Wounds
Wounds
The two most important goals in treating wounds are to stop the bleeding and
to prevent infection. Wounds are painful, so be prepared to restrain and muzzle the dog before treating the wound.
CONTROLLING BLEEDING
Bleeding may be arterial (bright red blood will spurt out) or venous (dark red
blood will ooze out), or sometimes both. Do not wipe a wound that has
stopped bleeding, as this will dislodge the clot. Similarly, don’t pour hydrogen
42 • DOG OWNER’S HOME VETERINARY HANDBOOK
peroxide on a fresh wound. Peroxide dissolves clots and starts a fresh round of
bleeding. It may also damage the tissues and delay healing.
The two methods used to control bleeding in an emergency situation are a
pressure dressing and a tourniquet.
Pressure Dressing
The most effective and safest method for controlling bleeding is to apply pressure
directly to the wound. Take several sterile gauze squares (or, in an emergency,
use any clean cloth such as a thickly folded pad of clothing) and place over
the wound. Apply direct pressure for 5 to 10 minutes. Leave the dressing in
place and bandage snugly. If material for bandaging is not available, hold the
pack in place until help arrives.
Watch for signs of swelling of the limb below the pressure pack (see Foot
and Leg Bandages, page 47). This indicates impaired circulation. If you see
these signs, the bandage must be loosened or removed. Consider adding more
bulk to the pack and apply a second bandage over the first. Transport the dog
to a veterinary hospital.
Tourniquet
Tourniquets can be used on the extremities and tail to control arterial bleeding that can’t be controlled with a pressure pack. Tourniquets should never be
used if bleeding can be controlled by direct pressure. Always place the tourniquet
above the wound (between the wound and the heart).
EMERGENCIES • 43
A tourniquet should be used only if
bleeding cannot be controlled with a
pressure dressing. The tourniquet is
looped twice around the leg . . .
. . . and tightened by twisting
A suitable tourniquet can be made from a piece of cloth, belt, tire, or length
of gauze. Loop the tourniquet around the limb as shown in the photo on page
43. Then tighten it by hand or with a stick inserted beneath the loop. Twist
the loop until the bleeding stops.
A tourniquet should be loosened every 10 minutes to prevent tissue hypoxia
and to check for persistent bleeding. If bleeding has stopped, apply a pressure
bandage as described in the previous section. If bleeding continues, let the blood
flow for 30 seconds and then retighten the tourniquet for another 10 minutes.
TREATING WOUNDS
Nearly all animal wounds are contaminated with dirt and bacteria. Proper
care and handling will reduce the risk of tetanus and prevent many infections.
Before handling a wound, make sure your hands and instruments are clean.
The five steps in wound care are:
1. Skin preparation
2. Wound irrigation
3. Debridement
4. Wound closure
5. Bandaging
Skin Preparation
Remove the original pressure dressing and cleanse the area around the wound
with a surgical scrub solution. The most commonly used solutions are
Betadine (povidone-iodine) and Nolvasan (chlorhexidine diacetate). Both
products are extremely irritating to exposed tissue in the concentrations provided in the stock solutions (Betadine 10 percent, chlorhexidine 2 percent),
so be very careful that the solution does not get in the wound while scrubbing
the skin around it. Dilute the solution to weak tea color for Betadine or pale
blue color for Nolvasan.
Three-percent hydrogen peroxide, often recommended as a wound
cleanser, has little value as an antiseptic and is extremely toxic to tissues.
After the scrub, start at the edges of the wound and clip the dog’s coat back
far enough to prevent any long hairs from getting into the wound.
Wound Irrigation
The purpose of irrigation is to remove dirt and bacteria. The gentlest and
most effective method of wound cleansing is by lavage, which involves irrigating the wound with large amounts of fluid until the tissues are clean and glistening. Do not vigorously cleanse the wound using a brush or gauze pad
because this causes bleeding and traumatizes the exposed tissue.
44 • DOG OWNER’S HOME VETERINARY HANDBOOK
Tap water is an acceptable and convenient irrigating solution. Tap water
has a negligible bacterial count and is known to cause less tissue reaction than
sterile or distilled water.
If possible, add chlorhexidine solution or Betadine solution to the tap
water for antibacterial activity. Chlorhexidine has the greater residual antiseptic effect, but either antiseptic solution (not soap solutions) is satisfactory
when correctly diluted. To dilute chlorhexidine, add 25 ml of the 2 percent
stock solution to 2 quarts of water (2 l), making a 0.05 percent irrigating solution. To dilute Betadine, add 10 ml of the 10 percent stock solution to 2
quarts of water to make a 0.2 percent irrigating solution.
The effectiveness of the irrigation is related to the volume and pressure of
the fluid used. A bulb syringe is a low-pressure system. It is least effective and
requires more fluid to achieve satisfactory irrigation. A large plastic syringe
removes a moderate amount of dirt and bacteria. A home Water Pik unit
(used by people to clean their teeth) or a commercial lavage unit that provides a high-pressure stream of fluid is the most effective.
A garden hose with a pressure nozzle for the initial lavage, or a kitchen sink
spray unit, followed by one of the methods just described to deliver the antiseptic, is a good alternative. You want to flush and clean the wound, not force
dirt deeper into the tissues. Angle your flow of liquid to accomplish that and
let the fluid pool to bring debris to the surface.
Debridement
Debridement means removing dying tissue and any remaining foreign matter
using tissue forceps (tweezers) and scissors or a scalpel. Debridement requires
experience to determine the difference between normal and devitalized tissue,
and instruments to control hemorrhage and close the wound. Accordingly,
wounds that require debridement and closure should be treated by a veterinarian.
Closure
Fresh lacerations on the lips, face, eyelids, and ears are best sutured or stapled
to prevent infection, minimize scarring, and speed recovery. Lacerations
longer than half an inch (1.25 cm) on the body and extremities probably
should be closed, but small lacerations may not need to be. Small V-shaped
lacerations heal best if they are closed.
Wounds contaminated by dirt and debris are quite likely to become
infected if closed at the time of injury. These wounds should be left open or
sutured around a drain that can be used for through-and-through irrigation.
Similarly, wounds older than 12 hours should not be closed without drainage.
Suturing or stapling should be avoided if the wound appears to be infected (is
red, swollen, or has a surface discharge).
Your veterinarian may decide to close a wound that has been left open for
several days and has developed a bed of clean tissue. Wounds that are clean
after several days are resistant to infection and usually can be closed with
EMERGENCIES • 45
impunity. Suturing such a wound is
called delayed primary closure.
The length of time sutures or staples
should remain in place depends on the
wound’s location and other characteristics. Most sutures and staples can be
removed after 10 to 14 days.
Puncture Wounds
Puncture wounds are caused by bites
and pointed objects. Animal bites, in
particular, are heavily contaminated
with bacteria. Bleeding may occur.
There may also be bruising, particularly if the dog was picked up in the
teeth of a bigger dog and shaken.
Puncture wounds are often concealed
by the dog’s coat and may be easily
overlooked until an abscess develops a
few days later.
Treatment of a puncture wound requires a veterinarian. It involves surgically enlarging the skin opening to provide drainage, after which the area is
irrigated with a dilute antiseptic surgical solution. These wounds should not
be closed. If there is a large, open wound area, parts of the wound may be
sutured with a drain left in place to allow air to get in and discharge to
drainage. With all animal bites, keep in mind the possibility of rabies. If it is a
bite wound from an unknown animal, a rabies booster may be needed.
Antibiotics are frequently prescribed for bite wounds and wounds that are
heavily contaminated, such as puncture wounds.
Home Treatment
Small open wounds can be treated at home without sutures or staples.
Medicate twice a day with a topical antibiotic ointment such as triple antibiotic. The wound can be left open or covered with a dressing. Make sure the
dog is not constantly licking it. You can cover the area with a sock or a T-shirt
to keep the dog away from the wound.
Infected wounds that are draining pus require the application of moist sterile compresses. A number of topical antiseptics are effective in treating superficial wound infections. They include chlorhexidine and Betadine (diluted as
described in Wound Irrigation, page 44), Furacin (both the topical cream and
0.2 percent solution), 1 percent Silvadene cream, and topical antibiotics containing bacitracin, neomycin, and polymyxin B (triple antibiotic). Apply the
topical antibiotic directly to the wound or place it first on a gauze pad.
Change the dressing once or twice a day to facilitate pus drainage.
46 • DOG OWNER’S HOME VETERINARY HANDBOOK
A wound sutured around a drain allows
for through-and-through flushing.
BANDAGING A WOUND
Wounds may be left open or bandaged, depending on their location and other
factors. Wounds on the head and neck are often left open to facilitate treatment. Many wounds of the upper body are difficult to bandage and do not
benefit greatly from being covered.
Bandaging has the advantage of protecting the wound from dirt and contaminants. It also restricts movement, compresses skin flaps, eliminates pockets of serum, keeps the edges of the wound from pulling apart, and prevents
the dog from biting and licking at the wound. Bandaging is most effective for
wounds to the extremities. In fact, nearly all leg and foot wounds can benefit
from a bandage.
Dressings over draining or infected wounds must be changed once or twice
a day. The bandage should be bulky enough to absorb the drainage without
soaking through.
Foot and Leg Bandages
To bandage the foot, place several sterile gauze pads over the wound and
secure with surgical adhesive tape. Be careful not to make the tape too tight.
To secure a foot dressing, you will need to continue the bandage up the leg.
For leg wounds, cover the wound with sterile gauze pads. On top, pad the
entire leg with plenty of cotton so the dressing won’t become too tight and
interfere with the circulation. Wrap first with roll gauze, then wrap the leg
with elastic tape or bandage, as shown in the photographs on page 48. Your
veterinarian or a veterinary technician can show you the best way to bandage
a particular wound.
EMERGENCIES
The two most important goals in treating wounds are to stop the bleeding and
to prevent infection. Wounds are painful, so be prepared to restrain and muzzle the dog before treating the wound.
CONTROLLING BLEEDING
Bleeding may be arterial (bright red blood will spurt out) or venous (dark red
blood will ooze out), or sometimes both. Do not wipe a wound that has
stopped bleeding, as this will dislodge the clot. Similarly, don’t pour hydrogen
42 • DOG OWNER’S HOME VETERINARY HANDBOOK
peroxide on a fresh wound. Peroxide dissolves clots and starts a fresh round of
bleeding. It may also damage the tissues and delay healing.
The two methods used to control bleeding in an emergency situation are a
pressure dressing and a tourniquet.
Pressure Dressing
The most effective and safest method for controlling bleeding is to apply pressure
directly to the wound. Take several sterile gauze squares (or, in an emergency,
use any clean cloth such as a thickly folded pad of clothing) and place over
the wound. Apply direct pressure for 5 to 10 minutes. Leave the dressing in
place and bandage snugly. If material for bandaging is not available, hold the
pack in place until help arrives.
Watch for signs of swelling of the limb below the pressure pack (see Foot
and Leg Bandages, page 47). This indicates impaired circulation. If you see
these signs, the bandage must be loosened or removed. Consider adding more
bulk to the pack and apply a second bandage over the first. Transport the dog
to a veterinary hospital.
Tourniquet
Tourniquets can be used on the extremities and tail to control arterial bleeding that can’t be controlled with a pressure pack. Tourniquets should never be
used if bleeding can be controlled by direct pressure. Always place the tourniquet
above the wound (between the wound and the heart).
EMERGENCIES • 43
A tourniquet should be used only if
bleeding cannot be controlled with a
pressure dressing. The tourniquet is
looped twice around the leg . . .
. . . and tightened by twisting
A suitable tourniquet can be made from a piece of cloth, belt, tire, or length
of gauze. Loop the tourniquet around the limb as shown in the photo on page
43. Then tighten it by hand or with a stick inserted beneath the loop. Twist
the loop until the bleeding stops.
A tourniquet should be loosened every 10 minutes to prevent tissue hypoxia
and to check for persistent bleeding. If bleeding has stopped, apply a pressure
bandage as described in the previous section. If bleeding continues, let the blood
flow for 30 seconds and then retighten the tourniquet for another 10 minutes.
TREATING WOUNDS
Nearly all animal wounds are contaminated with dirt and bacteria. Proper
care and handling will reduce the risk of tetanus and prevent many infections.
Before handling a wound, make sure your hands and instruments are clean.
The five steps in wound care are:
1. Skin preparation
2. Wound irrigation
3. Debridement
4. Wound closure
5. Bandaging
Skin Preparation
Remove the original pressure dressing and cleanse the area around the wound
with a surgical scrub solution. The most commonly used solutions are
Betadine (povidone-iodine) and Nolvasan (chlorhexidine diacetate). Both
products are extremely irritating to exposed tissue in the concentrations provided in the stock solutions (Betadine 10 percent, chlorhexidine 2 percent),
so be very careful that the solution does not get in the wound while scrubbing
the skin around it. Dilute the solution to weak tea color for Betadine or pale
blue color for Nolvasan.
Three-percent hydrogen peroxide, often recommended as a wound
cleanser, has little value as an antiseptic and is extremely toxic to tissues.
After the scrub, start at the edges of the wound and clip the dog’s coat back
far enough to prevent any long hairs from getting into the wound.
Wound Irrigation
The purpose of irrigation is to remove dirt and bacteria. The gentlest and
most effective method of wound cleansing is by lavage, which involves irrigating the wound with large amounts of fluid until the tissues are clean and glistening. Do not vigorously cleanse the wound using a brush or gauze pad
because this causes bleeding and traumatizes the exposed tissue.
44 • DOG OWNER’S HOME VETERINARY HANDBOOK
Tap water is an acceptable and convenient irrigating solution. Tap water
has a negligible bacterial count and is known to cause less tissue reaction than
sterile or distilled water.
If possible, add chlorhexidine solution or Betadine solution to the tap
water for antibacterial activity. Chlorhexidine has the greater residual antiseptic effect, but either antiseptic solution (not soap solutions) is satisfactory
when correctly diluted. To dilute chlorhexidine, add 25 ml of the 2 percent
stock solution to 2 quarts of water (2 l), making a 0.05 percent irrigating solution. To dilute Betadine, add 10 ml of the 10 percent stock solution to 2
quarts of water to make a 0.2 percent irrigating solution.
The effectiveness of the irrigation is related to the volume and pressure of
the fluid used. A bulb syringe is a low-pressure system. It is least effective and
requires more fluid to achieve satisfactory irrigation. A large plastic syringe
removes a moderate amount of dirt and bacteria. A home Water Pik unit
(used by people to clean their teeth) or a commercial lavage unit that provides a high-pressure stream of fluid is the most effective.
A garden hose with a pressure nozzle for the initial lavage, or a kitchen sink
spray unit, followed by one of the methods just described to deliver the antiseptic, is a good alternative. You want to flush and clean the wound, not force
dirt deeper into the tissues. Angle your flow of liquid to accomplish that and
let the fluid pool to bring debris to the surface.
Debridement
Debridement means removing dying tissue and any remaining foreign matter
using tissue forceps (tweezers) and scissors or a scalpel. Debridement requires
experience to determine the difference between normal and devitalized tissue,
and instruments to control hemorrhage and close the wound. Accordingly,
wounds that require debridement and closure should be treated by a veterinarian.
Closure
Fresh lacerations on the lips, face, eyelids, and ears are best sutured or stapled
to prevent infection, minimize scarring, and speed recovery. Lacerations
longer than half an inch (1.25 cm) on the body and extremities probably
should be closed, but small lacerations may not need to be. Small V-shaped
lacerations heal best if they are closed.
Wounds contaminated by dirt and debris are quite likely to become
infected if closed at the time of injury. These wounds should be left open or
sutured around a drain that can be used for through-and-through irrigation.
Similarly, wounds older than 12 hours should not be closed without drainage.
Suturing or stapling should be avoided if the wound appears to be infected (is
red, swollen, or has a surface discharge).
Your veterinarian may decide to close a wound that has been left open for
several days and has developed a bed of clean tissue. Wounds that are clean
after several days are resistant to infection and usually can be closed with
EMERGENCIES • 45
impunity. Suturing such a wound is
called delayed primary closure.
The length of time sutures or staples
should remain in place depends on the
wound’s location and other characteristics. Most sutures and staples can be
removed after 10 to 14 days.
Puncture Wounds
Puncture wounds are caused by bites
and pointed objects. Animal bites, in
particular, are heavily contaminated
with bacteria. Bleeding may occur.
There may also be bruising, particularly if the dog was picked up in the
teeth of a bigger dog and shaken.
Puncture wounds are often concealed
by the dog’s coat and may be easily
overlooked until an abscess develops a
few days later.
Treatment of a puncture wound requires a veterinarian. It involves surgically enlarging the skin opening to provide drainage, after which the area is
irrigated with a dilute antiseptic surgical solution. These wounds should not
be closed. If there is a large, open wound area, parts of the wound may be
sutured with a drain left in place to allow air to get in and discharge to
drainage. With all animal bites, keep in mind the possibility of rabies. If it is a
bite wound from an unknown animal, a rabies booster may be needed.
Antibiotics are frequently prescribed for bite wounds and wounds that are
heavily contaminated, such as puncture wounds.
Home Treatment
Small open wounds can be treated at home without sutures or staples.
Medicate twice a day with a topical antibiotic ointment such as triple antibiotic. The wound can be left open or covered with a dressing. Make sure the
dog is not constantly licking it. You can cover the area with a sock or a T-shirt
to keep the dog away from the wound.
Infected wounds that are draining pus require the application of moist sterile compresses. A number of topical antiseptics are effective in treating superficial wound infections. They include chlorhexidine and Betadine (diluted as
described in Wound Irrigation, page 44), Furacin (both the topical cream and
0.2 percent solution), 1 percent Silvadene cream, and topical antibiotics containing bacitracin, neomycin, and polymyxin B (triple antibiotic). Apply the
topical antibiotic directly to the wound or place it first on a gauze pad.
Change the dressing once or twice a day to facilitate pus drainage.
46 • DOG OWNER’S HOME VETERINARY HANDBOOK
A wound sutured around a drain allows
for through-and-through flushing.
BANDAGING A WOUND
Wounds may be left open or bandaged, depending on their location and other
factors. Wounds on the head and neck are often left open to facilitate treatment. Many wounds of the upper body are difficult to bandage and do not
benefit greatly from being covered.
Bandaging has the advantage of protecting the wound from dirt and contaminants. It also restricts movement, compresses skin flaps, eliminates pockets of serum, keeps the edges of the wound from pulling apart, and prevents
the dog from biting and licking at the wound. Bandaging is most effective for
wounds to the extremities. In fact, nearly all leg and foot wounds can benefit
from a bandage.
Dressings over draining or infected wounds must be changed once or twice
a day. The bandage should be bulky enough to absorb the drainage without
soaking through.
Foot and Leg Bandages
To bandage the foot, place several sterile gauze pads over the wound and
secure with surgical adhesive tape. Be careful not to make the tape too tight.
To secure a foot dressing, you will need to continue the bandage up the leg.
For leg wounds, cover the wound with sterile gauze pads. On top, pad the
entire leg with plenty of cotton so the dressing won’t become too tight and
interfere with the circulation. Wrap first with roll gauze, then wrap the leg
with elastic tape or bandage, as shown in the photographs on page 48. Your
veterinarian or a veterinary technician can show you the best way to bandage
a particular wound.
EMERGENCIES