Signalment: Pistol, 8-year-old FS Corgi cross.
History: Pistol had been attacked by a house-mate about 2 ½ weeks prior to presentation. Owner did not seek treatment initially due to financial constraints and lack of external wounds. Over the 3 days prior to presentation she had stopped eating and had become progressively more lethargic and a large abscess had ruptured on her back.
No major past medical or surgical history.
No medications or supplements.
T: 103.5 F (39.6 C) P: 76bpm R: pant
GEN: attitude – quiet, alert and responsive. Hydration – mild (6-8%) dehydration. BCS 6/9
EENT: eyes and ears clean and free of debris, nose clean and moist, no cough elicited on tracheal palpation
INGT: overall healthy skin and hair-coat, large (approximately 15 cm x 10cm) area of necrotic skin on dorsum spanning from caudal c-spine to mid-lumbar region. Purulent discharge from wounds around necrotic skin.
CV: pink but slightly tacky mucous membranes; strong and synchronous femoral pulses; no murmurs or arrhythmias auscultated.
RESP: tachypneic, normal bronchovesicular sounds in all quadrants, no crackles or wheezes
ABD: abdomen soft and non-painful on palpation, no organomegaly or masses palpable
MS: symmetrical muscling, no lameness noted on ambulation
NEURO: complete neurologic exam NOT performed, normal mentation, CN exam within normal limits
LN: all palpable peripheral lymph nodes soft and non-painful
CBC: WBC 22.0 (6.0-17.0 K/mm3), HCT 59% (37-55%), all other values WNL
CHEM: TP 7.8 (4.8-7.5) all other values WNL
Initial Treatment Plan:
Intravenous catheter was placed in left cephalic vein and fluid therapy with 0.9% NaCl with 20mEq KCl/L was initiated at 1.5x maintenance.
Due to financial constraints, culture and sensitivity of wound was declined so broad spectrum antibiotic therapy was initiated: Unasyn (ampicillin sulbactam) @ 22mg/kg IV q 8 hours, Baytril (enrofloxacin) @ 5mg/kg IM q 24 hours.
Additional medications: Cerenia (maropitant) @ 1mg/kg IV q24
hours, Rimadyl (carprofen) @ 2.2mg/kg subq q 12 hours
Surgical debridement was scheduled for the following morning.
Pre-anesthetic: atropine 0.01mg/kg, hydromorphone 0.1mg/kg IV
Induction: propofol 4mg/kg IV slowly
Maintenance: isoflurane to effect
Patient was placed in sternal recumbency. All necrotic tissue was removed and revealed an unhealthy bed of early granulation tissue with significant purulent exudate. Additionally, a secondary wound was identified with significant pocketing caudo-lateral to the main wound. Both wounds were cleaned with chlorhexidine scrub and sterile saline flush. A penrose drain was placed in the caudo-lateral wound to facilitate closure of dead space and a tie-over bandage with hypertonic saline was placed over the large, open wound.
Patient recovered from anesthesia without event.
IV fluids, parenteral antibiotics, anti-inflammatory, and anti-nausea therapy was continued over the next 5 days, until patient was normo-thermic and voluntarily eating.
Wet-to-dry hypertonic saline debriding wound dressing was removed and granulation bed evaluated – once wound was no longer exudative , tie-over bandage was maintained but hypertonic saline dressing underneath was replaced with Calcium Alginate to promote granulation tissue growth.
On day 3 post-op, the penrose drain was removed from the caudo-lateral wound.
Every other day bandage changes were performed and the use of Calcium Alginate was continued. When a healthy epithelial rim was identified, bandaging was changed from calcium alginate to silver sulfadiazine ointment to keep the wound bed moist and promote continued contraction and epithelialization
Patient was discharged from the hospital on Day 7.
Rx: Clavamox (Amoxicillin-Clavulanic Acid) 13.75mg/kg PO BID, Baytril (Enrofloxacin) 5mg/kg PO q24 horus, Rimadyl (Carprofen) 2.2mg/kg PO BID as needed for pain control.
7 days of oral antibiotic therapy were prescribed to a total
of 14 days of treatment.
Patient was returned to the hospital every 4 days for bandage changes and wound progress assessments. A small hydrosorb (COPA) with silver sulfadiazine was used under the tie over bandage to promote continued wound contraction and epithelialization.
Patient was released from follow up care. Bandaging was discontinued and remaining place-holding sutures for tie-over bandage were removed.
Pistol has not experienced any further complications related to this event.
Initial therapy was aimed at stabilizing the patient and combating infection.
Wound management stages: