like greyhounds, are especially prone to skin injuries due to their delicate skin. Similarly, patients with specific conditions, such as acquired skin fragility syndrome (often secondary to hyperadrenocorticism4), are more likely to experience complications.
Tip: When treating patients with specific healing characteristics, such as cats or thin-skinned breeds, tailor the wound care plan to account for these factors.
Wound Cover: choosing the correct dressing
Selecting an appropriate wound dressing is crucial for supporting wound healing and minimizing complications. The choice of dressing should reflect the wound's type, healing phase, and level of contamination and it should be placed with attention to sterility:
- Wet-to-dry dressings: can be beneficial in the initial stages, particularly for non-surgical debridement of contaminated or highly exudative wounds. Debriding dressings should be avoided in wounds that already have a healthy bed of granulation tissue.
- Non-adherent dressings: In clean wounds or during later healing phases, non-adherent dressings support the formation of granulation tissue and help to reduce tissue trauma during dressing changes.
- Moisture-promoting dressings: Hydrocolloid or hydrogel dressings add water to the wound bed. They are useful for dry or necrotic wounds but should not be used in highly exudative wounds.1
Tip: Regularly assess the wound's condition and adjust the dressing choice as necessary to create a healing environment suited to the current wound phase, preventing complications and promoting efficient recovery.
First Layer: support and comfort
The first layer is essential for securing the wound dressing, providing comfort to the area / patient and wicking moisture away. Proper padding within this layer enhances patient comfort and prevents complications such as rubbing, abrasions, and pressure sores. This layer should be applied evenly, with no creases or lumps, considering the bandage location. For example, joints or bony prominences, such as the olecranon or calcaneus, often require extra padding attention to protect against pressure injuries.
Tip: Bandage donuts, properly secured to avoid slipping, can help protect bony prominences by distributing pressure more evenly.
Second layer: support
The second layer provides the support required and is there to achieve the end goal of the bandage. Conforming bandages are ideal for this layer, as they are able to be applied at the correct tension and conform to the body contours extremely well. Conforming bandages contain a widthways and lengthways elasticity to aid correct application. However, they can easily become too tight if not applied correctly, especially around pressure points and bony prominences. The resulting ischaemic injury can lead to neurological compromise, issue necrosis and even limb loss. It is important to note that even with appropriate bandaging technique, constriction can arise due to swelling of the affected area and regular monitoring is essential.
Third layer: bandage security
The third layer is used to secure the bandage. It needs to be applied so as to prevent the bandage from slipping off but avoiding constriction or ischaemic injuries. While stirrups can help prevent slipping, they should not be relied upon as a substitute for properly fitted bandages or correct bandaging technique.
Tip: Stretch the bandage and release it before placing it on the patient.
Tip: When securing casts or additional support layers, use the palm of your hand rather than your fingers to support the limb to prevent indentations in the padding or cast, which could lead to pressure points.5
Extremities: to cover or not?
Particular attention should be paid to paws, digits and tail tips and when bandaging limbs, beginning at the toes and continuing proximally, as this helps to prevent pooling of blood / fluid into the distal limb. If the whole paw is included in the bandage, care should also be taken to pad between the toes and under the dew claw. On immobilisation bandages, such as a Robert Jones, it is often recommended to leave some of the paw visible or easily accessed for easier monitoring of circulation.
Tip: If toes are exposed leave enough visible to assess distal limb circulation – the pads and nails of digits 3 and 4 are usually sufficient.5
Top tips for owner education
While much of the responsibility for ensuring optimum wound healing and a good clinical outcome lies with the clinician, owners also play a vital role. One of the key aspects of care is ensuring that the bandage remains clean and dry. It is also prudent to make sure owners know the signs to look out for that may indicate a problem with the bandage or wound. For instance, if the pet is licking or chewing at the bandage, it could signal discomfort, pain, or an issue with the dressing. Most (but not all) serious issues develop within 24 to 48 hours of bandage application and any pet that is showing behaviour of this nature should be checked without delay.
Tip: Book a bandage check appointment before the owner leaves the clinic.
In conclusion
Preventing wound complications relies on a good understanding of the wound healing stages, proper dressing choice, and skilled bandaging techniques. Tailoring care to each patient’s needs and ensuring secure, comfortable bandages can significantly reduce risks, improve clinical outcomes and contribute to client satisfaction.
References
- Winkler, P. Wound bandages and dressings for small animals. (2023) MSD Veterinary Manual
- Gouletsou, P.G. et al. (2024) First-Intention Incisional Wound Healing in Dogs and Cats: A Controlled Trial of Dermapliq and Manuka Honey. Vet Sci. 1;11(2):64
- Bohling, M.W. et al. (2004) Cutaneous wound healing in the cat: a macroscopic description and comparison with cutaneous wound healing in the dog. Vet Surg. Nov- 33(6):579-87
- Grant, D. (2016) Ehler-Danlos syndrome (cutaneous asthenia, dermatosparaxis). Improve Veterinary Practice
- Harper, T. (2017) Bandaging Complications. Clinician’s Brief.
