Wound Management / V.A.C. Therapy
Note: This area is under construction.
There are many factors that will effect your decision on how to treat a soft tissue wound (fractures will be addressed elsewhere). Some of these factors are: the extent of the wound, the length of time between injury and presentation, what facilities are available, and what materials are available.
The approach to wound management in sea turtles is very different from wound management in terrestrial reptiles. Wounds are often extensive in the case of shark attack, and severely infected in most cases. Sources of infection include: predator contamination, the environment, and the turtle itself. Some of the more common pathogens include: Vibrio spp., Pseudomonas spp., Clostridium spp., Plesiomonas spp., and E coli.
If the wound is acute (less than 24 hours old), has clean, bleeding edges, and is not contaminated with sand or debris, then suturing is ideal if anesthesia is available. Closure via primary intention results in shorter rehabilitation times, and less staff time to clean and medicate the wound. Recommended suture material is monofilament absorbable for muscle and subcutaneous tissues (Monocryl) and monofilament nylon for the dermis (Ethilon). If the skin will be experiencing any movement while healing, then some tension relieving strategy is needed. This may be an everting suture pattern (image) or overlaying the primary suture line with stents (image). In any event, the stents may be removed in 4 weeks and the primary sutures in 6 weeks. Post operative antibiotics and analgesics are needed for a minimum of 2 weeks after surgery. If there is extensive movement of the skin (as in the neck area), the wound will often dehisce. At that point the decision to re-suture is up to the surgeon, although closure by secondary intention is a viable option.
Infected wounds typically respond well if treated as an open wound. This treatment involves:
1. Systemic antibiotics, with the choice ideally based on culture and sensitivity. If culture is not practical, parenteral use of Amikacin and Naxcel provides coverage against most pathogens.
2. Daily debridement, sometimes requiring anesthesia/analgesics.
3. Topical antimicrobial treatments.
This approach is only practical if there is a facility in which to hospitalize the animal with excellent water quality to prevent the patient from contaminating it’s own wound with feces. Very extensive shark bite wounds have been treated this way with great success.
For more information see Wound Management. PDF
This chapter should be cited: Mettee, Nancy. 2014. Wound Management/V.A.C. Therapy. Marine Turtle Trauma Response Procedures: A Veterinary Guide. WIDECAST Technical Report No. 17. Accessed online [date].