Assessment of Wound Healing Complications With a Lower Cost Outpatient Wound Management Protocol: A Pragmatic Randomized Clinical Trial in Dogs

OBJECTIVE: To determine whether a lower cost (LC) outpatient wound management protocol for dogs could achieve equivalent rates of wound healing complications with fewer veterinary visits and less impact on fecal microbiota diversity compared with the gold standard (GS) treatment. DESIGN: Pragmatic noninferiority randomized controlled trial. SETTING: Veterinary teaching hospital. ANIMALS: Convenience sample of 58 dogs. INTERVENTIONS: Dogs were quasi-randomized by admission date into GS (n = 33) or LC (n = 25) bundled interventions. The GS group comprised use of sterile surgical gloves, sterile saline at 8 psi, hair clipped with a No. 40 blade, nylon used with an interrupted pattern for skin closure, and a 7-day course of potentiated amoxicillin. The LC group used clean examination gloves, a tap water gravity lavage, a No. 10 blade for clipping the hair, poliglecaprone-25 in a continuous pattern for skin closure, and a 3-day course of potentiated amoxicillin. Outcomes were assessed by follow-up with blinded owners and primary veterinarians. MEASUREMENTS AND MAIN RESULTS: Wound complications in the LC group prompted interim analysis, and the trial was stopped early. Ten of 25 wounds (40%) in the LC group became infected compared with 4 of 32 (12.5%) in the GS group, corresponding to a risk difference of 27.5% (95% CI, 5.1-49.8; p = 0.03) and a risk ratio of 3.20 (95% CI, 1.14-9.01; p = 0.03). Follow-up veterinary visits were similar between the two groups (p = 0.3). Reduced treatment impact on fecal microbiota diversity was seen in nine dogs in the LC group (delta Shannon diversity index: 1.16 ± 0.28) compared with 16 dogs in the GS group (delta Shannon diversity index: 0.76 ± 0.27) (p = 0.002). CONCLUSIONS: The bundled, LC wound management protocol described in this study is not recommended for outpatient management of superficial wounds in dogs.