Wound closure: what you need to know

Well I did it again… where I set out to write a blog post and it ended up being just shy of 2000 words. I know that is a lot of content, so we are breaking this up in a two-part segment. This is a continuation of our last blog post, where we talked about the importance of closing and covering your dog’s cuts and lacerations.

Again (quick reminder) your three-step process to wound management is 1) clean it, 2) close it, 3) cover it. And this applies to MOST wounds you will encounter…. There are always exceptions to the rule, because…

Covering and closing cuts and lacerations can be the simplest and at the same time most complicated process. Unfortunately, when it comes to the extent of the wound, the patient, and the healing process- each and every case is going to be different. Therefore, I cannot give you a one size fits all hack, tip, or trick when it comes to wound management and the final two steps to be your dog’s first responder in the event of a cut or laceration.

So, you cleaned it as the first step, and we already talked about why you need to close it then cover it. Let’s discuss a few techniques on how to make this happen in a safe and effective manner.

And because we are confined to the pages of this blog post we are going to try to keep this as simple as possible. We cover the nitty gritty details of wound management in our membership site. So, if you want to be the first to know when we open back up for enrollment click here to get on our waiting list.

 

For the purposes of this blog post we are going to talk about closing and covering a simple, superficial, and clean- non contaminated wound. Meaning only the outer skin layer is compromised. If the underlying layers are compromised (meaning you might be seeing fat or muscle underneath) there is potential that we may develop secondary complications by simply closing it externally.

 

So, the deeper the wound, the higher the risk of infection, the slower the healing process, and the potential need for multiple layers of sutures to bring everything back together. BUT if you are remote- this approach is still going to be better than nothing until you can get to higher care.

 

Note: this blog post assumes that the laceration is NOT hemorrhaging. If it is, getting the hemorrhage to stop is your first priority. We can discuss this in further depth in the future, but for now you should know to apply firm direct pressure with absorbent material and do not lift the material from the wound to “peak” or check if the wound is still bleeding, as this will disrupt the clot. As the blood soaks through add additional absorbent material to the top instead of removing the saturated material, again to prevent disrupting the clot.

 

So, first step: Clean it.

I am assuming you already know how to clean it, if you need a refresher revisit this blog post.

 

Second step: Close it. Here is how.

Your three options for closing a wound (if you decide to do so) consist of the following:

  • Gluing
  • Stapling
  • Suturing

Because stapling and suturing require more advanced training, they are a bit beyond the scope of this blog post. If you would like more detailed information on these practices, again we cover that in the WD membership site and community.

Gluing however, (a wound that is superficial, clean, non-contaminated, has stopped bleeding and has minimal discharge) can be very effective. It is also relatively inexpensive and is a piece of equipment that does not take up much space in your med kit.

I know an ER doc (the human kind) that glues superficial lacerations on people with krazy glue. I, however am fancy and prefer Vetbond by 3M. I use it nearly every time I perform a surgery, or with superficial cuts and lacerations that I see in clinic.

There are pros and cons to this approach of using a tissue adhesive or Vetbond that must be considered, however:

The pros of using Vetbond include:

  • It is very quick. You can literally bring the skin edges together, apply it, and allow it to dry in about 15 seconds and you are done.
  • It does not require any advanced training. Literally by reading this blog post this is something you can do -and do it safely without doing any harm- as long as the pre stated conditions apply (superficial, non-contaminated wound, not hemorrhaging)
  • VetBond is easily accessible and fairly inexpensive. – roughly $20 dollars on amazon
  • Its multi-use, you can use it on yourself. Perhaps use it for gear repair?… the sky is the limit.

 

The cons of using Vetbond:

  • Less effective for deep wounds
  • If the wound is hemorrhaging or oozing excessively it’s less effective
  • Once used the tip can become clogged- as long as you have something sharp on you – you can usually get it unclogged
  • Keep an eye on the expiration date, it may lose efficacy
  • For wounds with tension (think tight with less skin to close -on pads or lower limbs for example)- it will be less effective

The good news is, is if you combine the use of Vetbond with a bandage you can mitigate some of the cons listed above. For example, a bandage combined with Vetbond can help the skin edges stay together in a laceration closure that has some tension, and reduce the amount of blood or bodily fluid oozing from the wound- which all aid in its efficacy.

 

So how do you use it?

After you have stopped all bleeding and oozing, gently press the skin edges together with your fingertips and apply a thin layer of the Vetbond where the skin edges meet. It is somewhat watery, so it spreads easily. Wait 15-30 seconds while holding the skin edges together to allow the glue to dry and to seal. Take care to only use externally. Do not use inside the wound.

Also take care not to glue you fingers to the dog, as when you pull away you can reopen the laceration.

So now that our skin edges are together, and our wound is closed we want to cover it.

We will be covering that next week, along with some bandage material alternatives… for those of you who might be concerned about space and weight. We will also be briefly touch on bandage technique for those of you who need a refresher.

So, until next week, let me know if you have any questions about the material we have covered so far!

Libbie Fort, DVM

 

1 comment

Cathy Brockway

Is there a way to remove it if you do accidentally stick your fingers together – or glue yourself to your dog? I know how I operate with Superglue and it’s not a pretty picture.

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