Here's the Hx: Ruffy is a 13ish year old dog who started as a stray found in the woods as a puppy. She lives outside and eats Ol Roy dog food. Her last vet appt was when she was spayed 12 years ago; we do drive by rabies clinics and internet worm medicine. On Dec 30 my husband discovered drainage with a foul odor on Ruffy's neck just below the collar. After cleaning it with some homemade Dakins with a drop of dish soap, I found an abcess. For those of you horse lovers, you would recognize it as the result of the bite of a certain, nasty fly that actually injects its egg under the dermis of the victim (gross!) and an abcess results from the whole process.
Assessment and course: The large amt of exudate had a foul odor, the wound opening was approx 1.8 cm with dead space/undermining about the volume of a golf ball. It was not painful, Ruffy didn't act sick, and she did not feel feverish. I treated it with BID irrigations of the Dakins/dish soap mixture and filled in the dead space with AMD gauze. Exudate became serosanguinous within a couple of days, decreased irrigations to once a day. By Jan 5, the undermining was gone, depth less than 1 cm.
What's the point of this? I was amazed at the rate of Ruffy's wound improvement. As I wondered what accounted for it, I thought of two reasons. First, Ruffy does not have the comorbidities that most of my patients have. We often forget to consider the host's potential to heal effectively and quickly. Second, I was reminded that clinicians often rush to apply advanced technologies and dressings to wounds that have not been appropriately treated with good basic wound care. I believe that in 2009 the big news in chronic wound management is going to be appropriate cleansing and management of biofilms.
So, the lesson that I learned from my dog was that my passion for excellent comprehensive basic wound management has value, and the information on this website is useful. I hope that it will help you make your patients' lives better. And no, I am not advocating dish soap to cleanse wounds.
Best wishes for a pleasant 2009, Beth