Friday, May 22, 2015

2168. VIdeo: A 16-year-old has an obnoxiously smelly armpit wound - 3rd opinion

The very old dog had an armpit wound. It is very risky to tranquilise this old dog. So Vet 1 prescribed medication. The 2nd opinion vet bandaged the left leg and anchored with Elastoplast to cover up the armpit wound. His antibiotic injection was said to last 2 weeks. The owner did not return every 3 days to change bandages.

There was a strong obnoxious smell when I removed the bandage and the swabs which contained a green discharge of rotten smell.
As this dog is very old, anaesthesia is not advised. My solution was to sedate the old dog, wash the wound thoroughly and let it heal by granulation. Potassium permanganate powder sealed up the bleeding.
Injection to bring down the swollen left limb due to tight bandaging. Antibiotics and sleeping tablet sedation to let the dog have peace and sufficient rest.

FOLLOW UP 3 DAYS LATER.
The old dog's limb was much less swollen and the wound was not smelly. "Sleeps a lot," the owner was satisfied with this open wound method to prevent stench of smelly bacterial infection.
In this old dog, the armpit wound is very difficult to stitch up as it is a mobile high tension area. In this video, I proposed 2 surgical approaches.  The Z-plasty and making another new skin incision further behind the armpit wound.

Z-plasty is used to release tension and the stitched area looks like a "Z" after stitching.
In the 2nd approach, the newly created skin incision is left open. It releases tension so that the debrided armpit wound can then be stitched. The new skin incision is not sttiched but left to heal lby 2nd intention. Antibitoic cover. These are my 2 surgical approaches if the dog is still young. Otherwise, lit takes months to heal a large armpit wound as in this case..

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