Manuka_overview

Wound Care

Wound healing and modern wound care

For more information on products detailed in above and other products for Wound Management, please refer to the:

KRUUSE Wound Management Portfolio

You can also view these pdf files for more information:

See the KRUUSE Wound Chart for small animals
See the KRUUSE Wound Chart for equine

Read more about Wound Flushing
See KRUUSE Foam Dressing
See KRUUSE HydroGel

See our Manuka Cat Case Study
See our Manuka Horse Case Study
Research Article from Daily Mail

Wounds heal through a process of events that are influenced positively or negatively by the local environment. Research in the 1960’s pioneered the development of advanced dressings that try to positively effect the wound environment to achieve the optimum wound healing rates. Since then many modern products have been developed that in principle reduce bacterial burden and/or maintain a healthy level of moisture within the wound bed.

The development of antibiotic resistance is largely responsible for a move toward topical management of bacterial burden and contamination. The rediscovery and research into more ‘traditional’ methods of wound management finds us recognising the true value of products that were once considered ancient remedies.

Honey, particularly Manuka, is one of these ancient remedies. Honey derived from nectar of the Manuka bush (leptospermum scoparia) has now proven itself of great value in modern wound care. Able to positively influence the wound environment, regular and successful use of this potent antimicrobial, debriding and anti-inflammatory agent is proving a routine option for all types of veterinary wounds in practice.

All wounds require a full assessment and careful preparation before a dressing is selected. The aetiological description of wounds assists in the clinical decision making process giving a guide to the extent of injury and the level of contamination.

Surgical wounds: Generally Clean
Lacerations: Contaminated/Dirty
Degloving injuries: Contaminated/Dirty
Avulsion: Contaminated/Dirty
Puncture or bite wounds: Dirty/Infected
Abrasions: Contaminated/Dirty
Burns: Contaminated

Each wound should be addressed systematically:
• Accurate history taking
• Thorough examination of the patient and extent of trauma
• Wound preparation – clipping and lavage
• Surgery if necessary
• Debridement of clearly defined devitalised tissue
• Appropriate dressing selection
• Sympathetic bandaging
• Immobilisation if necessary

The status of the wound from first presentation and at each dressing change should be noted. It will assist in the choice of management and dressing selection.

Necrotic
Wounds presenting with dry, dead or devitalised tissue can be described as necrotic. Cleansing and lavage will be required to reduce wound bioburden. Wounds are usually heavily contaminated, dirty, with or without infection.

Necrosis

Sloughy
Thick, yellow to green slough is produced alongside the inflammatory process during the early stages of healing and alongside infection. With infection, wound edges may undermine, and infection may be suspected, coupled with purulent exudate, smell or the tissue that is fragile and bleeds easily.

Granulating
Healthy granulation is the first part of the proliferative phase of healing where a new vascular bed replaces tissue deficit. Closure by reconstruction or primary intention may be achieved at this stage assuming there is enough tissue to do so.

Granulating

Epithelialising
During granulation epithelial cells will migrate from healthy wound margins and the remnants of hair follicles. Wound contraction will contribute to considerable reduction in wound size at this stage.    

Epithelialising_high_res

Use of the KRUUSE products based on tissue status:

NECROTIC WOUNDS:
Objective: To remove devitalised tissue and promote healthy granulation tissue formation.

Preparation: Prepare for sharp debridement and lavage. Following physical removal of devitalised tissue and debris, a further thorough high volume lavage using 0.2 to 0.5% chlorhexidine, saline or balanced electrolyte solution will reduce further contamination.

Dressing Selection: KRUUSE Manuka Honey is ideally suited for wound type. Applied after physical debridement it will further assist autolytic debridement between dressing changes, while having a broad spectrum antimicrobial effect. An absorbent secondary dressing will be required.

Exudate Level:   Primary Dressing       Secondary Dressing 
Dry/Low  KRUUSE Manuka G      Steriprotect
Moderate  KRUUSE Manuka AD      Steriprotect
High  KRUUSE Manuka AD      Steriprotect

SLOUGHY WOUNDS:
Objective: To remove devitalised tissue and promote healthy granulation tissue formation.

Preparation: Cleanse the wound surface and any pockets using high volume lavage of 0.2 to 0.5% chlorhexidine, saline or balanced electrolyte solution.

Dressing Selection: KRUUSE Manuka Honey is ideally suited for sloughy wounds, contaminated and infected wounds.
KRUUSE Manuka AD has the highest capacity for absorption of the range, as wounds of this type tend to exude more heavily. It is the dressing of choice during this stage.
KRUUSE Manuka G may also be applied directly to the wound if preferred.

Exudate Level:  Primary Dressing      Secondary Dressing
Dry/Low  KRUUSE Manuka G      Steriprotect
Moderate  KRUUSE Manuka AD      Steriprotect
High  KRUUSE Manuka AD      Steriprotect

GRANULATING WOUNDS:
Objective: Healthy granulation tissue should be preserved and supported by maintaining a moist, clean wound environment. A decision should be made at this stage to find the best route to wound closure. This may be through reconstruction, grafting or closure by secondary intention.

Preparation: The wound should be gently irrigated with warm saline or balanced electrolyte solution to remove any exudate or residues from previous dressings. Do not scrub the wound surface.

Wound Dressings: KRUUSE Manuka ND gently supports formation of healthy granulation tissue by encouraging a beneficial moist wound environment due to its osmotic effect. The Manuka Honey also provides a broad spectrum antimicrobial effect. This ensures that those wounds that are not quite ready to close through surgery remain healthy.

Exudate Level:   Primary Dressing      Secondary Dressing 
Dry/Low   KRUUSE Manuka ND      Steriprotect
Moderate   KRUUSE Manuka ND      Steriprotect
High   KRUUSE Manuka AD      Steriprotect

EPITHELIALISING WOUNDS:

Objective: Protection of fragile tissue margins and support of any remaining granulation.

Preparation: The wound should be gently irrigated with warm saline or balanced electrolyte solution between dressing changes.

Wound Dressings: For wounds with remaining granulation a KRUUSE Manuka ND dressing will gently maintain a moist environment at the wound bed due to its osmotic effect. The Manuka Honey will also provide a broad spectrum antimicrobial effect to protect against bacterial contamination.

Wounds that are close to healed and are to be managed at home may be kept healthy with a twice daily application of KRUCARE Aloe Vera. Surrounding tissue and intact skin can be protected from drying and maceration using KRUSAN Zinc Oxide ointment, Pasta Plaster or KRUCARE Skin ointment.

Exudate Level:  Primary Dressing     Secondary Dressing
Dry/Low  KRUUSE Manuka ND     Steriprotect
Moderate  KRUUSE Manuka ND     Steriprotect
High  KRUUSE Manuka AD     Steriprotect

SURGICAL WOUNDS:

Objective: Maintain a clean wound environment for a minimum of 48 hours post surgery. Wounds over joints should be immobilised to avoid dehiscence.

Preparation: Gently irrigate the suture margin using saline, balanced electrolyte solution post surgery, or at dressing change to remove any residual exudate and debris. Pat the wound dry using sterile gauze.

Wound Dressings: Dress the wound using a sterile, non-adherent dressing. For situations where a dressing is not feasible or appropriate, protection from contamination can be achieved by using a layer of Wound Plast Spray. If contamination, infection or dehiscence is suspected, then use of the KRUUSE Manuka range may be advisable for topical management. KRUUSE Manuka ND may be used as a primary layer to reduce local contamination. Any open wounds can be filled with KRUUSE Manuka G or KRUUSE Manuka AD dressings and covered with KRUUSE Steriprotect.

NB. Topical infection control using KRUUSE Manuka dressings is not a substitute for the identification of the source of infection, disease factors and systemic management. Surgical revision and culture may be required prior to dressing.