# Using Duoderm before sutures



## Yong (Oct 15, 2003)

Hi Y'all! 

13 years ago I learned about a product called Duoderm. I worked as a nurse aid and used it on some of the patients. For those of you who don't know what it is, it's like a second skin. They use it on people with bed/pressure sores, like those who are wheel chair bound, or have diabetes. It comes quite thick or near rice paper thin. It is put on top of a wound that cannot heal right on it's own, especially skin with severe tissue trauma. You put it over a wound that has been cleaned. As it warms, it molds to the skin, and on the thinner version will amost become transparent. It can be left on for upto 6 days. When it starts to ooze out of the edges, then it is time to change it. You will see it bubble underneath, that means it is doing it's job. When you peel it back a week later, it looks drastically better. 

So on with my story. I got a bird from a rehabber about two weeks ago. she said it was ready to be released. I saw where it had crop trauma and appeared to be healed. The feathers were missing though. I took the bird home, and gave it a closer look. It had a huge tear down it's back, but she never noticed it. It was horribly infected, and the tissue beneath the skin had been badly traumatized. Two different doctors have tried three times to suture it, but the sutures just tear out. The skin is was too bad. The doctor said lets try Duoderm, and I thought duh...thats a great idea. so it's not often that I get a Duoderm pij, so hear are some pictures. Part has been sutured, and this is after 3 days of duoderm. The vet put the thick stuff on, and tonight it needed changing so I switched it to the thin stuff.

Buy the 4x4 sheets of the thin, then you can cut it to size, and it is much cheaper that way. If you buy the thin stuff, it is easier to wrap a piece of vetwrap around it, and the bird is less likely to pick at it. Anyway...meet Al. He is a Squeeker still and only weighs 230g. He stopped eating and is now being tubed. He is very skinny. I just put on the patch, so once it warms i will blend to skin better. I also put a piece of vet wrap over it to keep him from pecking at it (not pictured) . when the skin is all good again, then we will suture it once more. He is also on Baytril. yong


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## Reti (Jul 20, 2003)

Thanks for the info, Yong, sounds like great stuff to have on hands.
Where can one get Duoderm from?

Reti


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## Pidgey (May 20, 2005)

Yong,

Avian heterophils lack a proteinase necessary to liquify necrotic tissue. As such, they will often not deal well with deep wounds that create abscesses. What's typical is for the body to attempt to "wall off" such a plug by mineralizing it. It can create a persistent nidus of infection later. That stuff's gotta' go.

Baytril isn't the best antibiotic for penetrating necrotic tissue. Oddly enough, Metronidazole is better but you can also double-whammy it. The bird is probably dealing with a septicemia and bacteremia. You can still seal the wound and lose the bird. I'd probably err to the side of letting the wound heal by second or third intention, debride and slather on the topical antibacterials to help kill the surface infection. Kill 'em from both sides and kill 'em hard.

Pidgey


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## Maggie-NC (Jun 22, 2005)

We have used a product called Tegaderm (by 3-M) for large, superficial wounds.
It allows air to get to the wound. It is really, really thin and is a devil to apply because it keeps sticking to me!

For a deep wound, our vet usually debrides and sews up the wound.

Maggie


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## feralpigeon (Feb 14, 2005)

Hi all,

I've been using Panofil which is a miracle human debrider, and @ $100.00 a tube and script required, it will be a miracle if I can continue to use it when this tube runs out. It was a windfall. What debriders do you folks use and where do you get them? Are they script?

Also, the duoderm and hydrocolloidal dressings seem to be one in the same, am I imagining things? Or Pidgey, are there specific applications of the hydrocolloidal dressing that are more prefferable and if so, what would they be?
See figure #4 of the following link:

http://www.worldwidewounds.org/2003/november/Cousquer/Avian-Wound-Management-Part-2.html#

And if there are some applications of the hydrocolloidal dressings which are appropriate, what would those be and back to Reti's question, does anyone have a link where they may be purchased? Or is this just a general Medicine Supply Store product that can be had locally? I have some of those on hand, but have never purchased them, they were part of my "windfall".

fp


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## Pidgey (May 20, 2005)

Hydrocolloid dressings and hydrocolloid gel are slightly different in that the first is a skin-like membrane that is often sutured in place. The gel is a just that and can be painted on but it's not generally used to cover large areas. You can order it from online supply houses (don't remember where I got mine but searched on "hydrocolloid gel" and looked at several until I found the cheapest deal).

In any case, you don't want to enclose the wrong kind of infection. I worry that this one is proceeding to something like a necrotizing fasciitis. I find it hard to imagine that the first rehabber completely missed an infected area that large and so I'm wondering if it's spreading. Generally, you wouldn't see that in a bird but in an immunocompromised individual I fear it may be possible. I hope I'm wrong for this bird's sake.

That's the gauntlet I had to run for Pierpont--kept debriding and double-whammied the antibiotics although the secondary I chose was Keflex. I didn't have skin rotting away, just the muscle tissue. That's different.

Pidgey


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## feralpigeon (Feb 14, 2005)

Thanks Pidgey,

And the Flagyll, is that given orally @ same dose rate that it would be given for canker, and for how long?

fp


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## Pidgey (May 20, 2005)

Well, in a case like this, until you've got the war headed your way--when all the exposed tissue is granulating properly, showing no sign of necrosis and the bird's managing its own food and water intake, preening and acting normally. Wing flipping would be nice.

I'd use 30 mg/kg BID (formulary says 15 to 30). I must admit that the formulary that I have comes from a day before the dosage was generated for treating trophozoites but I doubt that it differs much if at all. I could be wrong but that's my best guess.

Pidgey


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## Yong (Oct 15, 2003)

The wound was hidden under all it's feathers, and the feathers had matted down, which is why the other person did not see it, and why I almost missed it as well. The feathers were pulled for ease of suturing, and so the wound looks obvious now. As the tissue has been healing we have been adding a stitch or two. The wound in the picture is half the size it was. The tissue underneath was quite chewed up looking, but is now looking like smooth pink muscle. I agree that Baytril is not the best option, but whenever I give Baytril I also dose .07 of Flagyl too. they make a good combo. I think that Clavamox might have even been a better choice, but since we are making progress we will stay with the program right now. Duoderm can be purchased at any drug store/pharmacy. It does not require a RX. But it should be used only in the case it is intended for, and under the supervision of a vet. In 5 years this is the first case that has needed it. If you can suture it, then go that way. Yong


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## Pidgey (May 20, 2005)

I didn't figure that the other rehabber would have missed a featherless, gaping hole like that, but I did expect that there would have been some other sign of the problem like a disagreeable odor or something in the behavior.

The skin in that section of the back is heavily anchored with fascia. As such, you wouldn't be able to pull it together over that expanse without procedurally breaking the underlying fascia anyway but it still seems too far to pull given the proximity to the wings. Birds sometimes exhibit an amazing capacity to reconstruct skin almost to factory specs in cases like that.

Pidgey


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## Maggie-NC (Jun 22, 2005)

I don't know, Pidgey, about the rehabber missing the hole. We've had it happen too, when the feathers completely covered the opening, but found it within a day or so. Sometimes it is easy to miss what is right in front of you even though you try to do a full body check.

Maggie


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## pdpbison (Mar 15, 2005)

It is amazing also that a Toenail can bleed copiously...and the sometimes large open wound to a back or side, will show almost no blood.

Debride, I always took to mean a mechanical removal of necrotic tissue, foreign contamination, or debris of whatever kind whose presence is not favorable to the healing process.

But in doing a fast 'google' to a Medical on-line Dictionary, I find -


débride (dé·bride) (da-brēd´) to remove foreign material and contaminated or devitalized tissue, usually by sharp dissection.

débridement (dé·bride·ment) (da-brēd-maw´) [Fr.] the removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. Cf. épluchage.

enzymatic d. removal of fibrinous or purulent exudate by application of a nontoxic and nonirritating enzyme that is capable of lysing fibrin, denatured collagen, and elastin but does not destroy normal tissue.

surgical d. débridement by mechanical methods, usually sharp dissection.



The 'Enzymatic Debridement' is reminiscent of the method of Maggots.

Which might prove an good recourse to a tiny $100.00 tube...!

If less immediately handy for short notice, especially in colder Seasons or climes...

Phil
l v


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## feralpigeon (Feb 14, 2005)

Panofil is enzymatic in action and far less muss and fuss than a bunch of maggots. The amount required to do the job is miniscule. 

Some old fashioned remedies I like, not the maggots, however.

Old fashioned root beer is just fine....

fp


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## pdpbison (Mar 15, 2005)

Hi fp,


Lol...

But serious main stream Medicine IS returning to them for their aid in some of these pesky problems...

As with Leeches of course for 'pulling' Blood into extremities which had been re-attatched, whose circulation otherwise, for the time being, would be too dubious...

Too, the little Maggots...if something scares them or they get excited, they can 'click' and sail themselves ass over teakettle, clear across the room...!

Anyway...

Good to apprise options...

Phil
el ve


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## feralpigeon (Feb 14, 2005)

Hi Phil,

I've known about that for a while now, guess what???

Old fashioned root beer it is.

I'll stick w/the Panofil and duoderm patches  

fp


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## Maggie-NC (Jun 22, 2005)

It is amazing what you learn on this forum. I had always thought the debridement was done through excising the tissue but didn't know you could apply an enzyme. 

Too, didn't know maggots could sail across the room.  

Also, I found in my notes another reference to the skin like dressing - Biodres Synthetic Absorbent Wound Dressing. This came from the vet and was used on a robin who had been attacked by a crow. The top of his head, one side of face including ear was raw and bloody. We applied the dressing and she told me to change it every 2 days but the stuff stuck so much I had to wait until it fell off.
The little robin did just fine though.

Maggie


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## Pidgey (May 20, 2005)

Chemical debridement seems to be application specific. From what I've read, they use this method in this situation, and that method in another. I'd have to re-read it to get a better idea why they use the chemical method when they do. It's certainly not going to be much use when you've got a large plug of scablike or necrotic material to get rid of. For that, you're just going to have to use forceps and other implements to remove them the old way.

As to the trapeze artist maggots, even they aren't going to bite through the hard stuff, I would think. Neither do I think they would do well swimming in root beer.

Realistically, if I'd used maggots for Pierpont, I probably could have cut the time to closure down to as little as one-half to one-third, though. I think that could be why they actually use them. And, also, for those of you who are non-plussed by the thought of them, you should understand that they don't just stop by the local roadkill and grab a handful. The ones used are Medical Maggots. They've graduated from med school in the top 5% of their class. It's just a pity that their usable professional career is so short due to their quick transition to becoming flies.

Pidgey


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## Skyeking (Jan 17, 2003)

Pidgey,

Although I'm not thrilled with the thought of using Medical Maggots, their job is to achieve one goal, as short as their career is, it is efficient.

Thanks for your wonderful as well as humorous explanation. You make me laugh, even at the thought of maggots....yuk....


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## mr squeaks (Apr 14, 2005)

*Yes, I agree,*

thanks for the humor, Pidgey! 

I'm not squeamish about maggots but for those who are, maybe your humor helped take the "worry out of being - uh - close"...to maggots, that is...


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## feralpigeon (Feb 14, 2005)

The enzymatic debrider I have is for removing non-viable tissue. It does a pretty good job w/scabs as well. It is great for ulcerated tissue.

fp


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## Pidgey (May 20, 2005)

Well, this is going to sound sarcastic but it's really not--does it work like paint remover? That is, do you have to do it in successive layers, do you slather it on thick, does it work on the 1/4" thick scabs,...?

Do tell!

Pidgey

P.S. Clean your PM message box!


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## Yong (Oct 15, 2003)

Pidgey said:


> I didn't figure that the other rehabber would have missed a featherless, gaping hole like that, but I did expect that there would have been some other sign of the problem like a disagreeable odor or something in the behavior.
> 
> The skin in that section of the back is heavily anchored with fascia. As such, you wouldn't be able to pull it together over that expanse without procedurally breaking the underlying fascia anyway but it still seems too far to pull given the proximity to the wings. Birds sometimes exhibit an amazing capacity to reconstruct skin almost to factory specs in cases like that.
> 
> Pidgey


Well she missed the hole because it was covered with feathers. Not shown in the picture I sent was the image of his whole ches ripped open. She happened to address that issue, and never looked past it. Thats a like a dog comes in because it can't eat it's food. you see it has a bad tooth, so you pull it, but never noticed his jaw was broken. sometimes people look at the obviuos and then stop the inspection. I noticed it becaue I inspect every square inch before a release. yong


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## Yong (Oct 15, 2003)

*Update*

Well...I was going to take a picture of the little guy tonight, but I guess it will have to wait. hubby ran off with the camera. Anyway, two patch changes since the first post, and WOW what a difference! He is doing great and is eating on his own now. his little voice is starting to change too. Cute thing! Yong


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## feralpigeon (Feb 14, 2005)

OK, OK, it's been cleaned for you, Pidgey the Poo, you can go and fill it up 
again  

"Well, this is going to sound sarcastic but it's really not--does it work like paint remover? That is, do you have to do it in successive layers, do you slather it on thick, does it work on the 1/4" thick scabs,...?

Do tell! "

Pidgey

Poo, I would never dream of thinking any comment from you to be in a sarcastic vein.... 

Panofil is used in very miniscule amounts, and left for a period of time to do its work. It is usually either twice or once a day that the bandaging is changed, the wound "washed" and treated again. Not a paint remover, it takes time for it to do its thing. But it does the do very well.

fp


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## Yong (Oct 15, 2003)

*Updated Picture, YEE HAA!!!*

HI All, Just giving you the little guys updated picture. I took it this morning. He had kept his patch on this whole time, but last night when I went in to check on him, he took has patch off. I guess he knew. Yong


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## feralpigeon (Feb 14, 2005)

Hi Yong,

Great results for this little guy, guess he's living up to his name  .

fp


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## Yong (Oct 15, 2003)

Thank you FP. I will be sad to see him go, when he is ready. I am going to take him to the avairy today to let him run with my the others. It's time for him to start living his life. Yong


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## dnrslucky1 (Oct 13, 2005)

Wow! that was fast healing! Squidget is only half way healed and I thought he was doing good!

Denise


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## Yong (Oct 15, 2003)

It sure was fast, actually it caught me by surprise. Two days ago when I took the patch off to change it, I could not believe my eyes. There was still a slight opening, but when I saw him with his patch off, I was shocked. Actually if someone had told me this I may not have believed it=) I didn't suture it, and it completely closed the gap in record time. I will still be suturing in the future, but I will consider patches in areas that are hard to heal and are similar in this nature. The whole patch costed $5, and I used less than half of it. Yong


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