by Mark C. Robinson, founder/president of Walkin’ Pets and inventor of Walkin’ Wheels dog wheelchair
Wound healing is not an isolated process – it is intricately connected to your pet’s overall health. A thorough general health check up is key to good management of this condition. Nutrition and mental health are key components to healing that should not be overlooked. A high-protein, high-carbohydrate diet with vitamin supplements is advocated to provide adequate nutrition.
Decubital ulcers are strongly associated with chronic, diffuse, systemic pain. Unlike a sharp, acute pain, this type of pain is difficult to diagnosis in animals. A veterinary consultation is important in alleviating this in your pet.
Since these types of ulcers are related to the skin and tissue not receiving enough oxygen and nutrients, the relief of pressure is the foundation of treatment. Healing the wound itself is the next concern. Don’t allow the dog to lie on pressure sores. Use foam pads or pillows to take pressure off the sore. A donut works especially well for the dog’s hips. Try not to let the dog rest on the hip bone on one side for very long (no longer than 2 hours optimally )
Stage I ulcers with signs of impending skin breakdown may require no dressing. Moist wound treatment is now the standard approach for all secondary healing wounds (such as pressure sores) with tissue formation. There have been many studies with human beings comparing the benefits of wet or dry wound management. The current medical research supports moist wound management. It has been shown that the formation of granulation tissue without scarring (replacement tissue) can only take place in a moist wound environment. Maintaining this environment is therefore the most important task of a wound dressing in this phase. In pets, this involves making certain that the area around the pressure sore is clipped, so that any bandaging is properly adhered to the skin.
Although there are many proponents of allowing the ulcer to drain and heal in the open air, this method will lead to greater scarring of the area, and proud tissue (an unwanted proliferation of epithelial cells) is more likely to develop.
An ulcer heals itself by forming replacement, or granulation tissue. This is often what makes the healing process the most difficult. The area must be kept completely free of pressure throughout the entire healing process so that enough blood reaches the area. The wound itself must never be allowed to dry out, if it does the cells necessary for vascularization die. A moist environment promotes the growth of these cells. Hydroactive wound dressings (available from your veterinarian) are made of see-through film and a hydrocolloid dressing A hydrocolloid dressing stays on for several days at a time and is a bandage made of a gel that molds to the pressure sore. They make it possible to keep the wound permanently moist.
The area must be protected against both chemical and physical irritation at this point in the healing process. Great care should be used if antiseptic is still being used around the edges of the wound. Carefully avoid physical damage to the area from skin tears from rough handling or bandages that are too sticky . As a general principle, powders, pastes and ointments should not be introduced into open wounds as they can interfere with wound assessment and impair fluid and gas exchange. Daily whirlpool use can be helpful to irrigate and mechanically débride the wound.
Differentiation of bacterial infection from simple contamination is best made by your veterinarian with a tissue biopsy. This will indicate whether antibiotics should be administered . Although the topical use of antiseptics for a short period of time is still recommended, the use of antibiotics is controversial. Using antibiotics may increase antibiotic resistance and allergy development and also dramatically changes the pathogens in the area. It’s also difficult to get the antibiotic deep enough inside the wound to positively effect treatment. Of course, systemic antibiotics are still recommended with an aggressive infection, and limited use of topical antibiotics is often prescribed in the beginning stages of treatment. When bone or deeper tissue is infected, intravenous antibiotics (given through a needle put in a vein) are often required.
Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore with saline solution every time you change the bandage is helpful.
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the edges of the sore. It may take 2 to 4 weeks of treatment before you see these signs of healing.
It’s important to keep the animal’s weight off the pressure sore until it is fully healed. Even after skin closure, the area will be significantly weaker than the rest of the animal’s skin, and close inspection of the area and supervision of the animal is warranted.
Diseases such as diabetes and hardening of the arteries can make it hard for ulcers to heal because of a poor blood supply to the area. Watch the area around the hips, elbows and knees closely for discoloration.