ABSTRACT: Veterinary wound management can often fall short of the high standards which most of us aim to provide and which our clients have come to expect. Whilst it is commonplace for most practices to offer the most up-to-date drugs for medical conditions and referral of complicated cases to a specialist, it is still all too common for a cat, presenting with a burst abscess, to be sent home with a course of antibiotics, a bottle of chlorhexidine and a gaping hole in its face!

Georgie Hollis’s philosophy of ‘Intelligent Wound Care’ is the perfect way to think about how to manage both the commonplace and less frequent wounds that we might see in practice – anything from a cat bite abscess to a degloving injury. The three principles of preparing the wound to heal, providing the optimum environment to allow it to heal, and protecting it while it does so, are simple yet effective.

The Veterinary Wound Library is an invaluable resource.1 It enables a range of case reports to be made available. These document the treatment and progression of wounds – from presentation through to, in most cases, complete healing – using ‘advanced wound management’ techniques.

The two cases I’ve chosen to report here – both of which are published, in full, in the Library – show that, with good management, even the most daunting of wounds can heal fully.

Both Thomas and Monica were initially examined, diagnosed, prescribed medication, and in the case of Thomas, anaesthetised by a vet. However, the wounds themselves were managed entirely by the nursing staff. The primary dressing used for both cases was medical grade manuka honey.2


Thomas, an ‘adopted’ entire male domestic short hair, estimated to be around 10 years of age, presented at the clinic with a burst, necrotic abscess behind his right ear (Figure 1). He was admitted for a general anaesthetic, castration and management of the abscess.

Figure 1: Presentation

The wound was clipped and surgically prepared then the eschar was surgically debrided (Figure 2). Thorough lavage was performed using one litre of warm Hartmann’s solution and the area was aseptically prepared and draped prior to resection of the necrotic tissue.

Figure 2: Wound following debridement

After further lavage, honey flush (50:50 solution of honey mixed, in a syringe, with warm sterile fluids) was instilled into the cavity and stay sutures were placed in the healthy tissue around the wound (Figure 3). 

Figure 3: Stay sutures placed and honey/swabs packed into cavity

Honey was syringed directly into the cavity, filling it to approximately 80 per cent capacity. A moistened sterile swab was folded and placed into the cavity to cover the honey and hold it in place, and additional honey was applied onto the swab (Figure 3). The initial secondary dressing we used failed to stay in place, so more success was found when the foam dressing was secured by placing suture material through the backing and tying it to the stay sutures (Figure 4). Stockinette was then used to keep the dressing in place for the required time (Figure 5).

Figure 4: Hydrophilic foam secured to stay

Figure 5: Stockinette

The dressing was changed at two and four days and the wound redressed in a similar manner, but using honey impregnated alginate rather than swabs. By day seven, the wound bed was filling with healthy granulation tissue, the ventral wound edges were still undergoing autolytic debridement and a large pocket of dead space remained in the area (Figure 6).

Figure 6: Day 7

The next two dressings were changed at three-day intervals and the last one was left in place for five days. Removal of this final dressing revealed a very healthy wound with no remaining non-viable tissue (Figure 7). Since the wound consisted entirely of healthy granulation tissue, it was redressed using hydrogel in place of honey.

Figure 7: Day 18

After five days, there had been significant contraction (Figure 8), and over a further five days the wound had contracted by another 50 per cent (Figure 9).

Figure 8: Day 23

Figure 9: Day 28

Unfortunately, at this stage we had to stop using the stockinette as it was making his chin sore. As an aside, this was cleaned and honey applied topically twice daily. After 48 hours, it had completely resolved.

His owner was asked to keep the wound clean and apply the hydrogel twice a day. Four days later, the wound looked healthy and after a further seven days it was almost fully healed (Figure 10). A week later, the hair was re-growing (Figure 11).

Figure 10: Day 35

Figure 11: Day 42

Finally, a very happy ending. Had it not been for Thomas’s primary and secondary dressings being provided through the Library, and giving a little of my time for free, he would probably have been put to sleep. Now he’s given up the tomcat lifestyle and has moved into the family’s home!


Monica, a 12-year-old, female, domestic short hair had been missing for over a month. She was eventually found over 65 miles away and reunited with her owners, thanks to her microchip.3 She was taken to an emergency clinic, where treatment was initiated and came to us two days later.

She had lost almost half of her body weight, had multiple burns and an extensive deficit over her left carpal joint extending almost 50 per cent of the circumference of the limb (Figure 12). This case study focuses on the carpal wound, but her burns were also managed, using honey, and her nutritional requirements addressed.

Figure 12: Day 1

A honey dressing had been applied at the emergency clinic two days previously and the wound was already looking reasonably healthy; particularly when considering the injury may have occurred over a month ago! The presence of synovial fluid was a worry and, given the extent of the deficit, it was thought that reconstructive surgery might be required.

Conscious radiography ruled out fractures but did show a loss of density in the distal tibia and fibula; so, as there was a risk of osteomyelitis, a six-week course of clindamycin was prescribed.

It was decided to continue to manage the wound using honey dressings and reassess it in two days. The dressing was removed two days later; granulation tissue had proliferated and contracted, closing the area over the joint where synovial fluid had been present, the wound had already reduced to 2cm diameter (Figure 13). Honey dressings were continued and, as progress was very good, were changed every four or five days.

Figure 13: Day 2

Five days later, there had been a further 25 per cent reduction in size (Figure 14). At day 19, the wound measured 6mm and was kept moist using hydrogel as the primary dressing while the healing process completed (Figure 15). By day 22, the wound measured just 3mm (Figure 16). The final dressing was applied, primarily to provide support of the limb.

Figure 14: Day 3

Figure 15: Day 19

Figure 16: Day 22

Four weeks after initial presentation the wound had completely healed and at the revisit on day 41, it was impossible to see that there had ever been an injury (Figure 17).

Figure 17: Day 41

Once the final dressing was removed, we had planned to start physiotherapy to help restore the normal range of movement and function to the limb and honey played a significant role in this too. Monica had acquired a taste for it and we found that applying honey around the paw for her to lick off allowed her to conduct her own physiotherapy – and it worked brilliantly! Monica’s progress from a 2kg cat covered in injuries to a healthy cat of normal weight, with her injuries all healed, was remarkable.


Alison King RVN

Alison qualified in 1997 and, as well as working in general practice, she worked in referrals and ECC. For the past three years she has been in general practice, working at the Animal Medical Centre, Northampton and she is currently studying for the ESVPS Nurses Certificate in Practical Techniques.

Her main focus is wound management and she is nurse advisor for the Veterinary Wound Library.


1.   www.vetwoundlibrary.com/

2.   www.medicalhoney.com/

3.   www.expressandstar.com/news/2010/04/27/m6- moggy-found-65-miles-from-home/

Veterinary Nursing Journal • VOL 25 • No11 • November 2010 •