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Debridement, or the removal of dead tissue, aims to speed up wound healing by removing necrotic (dead) cells which then allows healthy cells to invade the area and promote healing. This is a salvage procedure used when primary surgical closure (suturing) is not possible. This is usually because the wounds are unplanned or traumatic, such as those from a burn or a road traffic accident.
Debridement is often done in first opinion practice, and also in referral situations for more complex wounds. It may be necessary to repeat the debridement every few days for a period of two to three weeks.
After the initial accident the cat may be in shock and need stabilizing prior to treatment. Typically, open wounds are managed with dressing for the first few days, until the full extent of the devitalized tissue becomes clear. This allows the clinician to demarcate which tissue needs debriding and where the healthy margins start.
Dead tissue does not have nerve sensation, and so its removal is often done under light sedation (so the patient stays still) with local anesthesia to the surrounding areas. The commonest method is sharp surgical debridement.
The clinician prepares the area for debridement by flushing with sterile saline. Sterile surgical instruments are then used to cut away the dead tissue to a depth where the underlying area starts to bleed slightly. Bleeding is an encouraging sign that the surgeon has reached healthy tissue. Where the tissue bed is shallow, the surgeon will use the edge of a sharp scalpel blade to scrape away dead tissue down to healthy blood vessel ooze.
Once the clinician is satisfied, the area is then protected with a dressing. This procedure is repeated every two to three days, with dressing changes in between times as appropriate.
Debridement becomes unnecessary once healthy scar tissue forms or when the wound has shrunk such that it can be closed surgically with sutures.
The aim of removing dead tissue is to speed wound healing and reduce the risk of infection. Because of how the body heals, it is not realistic to expect a single procedure to complete the task, instead it may need repeating on multiple occasions as progressive layers die off.
However, when these limitations are understood, debridement is a powerful tool to promote the healing of otherwise seemingly hopeless wounds. This is known as healing by 'secondary intention' (or scar tissue formation) as opposed to healing by primary intention (suturing a wound.) Often a combination of the two methods is used, with debridement to the point where the wound is healthy enough to accept a skin graft or closure with sutures.
The recovery period can be prolonged, not least because the cat is liable to have sustained other injuries such as fractures, at the time of the trauma. Seriously injured patients may need hospitalization for days, of which wound management is just one aspect of their care.
Once the patient is stable, it is often possible for them to go home with a dressing covering the wound, and return to the clinic for dressing changes and repeat debridement. It is not uncommon for a complex wound to need attention for two to three weeks on an intensive basis, followed by a further couple of weekly visits.
During this recovery period, the cat may need to take medication such as pain relief and antibiotics. They also need to stay indoors, in order to keep the dressing clean. In some cases confined to a crate or small room, so as not to aggravate other injuries that are healing.
Although the actual debridement is not costly, taken as a whole with sedation, dressings, antibiotics, and the need to repeat this every two to three days, the costs soon spiral.
Specialized dressing can cost around $30, sometimes more depending on if medical grade honey or silver treatments are used. On top of this is sedation, at around $55 per visit, plus the debridement and vet's time which could range from $20 - $60. In all, you can expect each visit to come in around $100 - $150. When you consider a cat may need around seven debridements, this total becomes sizeable, and that's without considering adjunctive care for stabilization, radiography, and fracture management where necessary.
Surgical removal of dead tissue is more of a marathon than a sprint. In all but the most superficial injuries, you should expect the procedure to be repeated several times. This is because of the nature of healing, rather than any deficiency on the part of the surgeon.
In the long term, the outlook where debridement is successful is excellent. Once a healthy bed of scar tissue forms, this can mean the difference between salvaging a limb or amputation. As a result, many cats go on to lead completely normal lives with barely discernible scars.
Take stock of the circumstances in which the cat experienced a traumatic event. If the cat escaped, now is the time to review how secure the doors and windows are in order to prevent a repeat episode. If your indoor cat is allowed outside, consider whether a change of lifestyle to wholly indoors is appropriate.
For the cat that burns their paws on a burner, consider how you are going to protect the cat in future. Is this a matter of keeping the cat out of the kitchen or purchasing burner covers?
Healing by secondary intention is a lengthy process and for it to be successful it is crucial to cooperate fully with your vet. This means taking the cat regularly to all their appointments, and caring for the dressings in an appropriate way. However, your patience should be rewarded in the end by resolution of the wound.
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