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2 CASE REPORT Peer Reviewed Wound Management in a Trumpeter Swan using Honey and a Sustained Release Ionic Silver Hydrogel Christoph Mans, med vet; Janet Sunohara-Neilson, MSc; Geraldine Higginson, BSc; Dale Smith, DVM, DVSc and Michael Taylor, DVM Christoph Mans, med vet Ontario Veterinary College University of Guelph Guelph, Ontario, Canada cmans@gmx.net Christoph Mans obtained his veterinary degree from the University of Leipzig, Germany in He is currently the avian/exotic animal intern at the Ontario Veterinary College, University of Guelph, Canada. A 10-year-old male trumpeter swan (Cygnus buccinator) was presented for evaluation of a maggot-infested lesion on the distal right wing. This swan was valuable as part of a stable captive breeding pair within a trumpeter swan reintroduction program in Ontario, Canada. The bird had been previously deflighted by tendonectomy and carpal joint ankylosis of the right wing. On physical examination, an older, heavily contaminated, foul-smelling wound involved the distal right metacarpus. Two pieces of wood, measuring 5 x 3 x 3 cm and 2 x 1 x 0.5 cm, were lodged in separate cavities within the wound. Radiographs did not show any evidence of fractures or osteomyelitis in the underlying bones. The swan was hospitalized for wound management and supportive care. Under general anesthesia, the foreign bodies and numerous maggots were removed (Figs 1, 2). The wound was thoroughly lavaged, and necrotic tissue was debrided. Unpasteurized honey was used as wound dressing for the first 5 days of treatment (Fig 3). The wound was reassessed and lavaged, and new honey was applied daily. After 5 days superficial debris was removed under general anesthesia, and a viable wound bed was revealed (Fig 4). SilvaSorb Gel, a sustained release ionic silver hydrogel, was applied to the wound, which was bandaged and left in place for 3 days (Fig 5). On reassessment the wound was granulating well and the wound cavities had decreased in size (Fig 6). Secondary wound closure was performed on day 10 in order to accelerate wound healing and subsequent discharge from the hospital. The two wound cavities were debrided and joined to reduce dead space and allow alignment of the wound edges (Figs 7, 8). After closure the wound was rechecked every other day for signs of infection or wound dehiscence. No complications were noted. The swan was discharged after 15 days in the hospital and released in its home environment (Figs 9, 10). Reducing the duration of hospitalization is crucial in this species in order to prevent secondary complications, such as development of aspergillo- EXOTIC DVM VOLUME 8 ISSUE 5 21

3 CASE REPORT Peer Reviewed Fig 1. Day 1: Appearance of the right distal metacarpal wound of a trumpeter swan (Cygnus buccinator) after removal of foreign bodies and maggots. Fig 2. Shown are the removed wooden foreign bodies and maggots (25-ga needle for scale). Fig 3. Day 1: The wound was dressed with honey then covered with sterile gauze pads and a bandage. The dressing was changed daily for the following 4 days. Fig 4. Day 5: With the swan under general anesthesia removal of superficial debris revealed a viable wound bed. sis, pododermatitis and sternal sores or ulceration. Topical application of honey has long been recognized for its effectiveness in controlling wound infection and supporting development of a clean granulation bed. 1 Numerous studies have demonstrated that the use of honey in a wide range of wounds shortened healing time when compared with other wound dressings. 2 The wound healing properties of honey are not widely recognized in veterinary medicine but are being increasingly reported. 3-9 In mammals the beneficial effects of honey are the result of several biological effects, including decreased inflammatory edema, accelerated sloughing of devitalized tissue, stimulation of macrophage migration, provision of a cellular energy source and provision of a moist wound environment. 2,3 Honey rapidly clears wound infection and prevents re-infection because of its high osmolarity, the presence of hydrogen peroxide in a low, nontoxic concentration and its low ph ( ). 3,10 Honey used for wound care should be unpasteurized and should not be heated above 37 C. 3 In practice any unpasteurized honey would be effective in treating wounds, but various sterile products licensed for use in human wound care are also available. 2 Following the initial treatment with honey, SilvaSorb Gel ( was used in order to reduce the frequency of dressing changes and handling-related stress for the patient. SilvaSorb Gel controls bioburden for up to 3 days by the sustained release of ionic silver. Therefore, this product requires much less frequent dressing changes than many other wound dressings. Furthermore, as a hydrogel, it donates moisture to the wound, creating an ideal environment for wound healing. 11 Several sustained release silver dressings are available commercially and have been shown to be efficient in controlling wound infection. 12 The authors chose to use honey and SilvaSorb Gel in this case based on the ability of these products to accelerate healing times and for their antibacterial properties. Secondary wound closure could be performed, minimizing the period of hospitalization, and the trumpeter swan could be released without the need for further bandaging. 22 EXOTIC DVM VOLUME 8 ISSUE 5

4 Wound Management in a Trumpeter Swan using Honey and a Sustained Release Ionic Silver Hydrogel C. Mans, J. Sunohara-Neilson, G. Higginson, D. Smith and M. Taylor Fig 5. Day 5: SilvaSorb Gel was applied to the wound and left in place for 3 days without dressing changes. Fig 6. Day 8: The wound bed appeared healthy and the wound size had decreased. Fig 7. Day 10: After 2 more days treatment with SilvaSorb Gel, the wound size had further decreased. Secondary wound closure was achieved by ablating the tissue separating the two wound cavities (area between the black lines). Fig 8. Day 10: Appearance of the wound after closure with absorbable suture material using simple continuous and horizontal interrupted mattress patterns. Fig 9. Day 14: Appearance of the wound 4 days after secondary closure. No signs of infection or wound dehiscence were noted. Fig 10. Day 15: The trumpeter swan was ready for discharge after only 15 days in the hospital. References and Further Reading 1. Subrahmanyam M: A prospective randomized clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 24(2): , Molan PC: The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds 5(1):40-54, Mathews KA, Binnington AG: Wound management using honey. Comp Contin Educ Pract Vet 24(1):53-60, Hernandez-Divers SM: Principles of wound management of small mammals: Hedgehogs, prairie dogs, and sugar gliders. Vet Clin No Am Exot Anim Pract 7(1):1-18, Langlois I: Wound management in rodents. Vet Clin No Am Exot Anim Pract 7(1): , Dart AJ, Dowling BA, Smith CL: Topical treatments in equine wound management. Vet Clin No Am Equine Pract 21(1):77-89, Rudloff E: How to use honey/sugar bandages in reptiles. Proc No Am Vet Conf Sm Anim Exot, 2005, p Krahwinkel DJ, Boothe HW: Topical and systemic medication for wounds. Vet Clin No Am Small Anim Pract 36(4): , Harcourt-Brown F: Honey to treat rabbit abscesses. Exotic DVM 3(4):13-14, Cooper RA, Molan PC, Harding KG: Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med 92(6):283-5, Manufacturer s product information, Heggers J, et al: Therapeutic efficacy of three silver dressings in an infected animal model. J Burn Care Rehabil 26(1):53-6, EXOTIC DVM VOLUME 8 ISSUE 5 23

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