Stephen J. Birchard DVM, MS, Diplomate ACVS

Wednesday, February 26, 2014

Hershey Makes Great Progress But How Do We Close Her Final Open Wound?

This is the continuing story of Hershey: the 3 year female spayed Labrador attacked by 2 pit bulls.

Hershey continued to do well. She tolerated her daily wound care procedures very well and quickly recovered each day after sedation. After several days we were able to do her bandage changes without sedation. Throughout the entire process Hershey ate very well. Large open wounds increase caloric and protein needs, so her good appetite was a significant factor in her healing and overall recovery.

Thigh wound closure

Hershey's wounds filled with granulation tissue, and after 14 days I felt that her caudal thigh wound could be closed. It appeared healthy and was not infected.

Hershey caudal thigh wound after 14 days of wound management
The caudal thigh wound was closed with simple interrupted subcutaneous sutures
of Monocryl and cruciate mattress sutures of Novafil in the skin.

The thigh wound was closed by simply dissecting the skin edges to free them from the granulation tissue along the periphery of the wound and doing a side to side closure. Very little dead space was present so a closed suction drain was not necessary. 

Hershey seemed much more comfortable after the thigh wound was closed. She was less lame on the leg and more mobile and energetic. The tail base wound continued to be managed with a tie-over bandage but now using Adaptic sponges as the primary layer.
Adaptic sponge on Hershey's tail base wound as the first layer of the tie-over bandage
Hershey's closed thigh wound and tie-over bandage

Tail base wound closure

At 21 days after admission, Hershey's tail base wound was ready for closure. But, how could this be accomplished? Look at the wound in the following picture.

Hershey's tail base wound after 21 days of wound management
How would you close this wound?

In the next blog I'll show what we did and how it turned out.