Bubbles is a 5 year old cat who was brought in to us when her owner discovered a large wound on her right hind leg. On closer examination the Vet concluded that the wound would need to be sutured, however, due to the position of the wound on the leg she would not be able to close it fully and so it would need to be dressed and allowed to heal by second intention.
In normal skin, the epidermis (outermost layer) and dermis (inner or deeper layer) form a protective barrier against the external environment. Once that protective barrier is broken, the normal process of wound healing is immediately set in motion. This occurs in a variety of stages.
Within the first few minutes of an injury to the skin, platelets start to adhere to the injury site and eventually form a clot which stops further bleeding. This is followed by the inflammation stage where bacteria and cell debris are removed from the wound by white blood cells, a process known as phagocytosis. Once this stage of healing has occurred granulation tissue starts to form causing the wound to contract and begin to close or shrink. In order for the wound to contract cells, known as myofibroblasts, ‘grip’ the wound edges and contract using a mechanism similar to that of cells found in smooth muscle.
It is at this stage that we are able to visibly see the wound beginning to close or shrink; however the wound is still susceptible to ‘break down’ as any infection will interrupt the healing process and delay it until the infection has been treated. This is why many wounds are bandaged and why the dressings must remain dry – any water on the outside of the dressing will absorb through the layers of the dressing and remain there until the dressing is next removed; this is a perfect environment for bacteria in which to grow.
Bubbles’ initial surgery took place on the 9th of October 2014, after which she was given a course of antibiotic and pain relief/anti-inflammatory tablets, but she was not discharged until the 12th of December showing just how important time and patience is when dealing with wounds.
When we initially started to dress Bubbles’ wound we applied Manuka honey, a honey specifically formulated to help wounds heal quicker, directly onto the wound itself, we then covered it with a Melolin patch and then dressed the leg fully. When dressing a leg you must always start at the bottom end of the limb and work upwards and not dress it too tightly – this is to encourage normal circulation and to prevent any pooling of body fluid in the wrong places which can become very uncomfortable and delay the healing process. The first layer of dressing (base layer) is a soft Soffban dressing, this is then covered with a conforming layer called Knitfirm and is followed by the final protective layer; this is the fun layer – you can pick any colour or pattern you like! We often use the animal print bandages which owners, and we, like to look at – it’s the best way to get a sympathy vote!
In Bubbles’ case we changed her dressings every four to five days, this can vary depending on the wound, but if we were to change a dressing too often then any new cells could potentially be disturbed and delay healing.
As mentioned before, time and patience are both needed when treating wounds and helping them to heal; we repeated Bubbles dressings until the wound was closed enough to leave the dressing off completely. Because the skin was still fragile at this stage Bubbles had to wear a buster collar to prevent her from licking the wound and potentially causing it to break down.