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Wound Care

Flushing and application of antimicrobial ointment

Wounds should be flushed with sterile saline before application of an antimicrobial ointment. Be extra careful when flushing a wound that leads directly into the coelom in order to avoid introducing excess moisture into the coelom.

1. Triple antibiotic ointment (TAO): Neomycin (Aminoglycoside), Bacitracin (Gram +’s , Polymyxin B (Gram –’s), used on flesh wounds NOT on the face
2. Ocular TAO: If the patient’s wound is found near the eye (aka on the face), ocular TAO should be used to protect the eyes
3. Silver sulfadiazine cream (SSD): Broad-spectrum, active in the face of organic debris, and not readily susceptible to bacterial resistance. These characteristics make it the best ointment to be placed on shell fractures. Please remember that only a thin layer of SSD is required in these cases. 
4. Veterycin spray: Used to clean, flush, moisturize, and help prevent potential infection in wounds, cuts, and abrasions.

An example of a fracture on which SSD can be used.

An example of a wound on a snapping turtle for which vetericyn or SSD can be used.

A soft tissue wound on which TAO could be used.

Bandaging

A turtle with multiple vet-wrap bandages for support and protection of injuries.

Honey/Sugar Bandage

To apply: 

• flush the wound with saline
• apply granulated sugar to the wound or generously spread the honey over the gauze you intend to use
• moisten one 2×2 gauze square and place it on wound
• cover it with 1-2 gauze squares
• wrap it with vet wrap +/- tape. 

The bandage should be changed either every day or every other day. If you notice the growth of mold on the honey/sugar, please flush the wound thoroughly and discontinue the bandage. 

Purpose:

The acidity of honey/sugar increases the release of oxygen from hemoglobin which promotes healing and makes the wound less favorable for the activity of destructive proteases.

The high osmolarity draws fluid out of the wound and thus aids the flow of lymph through the wound. Manuka honey contains methylglyoxal, which inhibits bacterial growth.

Wet to Dry Bandage

To apply:

• flush the wound with saline
• moisten 2 gauze squares with sterile saline and place it on the wound
• Cover the moist gauze with several layers of dry gauze, a telfa pad, or other absorbent bandages
• Use vet wrap +/- waterproof tape to cover it

A turtle with a wet to dry bandage.

Purpose:

Wet to dry bandages assist débridement by liquefying coagulum and absorbing necrotic debris while leaving viable tissue intact. The principle of a wet saline bandage is that, as the sponges dry, wick action pulls debris and exudates into the sponge and away from the wound. 

Features of wet-dry bandages are that (1) antimicrobials can be used in the wetting solution, (2) a physiologic environment can be maintained, (3) comfort is maintained, and (4) exudate is removed. 

However, bacteria may flourish in a moist environment, and tissue maceration may occur. Most importantly, debridement is nonselective, normal healing tissue is damaged, and dressing removal is often painful.

Maintenance:

Change the bandage daily or more often if strikethrough occurs or if the wound is heavily infected. To decrease discomfort associated with removal of the primary layers of the bandage (dry gauze sponges), moisten the sponges with saline and lift them from the wound; however, some efficacy of mechanical debridement will be lost. Removal of the primary bandage layer may cause bleeding or oozing. A non-adherent bandage generally is indicated after 3 to 5 days of wet-dry bandaging.

Considerations for Common Injuries in Turtles

Shell Fractures

• As shell fractures can compromise the protective barrier that turtles have, it is important to ensure they are fully healed prior to release (or removal of stabilizers)
  • If the membrane underneath a shell fracture is intact, over time it will calcify with proper healing and become as strong as the shell was – however, the shell will not regenerate completely to look as it did before the injury
• Portions of fractures that are completely separated from the rest of the shell may lack the blood supply needed to heal
  • This can cause them to become necrotic and fall off
  • This can be an important prognostic indicator
• Bridge and plastron fractures are extremely difficult to stabilize, however, turtles can typically heal from them without intervention
• If the shell is compromised enough that a turtle will not be able to box for protection, they would be considered non-releasable

Amputations

• Turtles can survive successfully in the wild with 3 legs, but if they have bilateral injuries compromising their cranial or caudal limbs, they may be considered non-releasable
• Amputations are indicated in the case of open or necrotic wounds, or if a fracture is highly comminuted and cannot be stabilized
  • Otherwise, limbs can be saved with splints and occasionally fixations
• Reptile skin should be sutured with a horizontal mattress pattern to oppose the dermis and promote healing beneath the level of the scales
• Post amputation, triple antibiotic ointment can be applied to the incision site and a bandage should be applied for at least 24 hours after the surgery to promote coagulation
• Turtles should be dry-docked for at least 2 weeks post-amputation, sutures should be removed in 4-6 weeks

Ectoparasites

Coelomic Breach

• If a wound or shell fracture is severe enough, the coelomic cavity and correlating viscera may be exposed
• Antibiotic therapy is always indicated with coelomic breaches
• It is important to keep the breach dry and clean, with proper topical ointment (triple antibiotic or SSD) and keeping the turtle dry docked
  • Any time a turtle is dry-docked, fluid therapy is indicated
  • Proper debridement will aid in the healing of healthy tissue

A box turtle with a significant coelomic breach.

Relevant Videos

• Applying Topical Medication
• Ioban Bandage
• VetWrap Bandage

Additional Resources

Lafortune M, Wellehan JFX, Heard DJ, Rooney-DelPino E, Fiorello CV, Jacobson ER. Vacuum-assisted closure (Turtle VAC) in the management of traumatic shell defects in chelonians. Journal of Herpetological Medicine and Surgery 15(4):4-8. 2005.