Stephen J. Birchard DVM, MS, Diplomate ACVS

Tuesday, February 25, 2014

Initial Treatment of Hershey: Supportive care and aggressive wound management

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

The emergency service at Ohio State began supportive care on Hershey immediately after admission consisting of intravenous fluids, broad spectrum antibiotics, and analgesics. 

Once she appeared more clinically stable, Hershey was placed under anesthesia for her initial wound assessment. The wounds were probed to determine the extent of undermining, and lavaged with sterile saline. A rectal exam was performed to confirm there was no injury to the rectum.
Hershey's wounds were initially probed and flushed with sterile saline
Some debridement of necrotic tissue was initially done and areas of obvious infection opened up to establish drainage.

My surgical service began treating Hershey soon after admission. Our biggest concern was sepsis; wounds of this magnitude with obvious severe infection can quickly result in septicemia and lead to a downward spiral of organ failure and death. Hershey was not showing signs of that yet. 

We began a daily routine of general anesthesia, serial debridement of necrotic and infected tissue, lavage, and wet to dry tie-over bandages. 
Each day meticulous surgical debridement of the wounds was preformed.
The most important principle with severe infected wounds like this is to surgically open all areas where the skin is undermined. Aggressive debridement of infected and necrotic tissue can then be done. 
After debridement, lavage with copious amounts of sterile saline was done.
Packing the wounds with sterile saline moistened sponges for the wet to dry tie-over bandages.
Tie-over bandages on the rump, tail base, and left caudal thigh.
You will frequently hear surgeons say that they are waiting for the wounds to “declare themselves”. This simple phrase refers to the daily assessment of the tissues to determine what is viable and what is sloughing out and in need of debridement. Wound closure is not even considered until the tissues appear healthy and granulation tissue is well established. Depending on the wounds, this can take several days or even weeks to develop.

After several days of wet to dry dressings, we transitioned to sugar bandages. This allowed us to change Hershey's bandages with only mild sedation, and ultimately with no sedation at all.
Granulated sugar tie-over bandages were used as the second phase of wound treatment

In the next blog we’ll look at how the wounds progressed and what the next phase of management would entail.