Thursday, April 22, 2010

37. Non-closing midline wound

Every vet will encounter non-healing of a long midline surgical wound. Stitch breakdown is one complications of surgery. This Cocker Spaniel is normal but the wound just will not close some 4 weeks after surgery to remove the stones in the intestines by Vet 1.

The dog went home and the stitch broke down. So Vet 1 had to stitch up the wound again. Yet, the wound just does not heal as the tension in this area is very great. I could see the stitches cutting through and the gap getting bigger.

The assistant applied antibiotic powder daily for the last 2 weeks. The wound was moist, as if exudate leaked from below the skin prevents granulation tissue from forming. Thus the long wound persists and the family members esp. children could not stand the sight of a long moist channel in the belly or underside of their dog.

What can be done to resolve the problem so that the dog can go home? This case study of the management of non-healing wounds in a normal dog would be good for Tanya, the intern.

1. Remove all stitches.
2. Wash the wound daily with clean warm water.
3. Use trimaxazole antibiotic powder. Do not apply cream.
4. Pack gauze onto surface of wound.
5. Bandage the lower chest and abdominal area to prevent exudate formation or irritation by the dog's paws. Although a big e-collar was in place, I suspect that there was some way the dog could lick the wound or the stitches were irritating.
6. Remove the bandage daily and repeat steps 1-5.
7. Antibiotics and non-steroidal anti-inflammatory would be given to effect.

Today April 22, 2010 is the first day of bandaging. I took a picture yesterday. I have told Tanya to expect granulation in 14 days if the above procedures were done diligently. Let's see.

Basically, a wound will heal by granulation if it is kept clean and dry. Somehow, this dog's wound had not healed and I suspected that the dog had been irritating it when nobody is looking. It is my hypothesis. Whatever it is, all the owner wants is for the wound to close and the dog to go home.

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