Episode 11 - The Queen of Wounds

This week Sue, John and Paul welcome a very friendly face (voice?!) to the podcast - one Georgie Hollis. Georgie is a wound specialist who built her career in the human healthcare industry but moved over to veterinary and created The Vet Wound Library as an incredibly useful resource for vets and nurses.

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SHOW NOTES

Intro

(00:00) John introduces the podcast team and Georgie Hollis

Chapter 1 – The queen of wound management and her wound angels

(02:16) Sue asks Georgie to introduce herself and Georgie explains her origins were in podiatry and human patients with wounds and dressings; now she has taken that understanding to the veterinary world, as there has been a lack of understanding in this area of the veterinary profession.

(04:00) Sue introduces the Veterinary Wound Library and Georgie explains how she identified that she could either become a distributor for product or independently set up a platform for vets and nurses to come and get help on choosing dressings and with cases; she then set up the library for this, with a team of specialists to help answer questions on wound surgery and dressings. Georgie talks about the ‘bandaging angels’ who go in and help practices in dealing with bandaging issues and improve their wound management.

(06:48) John asks what a wound is, and Georgie describes this as any break in the skin, caused by a surgical instrument or by accident – she goes on to say that surgical wounds are kept as clean as possible and accidental wounds are from injury and involve more damage and contamination, as well as potentially including bruises and contusions where you may have an impact.

Chapter 2 – Wounds At Home

(08:27) John then asks about whether healing is different between the two types of wound – Georgie uses an example of a cut from glass being a laceration vs a scrape along the ground which would be an abrasion, stressing all of these all need cleansing and preparing in order to allow them to heal – and this healing may not be necessarily in the way the owner would expect.

(09:30) John asks what would lead you to decide whether a wound would need stitching / leaving open / or more drastic action such as a skin graft. Georgie says one of the biggest considerations is how old the wound is, the time between when the wound happens and when it is cleaned is critical. She mentions a study where they looked at wounds in goats and saw a marked reduction in bacterial growth when the wound was new, and the research shows that for every hour earlier a wound is washed, the bacteria present was reduced by half. The multiplication of bacteria in a wound reaches a point where it overcomes the hosts response – so the earlier the wound is washed the greater chance to prevent this from happening – therefore the wounds cleaned the earliest are the most likely to heal successfully.

(11:26) Sue asks how an owner would clean a wound. And Georgie advocates the use of saline – saying this balances with the body’s own cells and citing the example of the skin becoming wrinkly in the bath. This happens because the bath water is less salty than the skin and the skin cells swell – which causes some damage. So, this is preferable to normal water and can be made with a teaspoon a salt in a pint of previously boiled water.

(13:25) Sue clarifies what is meant by an isotonic solution. Georgie does say a bottle of water to flush the wound is preferable to not flushing the wound however.

(14:08) Sue asks how the owner would then use this saline solution on a wound and Georgie speaks of the water bottles with the type of end to suck or squirt the water from, as ideal as this creates a bit more of a flush – even a clean garden sprayer. The ideal pressure is 8-15 pounds per square inch - this is a like a high pressure jet of water.

(16:20) John asks whether a pet should be allowed to lick a wound and Georgie says alpha amylase in saliva is a good thing for cleaning wounds, as this is cleaning and removing all the dead stuff from the wound, which they refer to as wound bed preparation – however the tongue is very abrasive and the mouth can be contaminated, and so they don’t suggest that licking is allowed. Georgie does also point out a patient continually trying to interfere with a wound may be a sign that things aren’t great.

Chapter 3 – Wounds At The Vets

(19:09) Sue then asks what products vets or nurses should use once they see the wound and Georgie says Saline would be advocated, or Hartmanns solution or lactated ringers solution.

(19:50) Sue clarifies that Georgie is saying she would advise that a vet or nurse flushes as the client would, with an isotonic solution and not immediately use a disinfectant such as chlorhexidine. Georgie says it is always best to flush again with this isotonic solution again anyway, and uses the analogy of poo in a toilet, and how you would flush the chain to get rid of it rather than just spraying it with disinfectant.

(21:20) Sue asks what antiseptic Georgie would then recommend going onto and Georgie says there is controversy and confusion around this, which drives people to use toxic substances such as chlorhexidine in wounds. This is known to damage cells which are involved in the regeneration of wounds, meaning the use of this in a wound which is healing will actually slow this process; this is the same for iodine when too concentrated. They will kill bacteria as they are intended to, but they will also damage cells and delay wound healing and so must be used carefully, if at all. Georgie goes on to say there are antiseptics which are much more wound friendly, including hypochlorous acid (see previous podcast episode)

(25:55) Sue asks about how different species react and whether as a horse owner, knowing that horses have a lot of granulation tissue, she would suggest hypochlorous over chlorhexidine or any other products for equine wounds. Georgie says all mammals heal in the same way with some subtle differences, which in horses does means more granulation tissue, but highlights what is most important, going onto list some of the important factors which will cause wounds to fail or be inhibited.

1 Necrotic Tissue – Dead tissue around and in the wound

2 Foreign Body – Something in the wound

3 Movement – a key one where movement in the wound constantly traumatises the cells and delays healing.

4 Proud flesh – but this is often a consequence of the above

5 infection – which again is a result of the above or contamination, and the growth of bacteria will then prevent the wound from healing properly.

Georgie says it doesn’t matter what species you are dealing with, the mammalian response is the same to wound healing across species; which is first for the body to stop any bleeding, then inflammation where the body digest any bugs or dead tissue around the wound, then granulation where it remodels and regrows new granulation tissue and blood cells, which acts as a carpet underlay for the epithelial cells of the skin to then re-migrate across and close over the wound. The wound will at this point also contract by 30-50% of its original size at this time, so that a scar is never the same size as the original wound. So thorough lavage with a non toxic substance during this process is best and hypochlorous or saline would support this.

(29:41) Sue clarifies then that something like hypochlorous would be better in a wound first aid box than something like hibiscrub (a soap scrub containing chlorhexidine used in veterinary practice). Georgie in response to this stresses that there is no place for hibiscrub in the management of wounds – as this is a ‘scrub’ and has soap elements and is used for the cleaning of the surface of the skin for example in a skin prep for surgery and has no place for use with broken skin – so hypochlorous would be far preferable.

(30:36) John asks if there are any top tips to approach managing wounds. Georgie talks about prepare, promote and protect as a way of summarising the steps for managing wounds, and suggests a vet nurse in a practice as the perfect person to establish a trolly in the practice and divide it into those three sections. So you can’t go to the promote and protect drawers before you have done the prepare.

Prepare: Clipping, cleaning and getting rid of dead stuff – which she clarifies is debriding the wound and prepares the wound bed for healing.

Promote: Is about dressing selection to encouraging a healthy granulation wound bed to help the wound through the healing phases, so granulation tissue at 4 days, start to fill in 7-10 days and wound contraction occurs around that time. If there is a lot of granulation tissue at this time a decision needs to be made as to whether to now close this surgically or allow to heal by granulation alone. She says that at the veterinary wound library they have seen many cases where the wrong decision has been made here and the wind has been left to heal for too long.

Protect: Is looking at the inhibitors of healing as discussed previously plus interference, cell transformation such history of tumours meaning the wound wouldn’t heal as you would expect, client compliance (owners being able to follow the right treatment plan correctly), correct products used as discussed before. Applying this logic to the wound to make sure it is encouraged to heal as sympathetically as possible.

OUTRO

(34:14) John wraps up part one and says to look out for the next episode where we continue the conversation with Georgie.

(35:00) HIDDEN OUTTAKE: distribution of contamination secret 'easter egg'...