Table 3 Detailed treatment protocols and additional rationale

Pressure Ulcer

1. Debride with chlorohexidine and Neosporin.

2. If break in skin, place Telfa pad directly on wound.

3. Layer two 4 × 4 layers of gauze padding at the heel and one 2 × 2 gauze layer at the ankle.

4. Start self-adherent bandage above the ankle and work towards the toes. Check for excessive compression throughout your bandaging process.

Note: Depending on the severity of the pressure ulcer, antibiotics might be necessary. Bandage should be changed every 2 days or once a week depending on the severity of the pressure ulcer. Bandage should be changed once every two weeks when there is no pressure ulcer.

Animals are insensate; therefore, they have no painful feedback preventing them from injuring themselves. Bandaging provides extra cushioning at the heel for when the animal stamps its foot. The Telfa pad prevents gauze from sticking to the wound.

Foot Dragging

Minor Irritation:

1. Place one 2 × 2 gauze layer over the affected region of the foot.

Break in the Skin:

1. Remove any necrotic tissue.

2. Place one Telfa pad directly on wound.

3. Place a layer of 4 × 4 gauze for padding before adhesive bandage.

4. Wrap self-adherent bandage as above.

5. Antibiotic treatment for 7 days.

Note: Depending on severity of the injury, suturing or amputation of toes might be required. No E-collar placement is necessary. Bandage should be changed once a week.

The wound should be shielded from additional damage. Removal of necrotic tissue is necessary to allow healthy tissue to grow. Suturing is only necessary when bone is exposed. If a layer of muscle is exposed with no bone exposure, suturing is not required. Amputation is required if phalanges are exposed.

Self-Mutilation

1. Debride and sterilize injury site.

2. Toe amputation at the metacarpal will be necessary unless there is enough healthy tissue to close the opening.

3. Rinse with saline before suture closing.

4. Apply Triple antibiotic and Telfa pad on the wound.

5. Place one 4 × 4 gauze layer on top of the Telfa pad.

6. Wrap self-adherent bandage as above.

7. Place E-collar immediately, with periodic supervised off-collar time.

The intent is to clean and close the wound, and shield wound from additional damage. E-collars are placed to prevent further self-mutilation. If animals do not show indications of additional self-mutilation during supervised off-collar time, E-collar usage may be reduced through a systematic weaning process.

Neck Abscess

1. Excise necrotic tissue and flanking margins of healthy tissue.

2. Either leave incision open to drain on its own or implant drains.

3. Apply Triple antibiotic and one Telfa pad.

4. Place one layer of undercast padding.

5. Place two layers of 4 × 4 gauze only at the injury site.

6. Place one stockinette around the neck.

7. Wrap a loose self-adherent bandage around the neck. Place two fingers between padding and neck to avoid over- compression.

Note: BupSR must be given for pain management. NSAIDs are unlikely to sufficiently alleviate pain. With every bandage change, slowly shift drains side to side to help the pus drain. Bandage should be changed daily until draining subsides. Suturing of a neck wound may be required based on the depth of the wound, per consultation with veterinary staff.

Bandaging both shields the wound from additional trauma and provides a distraction for the rabbit, so as to minimize grooming/pawing of the wound area. For the latter, a loose bandage that slips off of the wound wsa observed to be favorable compared to an absence of bandaging. The stockinette is placed to prevent the gauze from rolling out from the bandage and to keep the adhesive bandage in place.

Dorsal Ankle Abrasion or Injury

1. Apply one layer of 2 × 2 gauze

2. Wrap self-adherent bandage as above.

Note: If possible, try to keep the fur on the area (do not shave – trimming of hair with scissors will suffice and preserve some padding). Bandages should be continuously wrapped, to reduce likelihood of unraveling.

The dorsal ankle is the main pressure point of the bandage during typical paw positioning, and is a generally delicate area. There is less likelihood of stamping or dragging trauma in this region, but gauze provides some padding in a mobile and flexible area.

Product Irritation

1. Do not use athletic tape (e.g., Elastikon) to secure self-adherent bandage.

2. Gauze should not directly contact an open wound.

Athletic tape is extremely adhesive, while rabbit skin is very fragile; therefore, removal of the athletic tape has the potential to tear the rabbit skin (see images).

Telfa pads provide a suitable protective barrier between gauze and open wound.