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

The lower cost wound protocol significantly increased infection risk and is not recommended for outpatient wound management in dogs.

This pragmatic noninferiority randomized controlled trial evaluated whether a lower cost (LC) outpatient wound management protocol could achieve equivalent wound healing outcomes compared to a gold standard (GS) protocol in 58 dogs. The GS protocol included sterile surgical gloves, sterile saline lavage at 8 psi, No. 40 blade clipping, interrupted nylon skin closure, and a 7-day course of potentiated amoxicillin. The LC protocol substituted clean examination gloves, tap water gravity lavage, No. 10 blade clipping, continuous poliglecaprone-25 closure, and a 3-day antibiotic course. The trial was stopped early due to interim analysis triggered by excess wound complications in the LC group. Wound infection rates were significantly higher in the LC group (40%, 10/25) compared to the GS group (12.5%, 4/32), yielding 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 visit frequency did not differ significantly between groups (p=0.3). Notably, the LC protocol demonstrated a lesser impact on fecal microbiota diversity, with higher delta Shannon diversity index values compared to the GS group (p=0.002), suggesting the shorter antibiotic course better preserved gut microbial diversity. Despite this microbiome benefit, the substantially increased infection risk renders the bundled LC protocol unsuitable for routine outpatient superficial wound management in dogs. Clinicians should adhere to established sterile wound care techniques and appropriate antibiotic duration when managing superficial wounds.

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