One of the most frequently asked questions The Veterinary Wound Library receives through our online Chat Bot is from pet owners asking if they can use over the counter creams for their pet's wound.
We have a clear position on this subject based on the physiology of wound healing, and feel that there really does need to be greater awareness of the ingredients of such creams and that not all of them will be beneficial to healing, especially when used on animals.
First things first: As a service the Veterinary Wound Library was set up to support veterinary professionals with challenging cases, to support their decision making and product choices. We certainly don't mind the odd request for help from owners looking for answers, and we get some really great questions. However, we can't advise on individual cases directly to owners. This is because we would be making a decision based on a patient we have not seen in person (all patients usually require a full check over to ensure there are no other complications or factors that may delay healing) and more importantly, we could contradict your own Vet's advice which could get us all into a muddle over the care of patient.
So, for that reason we encourage owners who contact us to seek advice from their Vet and we can certainly help their Vet if they need it.
We appreciate that all owners seeking our help are looking for answers and just care about the welfare of their pet. We are very glad that so many people do. We didn't want to leave you with no advice if you have come here searching for answers, so we have included the advice we usually give in terms of basic wound care below.
Our basic wound management advice (as we teach the veterinary profession) is that wounds require 3 things to heal well;
1. Good preparation of the wound before anything else- to wash the wound thoroughly using lots of warm water or saline (you can make saline using 1 tsp salt to 1 pint/500mls of warm boiled water).
2. Promotion of healthy healing environment - Promotion of wound healing means keeping the wound clean and covered if possible. We advocate the use of water based hydrogels (you can ask your chemist for brands of wound hydrogels, some are sold over the counter). Hydrogels provide a better environment for healing than oil based products. Any oil based products can not be dissolved naturally by the body and actually inhibit cell migration and may lock debris into the wound. Sudocrem, Bepanthen and Vaseline are all Oil based products and in our opinion should not be used on open wounds. Further more, if you have washed the wound well there will be no need for the antiseptics in creams or ointments. Many of the off the shelf nappy creams have some of form of antiseptic (cetrimide, chlorhexidine, iodine, phenol) and these can be sensitising (cause reactions) or can actually inhibit healing and may even be toxic to animals. Yes antiseptics may kill bacteria, but they may also damage the healing process in a healthy wound.
3. Protect - protect the area from interference, contamination from soil, urine, and scratching. This can be challenging and if your pet is scratching and has an itching area it's likely that a dermatological issue is present and that the wound is secondary. You really do need to seek veterinary attention if this is the case.
Whatever the size of the wound, and even with Veterinary support its important to monitor your pet to be sure they are not irritated by the wound or that there are complications arising from a bandage or treatment. Infection is a complication in wounds when they have been contaminated or become dirty and signs include inflammation, redness, swelling, pain and production of pus or slough. If this is the case it is very important to seek help from your Vet as antibiotics may be required sooner rather than later. Some wounds such as bite wounds or puncture wounds can become infected and deteriorate very quickly, so a trip to the vet should be your first priority.
If the wound is healing well, and the edges are closing together nicely without inflammation or signs of infection it will seem all is progressing well. Your vet will advise to keep the wound clean and we suggest regularly washing any scurf and debris away from the wound edges with warm salt water. This shouldn't be done too often if the wound is healing well as it may disturb new cells - once daily to every other day may be all that is needed once a wound is very close to healed. Be sure not to scrub these healing wounds, just gently pat dry with clean toilet paper or clean cloth.
If in doubt for any reason contact your Vet or vet nurse immediately. A call to the vet nurse and a photograph of the wound will be all you need for them to help you. There is a misconception that Vets will look for an excuse to charge owners for care and wounds can become expensive if they start to deteriorate. The reality is, that with smart phones available to be able to send a photo and some detail to your Vet or Vet nurse they will usually be honest about the need for you to visit. If money is tight they will advise accordingly, but be aware that some tiny wounds can become very serious very quickly. Your Vet is the best person to advise and they can always contact us for specialist help if they need it.
We hope this helps, if in doubt please don't be afraid to ask your Vet for advice.
The Veterinary Wound Library’s team of Bandaging Angels are winging their way to 7 venues across the UK to deliver the latest tips & tricks in wound care & bandaging. and attendance is FREE* for Vet Wound Library members.
Our first inbound arrival is at Cheshire Conference & Events, Stockport on Wednesday 10th July and our final departure will be from Edinburgh Zoo on Tuesday 12 November, with stop overs at the following five venues between these dates;
10 September - Twycross Zoo, Leicestershire CV9 3PX
17 September 2019 - Bristol Zoo, Bristol, Somerset BS8 3HA
21 September - Scotland's Rural College, Aberdeen AB21 9YA
27 September - East Sussex National Hotel, Uckfield, East Sussex TN22 5ES
2 October - Kirkley Hall Zoological Gardens, Northumberland NE20 0AQ
Course content is a mix of theory and practical sessions to include:
The physiology & stages of wound healing, what is new in wound care?
Dressing selection - which product to use when?
The art of bandaging - the science behind the complications
Practical bandaging workshop & case reviews
Time: 9:00am start, Finish at 16:00pm (7hrs Certified CPD)
Includes: Notes, lunch & refreshments, certificates, exhibition & goodie bag
To book your place:
VWL Members: Register for FREE* - log in to the VWL member area at www.vetwoundlibrary.com where you will find your discount code and link to online booking form
Non-Members can register at £135+VAT at www.vetwoundlibrary.com/events--cpd
Not yet a VWL member?
You can join the Vet Wound Library for just £180 per year and benefit from ongoing specialist support, webinars, product offers and more. To become a member please visit: www.vetwoundlibrary.com
The Veterinary Wound Library is excited to announce their partnership with BSAVA offering a Veterinary Nurse Merit Award in Wound Management.
The course length is 6 months and is made up of webinars and reading material with a practical day based at BSAVA HQ to consolidate your learning and get hands on.
“The course aim is to give vet nurses the knowledge and confidence you need to be able to start to challenge assumptions and to lead your team to improve dressing selection, bandaging techniques and to reduce complication risk. We know how rewarding it is to become more confident in this area and what a critical and rewarding role the vet nurse can play in improving the outcomes for patients and practice.”
More details of the course are posted on the BSAVA VNMA webpage: https://www.bsava.com/Education/VN-Merit-Awards
If you are interested in signing up for the course then please email: email@example.com
The Veterinary Wound Library has organised an Equine CPD Day with a mix of theory and practical sessions on Wound Management and Bandaging Techniques with renowned speakers Georgie Hollis BSc and Patrick Pollock BVMS PhD CertES(Soft Tissue) FHEA DipECVS FRCVS on Tuesday 14th May 2019 at Redwings Horse Sanctuary, Aylsham, Norfolk. This CPD is open to both Equine veterinary nurses and Equine Veterinary Surgeons.
We will look at the physiology of healing, common challenges in the equine and the latest tips and tricks for optimal healing, with the aim of helping clinicians go back to practice with the knowledge to make informed decisions to optimise healing based upon: The presenting wound, the temperament and tolerance of the patient, and the resources available.
At the end of the session delegates will be able to:
Time: 9.30am - 5.00pm
Cost: £125 (exc. VAT) VWL Members, £175 (exc. VAT) Non-VWL Members
Price includes refreshments, lunch, notes, and CPD Certificate
Further information and a full agenda can be found here
CLICK HERE for our online booking form to reserve your place!
Following requests for some CPD from RVNs in the South West of the UK via our Bandaging Angels Facebook page, Veterinary Wound Library Bandaging Angel for the South West, Shelly Jefferies RVN NCertPT, is holding a CPD Day entitled ‘Wound Worries, Bandaging Breakdown and Dressing Dissection’ at Paignton Zoo on Tuesday 7th May 2019, which is open to both veterinary nurses and Veterinary Surgeons.
The aim of this CPD day is to update delegates on the latest in wound management, dressing selection and bandaging techniques.
The following areas will be covered:
Time: 9.00am - 3.00pm
Cost: £99 (+VAT) VWL Members, £149 (+VAT) Non-VWL Members
Price includes refreshments and lunch, printed notes, CPD Certificate, and free entry to the zoo after!
Further information and a full agenda can be found here
CLICK HERE for our online booking form to reserve your place!
From wives tales to modern day:
Using honey for wounds is nothing new. From ancient egyptian texts to roman times its properties have been extolled as an aid to healing and for reducing inflammation. For many a miracle cure, for the more scientific it is a case that the high sugar (84%) low pH environment created by honey will aid debridement and help to decontaminate wounds to enable the wound to progress from inflammation through to the proliferative.
Honey (of all types) offers the wound several benefits due to its ‘natural’ high sugar content which creates an osmotic effect in the wound, a low pH which inhibits microbial proliferation, and some key enzymes which create an antimicrobial effect related to the release of low levels of hydrogen peroxide. In fact this ‘peroxide effect’ is similar to that adopted by neutrophils in defence of pathogens during inflammation.
Manuka honey from New Zealand is considered 'gold standard' for wound management since research led by Dr. Peter Molan at the University of Waikato began to explore its properties as an antimicrobial and debridement aid. The research identified that honey derived from nectar from the Manuka bush (Leptospermum scoparium) had an additional antimicrobial effect independent of that associated with standard mixed floral honey being independent of the pH, Enzymes and sugars. In 2008 Maveric et al reported that they had found methylgloxal to be the chemical responsible. The level of antimicrobial effect being directly proportional to the concentration of methylgloxal in the honey. A method of testing potency of antimicrobial effect was registered to give batches of Manuka honey a rating and guarantee of the presence of this unique manuka factor or UMF®. Some manufactures will choose to use an NPA statement or logo instead of the UMF® mark. NPA stands for non-peroxide activity and can be used to demonstrate that the product has been tested similarly to guarantee an antimicrobial activity that is maintained without the presence of glucose oxidase.
So why not just use it from a jar?
Manuka honey is one of the worlds most expensive honeys. For comparison a few years ago a tonne of standard mixed floral honey may have cost you around £5,000 per tonne with an equivalent amount of Manuka honey being nearer £50,000. Unfortunately where there is money to be made there is also the temptation for fraud. In May 2015 the Grocer magazine reported on a commissioned special investigation into the Manuka honey market in the UK and found that only 1 in 7 of the jars they tested were positive for the presence of methylgloxal at a level matching the NPA or UMF® rating on the label. Furthermore they stated that the maximum volume of Manuka honey being shipped out of New Zealand in one year was less than 2,000 tonnes, whereas the shelves around the UK appear to be stocked with over 11,000 tonnes.
Risk and reward:
Despite its potent and evidenced antimicrobial effect even Manuka honey is not immune to harbouring bacterial spores. When cold gamma sterilised (to preserve valuable antimicrobial enzymes) spores are rendered inert while the potent antimicrobial effect is preserved. This is the standard process for medical grade honey which will normally be sterilised in batches that will be guaranteed through a batch number and expiry date. The expiry date does not apply to the efficacy of the honey itself, but the guarantee that the packaging (if stored as advised) will ensure sterility to that point.
Pasteurisation is used for honey intended for consumption and being a heating process will inhibit some of the enzymes that we consider beneficial for assisting wound management. When eating honey we deliver it into an environment that is hostile enough to deal with many bacterial threats through digestive and immune system. Its a good job as pasteurisation is ineffective at inhibiting spores of some of the most pathogenic bacteria we face, specifically Clostridium botulinum. Most adults will have become immune to proliferation of this dangerous pathogen, but if ingested by children under one year of age the consequences can be lethal. This is why most honey meant for consumption will be labelled as not suitable for children under 1 year of age.
When using a jar of food grade honey for wound management there is a risk of contamination, regardless of the rating of the honey. Evidence of such complications are scarce, but such infection or contamination that delays healing may not even be recognised by the clinician, it may be considered simply as a failure of the wound to progress for a period of time. While we research this a little more it is worth considering the image below. The plates were used as part of a study looking at the efficacy of a range of honeys against equine wound pathogens. (Pollock and Regan). The plate on the left was a the growth resulting from a 'value' range of honey where more species proliferated than had been inoculated.
If you wish to use honey from a jar for wound management there is nothing to stop you. However, if you are a clinician you have a duty of care to your patients and clients. That means that you are obliged to do no harm, however small the risk. Only medical grade, cold gamma sterilised honey (Manuka or otherwise) will have all its benefits preserved while guaranteeing it safety through a batch number system. The fear is that it is more expensive to buy as a medical product but if you consider buying 15g versus a whole jar, you'll find the its the Jar that costs you more!
Click here to read the 2015 article from "The Grocer"
The Veterinary Wound Library Advanced Surgical Skills For Small Animal Practice CPD Day | 20th March 2019
This will be an invaluable day for any clinician who has faced prolonged healing post lumpectomy, frustrating wounds over joints, and those unsure if they should refer or give it a go.
Vet Wound Library
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