Plus-Hex CLINICAL
After being exposed to an antimicrobial substance repeatedly, microorganisms can undergo changes that stop them being killed or inactivated by the treatments [ 6 ]. Therefore, it is essential that the use of antibiotics is carefully considered and they are only used responsibly to prevent the development of resistant strains of bacteria. The emergence and steady increase in the occurrence of bacteria that are resistant to multiple antibiotics has become a global public health threat, due to the lack of therapeutic options to treat certain infections in humans.
During the 6-month period of Maddie ' s treatment, there was only a 4-week interval of no antibiotic use; however, this was continually reassessed and was always dependent on swab results.
Wound management
The owners opted for the wound to be closed, but they were advised of the high chance of wound breakdown.
The VN collaborated closely with the VS throughout the wound management process, with the VN primarily leading the dressing consultations. The VN was responsible for removing the dressing, after which the VS would assess the wound to determine if swabbing was necessary and to evaluate its condition. Subsequently, the VN undertook wound and limb cleansing, re-dressing and the management of client expectations.
The owners were extremely dedicated to Maddie ' s care and they even made special pads to go inside her leg coverings to give extra protection for her elbows( Figures 4 and 5).
Figure 5. Maddie wearing a home-adapted dressing.
Dressings and wound progression
Between March and October 2023 Maddie visited the practice on several occasions, due to setbacks to her recovery, which required dressings to be changed. Further details and a timeline of the case can be found in Appendix 1.
Ring doughnut dressing
The first dressing, applied post biopsy on 9 March, was adapted to suit Maddie ' s specific needs. The area was already clean from the biopsy. A‘ ring doughnut’( Figure 6) was created using cotton wool and conforming bandage, and placed directly over the elbow to prevent contact between the wound and any surfaces or dressing material.
The doughnut was secured with layers of Soffban, conforming bandage and vet wrap. A small hole was
Figure 4. Maddie wearing homemade protective pads.
Figure 6. A bespoke‘ ring doughnut’ dressing.
Volume 40( 4) • August 2025
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