Degloving Wound Care and Reconstruction

Large cutaneous wounds in dogs and cats can become difficult and frustrating to manage. Most large wounds occur following blunt or penetrating trauma. Although the size of the defect and damage to underlying structures may be considerable, wounds are of little importance in the initial period following presentation unless there is a significant arterial bleed or penetration into the abdominal or thoracic cavity. Assessment of the entire patient is critical, with priority given to the cardiovascular, respiratory, and neurologic systems.

Good basic wound management will allow for rapid healing or provide a healthy wound bed for surgical closure. Principles of wound care include prevention of further contamination, wound lavage, debridement of devitalized tissue, and appropriate bandage placement and use of wound dressings. Gloves should always be worn when dealing with open wounds to prevent the introduction nosocomial infection. Large wounds may be overwhelming on presentation to both the owner and veterinarian. However, unless there is obvious, irreversible vascular, neurologic or musculoskeletal damage, the wound should be given time to declare itself before making hasty decisions, such as amputation.

Gross contamination of large wounds may be removed with tap water. For cleaner wounds, sterile isotonic solutions such as 0.9% saline and lactated ringers are preferred. Antiseptics can be added to lavage solutions, but are often unnecessary as the goal of lavage is to mechanically remove foreign material, necrotic tissue, and bacteria. If antiseptics are used, proper dilutions are important to avoid cytotoxicity. Chlorhexidine is diluted by adding 1 part of 2% chlorhexidine to 25 parts of normal saline to equal a 0.05% solution. Povidone iodine should be diluted to a 0.1 to 1% solution. Traditionally, achievement of mechanical cleansing without significant tissue damage (8 to 15 psi) was accomplished by administering with a 35-cc syringe and 18-gauge needle. Recent investigation has shown this method may not achieve expected pressures. An alternative is to utilize a 1-liter bag of fluids placed in a pressure bag at 300 mmHg connected to an extension set and 18gauge needle. […]