Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Revolutionizing Canine Wound Care with Nitric Oxide Dressing
Discover the revolutionary advancements in veterinary wound care with our special guest, Dr. Sarah Marvel, as she unveils the potential of a groundbreaking nitric oxide wound dressing for dogs. This episode promises to change your perspective on treating acute traumatic wounds, shining a light on the impressive median surgical closure time of just six days without any significant complications.
Join us as we explore the remarkable antimicrobial effects observed in this study and discuss the exciting future of this nitric oxide dressing in chronic wound management and biofilm treatment. We dive into the critical role of nitric oxide in wound healing, from inflammation to collagen maturation, and consider how AI might enhance wound assessment and management. For veterinarians eager to stay at the forefront of their field, we offer insights into the dressing's various formulations and its distinct gray hue. This is an episode filled with innovation and expertise, offering new hope and strategies for effective wound care in veterinary practice.
AJVR article: https://doi.org/10.2460/ajvr.24.04.0124
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You're listening to Veterinary Vertex, a podcast that AVMA journals. In this episode, we chat about the use of a novel nitric oxide wound dressing and acute traumatic wounds in dogs with our guest, Sarah Marvel.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have another Sarah joining us, so hopefully we can keep the Sarahs straight. Sarah Marvel, thank you so much for taking time out of your really busy schedule to be with us here today.
Sarah Marvel:Thank you so much for having me. I'm excited to be here.
Sarah Wright:All right, let's dive right in. So, Sarah, your AJVR article discusses the use of a novel nitric oxide wound dressing in acute traumatic wounds in dogs. Please share with our listeners the background on this article.
Sarah Marvel:Yeah, so traumatic wounds are unfortunately very common in veterinary medicine, and while it would be more convenient in many situations to suture these wounds closed, so many of them are heavily contaminated. They contain really severe pocketing and devitalization, and often that does require open wound management so we can improve that tissue health prior to closure, so we can ensure success of that wound closure and wound healing. When we perform open wound management, our goal is to use a wound dressing that's actually going to promote wound healing, and that really depends on what stage of wound healing we're in, and so sometimes this can require the use of multiple products. So, for example, we might want something that promotes autolytic debridement or the formation of granulation tissue or promotes epithelialization, and that can sometimes get a little complicated.
Sarah Marvel:What we know is that nitric oxide actually plays a really crucial role throughout wound healing and is involved in many of these pathways during wound healing. It's involved in inflammation and debridement, it's involved in angiogenesis and cell proliferation and even the formation of granulation tissue and epithelialization and even in that later phase, that collagen maturation phase. So it's really involved all throughout wound healing. And so the purpose of this study was to use this novel nitric oxide wound dressing and really describe wound healing times, infection rates and potentially, any adverse events that are associated with this product in these acute traumatic wounds in dogs.
Sarah Wright:I found your article super interesting because I feel like we didn't learn a lot about like wound dressing or alternative methods for wound care in vet school, so I thought it was really informative and a new perspective too.
Sarah Marvel:Yeah, it's always nice when there are new and innovative things out there, especially when it comes to wound management, because it's so common.
Sarah Wright:Definitely so. What are some of the important take-home messages from this AJVR article?
Sarah Marvel:Yeah, so after using this novel wound dressing in 24 dogs and then we had 30 acute traumatic wounds all of these wounds were able to go and be surgically closed at around a median time of about six days. There was a bit of a range depending on the severity of the wound, and some could be closed sooner and some took a little bit longer, but on average about six days. The product is really simple to use and so I think that's something that's important. We also didn't really find any complications or adverse events that we could attribute to the use of the nitric oxide wound dressing. That's always one of those important things when you're using something that's kind of new and different we always have concerns about could there be, you know, any adverse effects or complications, and nothing that we could really detect.
Sarah Marvel:There is, I guess, one contraindication to its use, and I don't think the study can really comment on that, because for us it was an exclusion criteria but that was having any kind of significant hemorrhage in the wound.
Sarah Marvel:So nitric oxide is a potent vasodilator, so obviously if you have significant hemorrhage you would want to potentially choose another dressing. We can't really comment on that. But one thing we did notice on the plus side of things is that our wound beds appear to be like quite vascular very quickly. And then I guess in terms of any of these studies, there's always the concern for potential wound complications like dehiscence that can happen afterwards. We did have a couple of wounds that went on to have dehiscence after closure, but that's pretty consistent with what's in the literature. Right now. We had one really complex case that had a pharyngeal tear that resulted in kind of saliva accumulating in our wound and while we weren't sure exactly what would happen there, that wound went on to heal very well and that pharyngeal tear healed on its own even in the face of using this nitric oxide. So it can be used for some of these really complex wounds as well.
Lisa Fortier:Yeah, thank you. I'm a horse owner and rider and equine veterinarian. We love our lotions, potions and sprays for wounds and there's so many out there. I'm curious what sparked your research interest specifically in this nitric oxide wound dressing?
Sarah Marvel:Yeah, that's a great question. So a lot of this was really just my interaction with the company that created this. You know, you go to a conference, you're going through the exhibit hall looking for kind of new and innovative products, and I was really drawn to their, like their photos. You know, obviously wound photos can be very dramatic and just seeing some of the case series that they had had and the progress and improvement of some of these wounds actually most of them were horses actually and so I really just developed an interest and then I just wanted to see for myself what this product could do.
Lisa Fortier:That's awesome. Sarah Wright asked you, Sarah Marvel, a little bit ago about what were some of the key take-home messages, but always when we do a study, there's a few things that surprise us. What was one or two of the most surprising findings in your AJVR article?
Sarah Marvel:Yeah, I was most surprised by the very low infection rate that we had following wound closure.
Sarah Marvel:When you look at some of the recent studies that are out there actually one that was done out of our institution here they found that 22% of dogs that had acute traumatic wounds, they were treated with antibiotic therapy.
Sarah Marvel:They were then closed. 22% of them went on to develop infections after their wound closure and in our study only 7% of wounds developed infection following wound closure. And so obviously you know you can't definitively say that it was related to the nitric oxide, but we know that nitric oxide has antimicrobial effects and there are studies that document it's used to treat biofilms, and biofilms have become a really big problem with metallic implants, but not only that, but with granulation tissue beds for these wounds that we're managing. And so potentially the antimicrobial effects of the nitric oxide may have played a role in the lower infection rates in our study. And I think this is just so important in the era where multidrug-resistant infections are just becoming really common, and so I think this is just a really exciting possibility with this product.
Lisa Fortier:Yeah, you stole my thunder. I was going to say, in this age of antimicrobial stewardship, this is really cool. What are the next step for research in this topic? And feel free to specifically call out the sponsor. They should get some recognition for this advancement.
Sarah Marvel:Yeah. So, this is kind of the first step right, which is a clinical study, and it's difficult, right, because there are no controls and that's hard in these like acute traumatic wound studies that are clinical. There's another group that's looked at the use of this product in a controlled like research model setting and so you know, obviously having controls and that's shown some really good results in terms of promotion of of early promotion of the formation of granulation tissue, and so I think that's great. But another area would really be like chronic wound management. So, all of these things have focused on kind of acute wounds and so I think that could be probably the next phase for this. I suspect that nitric oxide could really jumpstart many of these kind of chronic wounds that are kind of stalled out. Cats we know nothing about, obviously, other species, so that would be an area. But I also just really like this potential for biofilm treatment. So, and then, yes, this product, the Restore product by Noxano, has been used in a variety of species, but from a research standpoint.
Sarah Marvel:Right now, we really just have information in dogs
Lisa Fortier:Very cool. Do you see a role for AI in this area of research?
Sarah Marvel:Yeah, I mean thinking about this. Obviously, with AI becoming so popular, I could see AI playing a role in decision-making, potentially for open wound management or taking out some of the decision making, I guess. So you know, could there be a future where you like scan a wound and then AI could help in the assessment of that wound and deciding maybe what wound dressing would be appropriate. But there's a lot of, I think, potential options for that in the future.
Sarah Wright:Yeah, it's a cool question. We just recently added that, and hearing everyone's responses has definitely been super interesting. So let's look back in a few years and see if any of these come to fruition.
Sarah Marvel:Yeah, very exciting times and also just so much that AI can do that like I'm just not aware of, so it's kind of mind blowing a little bit.
Sarah Wright:For those of you just joining us, we're discussing the use of a novel nitric oxide wound dressing and acute traumatic wounds in dogs with our guest Sarah Marvel. Sarah, how did your training prepare you to write this manuscript?
Sarah Marvel:Yeah, so after veterinary school I trained in a combined small animal surgery residency and a master's program at Colorado State University and I would say it was really probably my master's coursework and research mentors, because they play a huge role in shaping who you become. But that really I think helped prepare me for the scientific writing side of things and just develop my interest in research in general.
Sarah Wright:So, this next portion is going to be really important for our listeners. So, what is one piece of information the veterinarian should know about the use of a novel nitric oxide wound dressing in acute traumatic wounds in dogs?
Sarah Marvel:So this nitric oxide wound dressing comes in multiple different formulations and basically you get to decide which formulation makes sense for you depending on the configuration of the wound. So it comes in a dehydrated gel precursor and then also a dehydrated pad, both of which then need to be reconstituted with saline. One thing I will let veterinarians know about is that the gel has this gray color and that gray color can actually stain the tissue to appear this kind of like grayish hue. You can see an example of this in our article in one of the images. There are no concerns with this gray color or with this product sticking to the tissue, as this product is bioresorbable, so nothing to worry about there.
Lisa Fortier:That's a good point, Sarah. I used it in a couple of horses that had, like you know, the classic tensile wire, kind of sort of degloving, and I thought, yep, I'll try this, and I put on. The next day I was like what the heck happened? And then I was like, oh yeah, nitric oxide, silver, it's okay.
Sarah Marvel:Yeah, exactly, Definitely startled me the first couple of times and I contacted the manufacturer and the company and they're like no, it's just the binder that's in there. It's all fine so, but good to know, because otherwise you're like is that healthy or unhealthy?
Lisa Fortier:It looked like a very sick tin man.
Sarah Wright:That's a really good disclaimer. So on the other side of the relationship, what's one thing clients should know about? The use of a novel nitric oxide wound dressing in acute traumatic wounds in dogs?
Sarah Marvel:So, I cannot confirm this for myself, but I have been told that the product tastes good to dogs. It has some gelatin and meat tenderizer in it, and while it's not toxic, we obviously just don't want our pets to consume it or further traumatize their wounds by getting to their bandages or to the wound dressing. So, it's obviously important for pets to wear an e-collar or another device to prevent them from getting to their wound, and then also, I guess, use caution. If you have other pets in the household as well too, you may find it tasty.
Lisa Fortier:Good old meat tenderizer and wound repair.
Sarah Marvel:Apparently, that tastes good.
Lisa Fortier:Thank you so much, Sarah. I learned a lot from your article and thanks for trusting us with your important work.
Sarah Marvel:Thank you very much.
Lisa Fortier:As we close out, we'd like to ask a fun question. So, what we would like to know from Sarah Marvel is if she could have a superpower, what would it be and why?
Sarah Marvel:So, my last name is Marvel, so I am actually often asked this question if I have a superpower, particularly by comic fans. I don't know if this is the superpower that they would choose for me, but I think being able to breathe underwater, so that I could just be underwater all the time and enjoy the aquatic creatures, would be amazing.
Lisa Fortier:That's cool.
Sarah Wright:That's actually funny because that's like DC Comics instead of Marvel.
Sarah Marvel:Oh no, I've lost all the comic fans right there.
Sarah Wright:That's ok! Thank you so much, Sarah.
Sarah Wright:I really appreciate you being here today and for contributing your research to AJVR.
Sarah Marvel:Thank you for the opportunity
Sarah Wright:To our listeners. You can read Sarah's article on AJVR. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
