Torsion of a Cryptorchid Testicle

Tank is a 5-month-old male intact boxer who presented to the Emergency Service for acute vomiting and abdominal pain. The vomiting began about 12 hours before presentation. The referring veterinarian had obtained abdominal radiographs and was suspicious of a gastric foreign body. There was no other history of medical problems with Tank.

 

On physical examination, Tank was quiet but responsive, ambulatory, and mildly dehydrated. He was painful on abdominal palpation, especially in the mid to caudal abdomen. Only one testicle was palpable in his scrotum, which was determined to be the right testicle. The left testicle was not palpable in the inguinal area.

 

A complete blood count and serum chemistry profile revealed no significant abnormalities. On review of the referring veterinarian's abdominal radiographs, we did not find evidence of a gastric foreign body or other abnormality. 

 

Abdominal ultrasound revealed a structure that appeared to be a testicle. (Fig 1)

Fig 1: Abdominal ultrasound showing a cryptorchid testicle (arrow)

Placement of the ultrasound probe on the structure elicited severe pain. We were concerned that Tank had torsion of the abdominal cryptorchid testicle. 

 

A left paramedian abdominal exploratory was performed. Torsion of the left retained testicle was confirmed, and the testicle was removed.

Fig. 2: Surgical removal of the abdominal testicle

 

The descended testicle was also removed. 

Fig. 3: Both testicles removed from Tank, normal on the right, testicular torsion on the left

Tank made an unremarkable recovery from anesthesia and surgery and was discharged from the hospital the following day. 

 

Cryptorchidism is a common congenital anomaly in male dogs. One or both testicles can be retained in the inguinal region, inguinal canal, or abdomen. For more details on surgery for this disorder, see https://drstephenbirchard.blogspot.com/2014/07/cryptorchidism-in-dogs-5-ways-to-make.html, and scan the QR code for a complete discussion of cryptorchidism in dogs and cats.

 

Adaptic Touch: The Ideal Dressing For Open Skin Wounds in Dogs and Cats

When managing open skin wounds in dogs and cats, bandaging materials and techniques are critical elements of the treatment strategy. The interior of the bandage in contact with the wound is called the primary layer and is the most important of the dressing for creating a suitable environment for healing. Many options for the primary bandage layer are available, including wet saline sponges, dry sponges, silicone dressings, medical-grade honey gauze, petroleum-impregnated gauze, and Telfa pads. The ideal first layer of the bandage should encourage granulation tissue formation. It should not inhibit healing cells and not promote infection. The primary layer should allow absorption of wound exudate into the second layer of the bandage to prevent accumulation at the wound surface.  

 

Telfa pads have historically been used for open wounds in animals, but newer materials that allow better absorption of exudate from the wound are available. Wet saline sponges are commonly used as the initial primary bandage layer in acute traumatic wounds because they are highly absorptive, allow gentle debridement of dead tissue, and are inexpensive. However, when saline sponges become dry, they are adherent, making bandage changes painful. Patient sedation is frequently necessary to prevent discomfort during removal. Lavage of the dried sponges with sterile saline during bandage change will allow them to be peeled off the wound more easily and with less pain. Although wet saline sponges are very effective in initially managing severe wounds, such as bite wounds in dogs and cats, a primary bandage layer is needed for the next healing phase. Ideally, this material should allow absorption of wound exudate and be non-adherent to reduce patient discomfort. 

 

Vitalitymedical.com

The Adaptic Touch is an excellent choice for the primary bandage layer on open wounds in dogs and cats. It is a soft and pliable silicone-coated mesh material that readily conforms to the wound surface. The pore size in the mesh is small enough to prevent the ingrowth of granulation tissue into the material. The Adaptic Touch mesh allows the passage of wound exudate into the secondary bandage layer and is non-adherent, minimizing patient discomfort during bandage changes. It has been used extensively for various human wounds and is gaining favor with veterinarians. Cotton is a good choice for the secondary layer of the Adaptic Touch bandage allowing for the transmission of fluid through the pores of the mesh. Use only one layer of the Adaptic to ensure adequate absorption into the cotton.

 

The original Adaptic mesh is a petroleum-impregnated gauze that allows absorption and is non-adherent. However, petroleum may have some detrimental effects on wound healing, and it is only partially non-adherent. These characteristics make them less ideal than their counterpart, the Adaptic Touch.

 

See the above video for a demonstration of the non-adherent nature of the Adaptic Touch dressing. 

In summary, the ideal bandages for open skin wounds in dogs and cats have primary layers that allow absorption of wound exudate, are non-adherent, and do not inhibit wound healing. For wounds that are highly contaminated and filled with dirt and debris that cannot be entirely removed by surgical debridement and flushing, moist saline sponges are indicated as the initial bandage. Since these bandages are adherent and painful to remove, transition to non-adherent dressings such as the Adaptic Touch is recommended for the next phase of wound treatment.

 

References

International case series: Using ADAPTIC TOUCH® Non-Adhering Silicone Dressing: Case Studies. London: Wounds International, 2013. 

Wounds International case studies evaluation. ADAPTIC TOUCHTM Non-Adhering Silicone Dressing in skin tear management. Wounds International, 2018 (Suppl). Cooper 

Janice Bianchi*, Simon Barrett, Fania Pagnamenta, Fiona Russell, Sandra Stringfellow, Pam
Cooper. Consensus guidance for the use of Adaptic Touch non-adherent dressing. Wounds UK, 2011, Vol 7, No 3  

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