November 12, 2017

A case study of conservative wound management following a laceration to a hindlimb in a greyhound.

PLEASE NOTE –  THIS POST INCLUDES SOME GRAPHIC PICTURES OF WOUNDS.

We are all familiar with the concept of surgery to repair and close wounds in our pets, but sometimes we need to adopt what is known as ‘conservative management’ of these wounds. Conservative management is indicated where there is not enough free skin to close the defect or where movement of the area makes closure difficult (e.g. over a joint), or if we have infection present and don’t want to close the wound. Conservative management means that we use medications and wound care with or without dressings to attempt wound healing, and normally this requires a fairly lengthy convalescence.

 

Jake, the lovely greyhound now fully recovered

 

As a rule surgery will provide the best outcome when we have a deep wound, allowing us to debride or remove dead tissue and close healthy tissue and skin giving the most predictable course for healing. However when we are faced with a challenging case we can adapt our approach. Sometimes treating as an open wound for a week or two reduces the size of the wound to a point where closure becomes easier. And this leads us to a recent case of a Greyhound, Jake, who had a deep laceration to his left hind in February of 2017. He was seen at the Out of Hours clinic where closure was attempted surgically, but unfortunately the wound broke down and he presented to our clinic with a large defect. The position of the wound made it very clear to vet Michael Morrow and his team that closure would be problematic, as the area was always under tension and moving, and there wasn’t a lot of free skin. To perform a skin graft would be a difficult surgery with the possibility of wound break down recurring.

After discussion with the owner and fellow vets Katie Love and Claire Turner, it was decided that we would manage the wound conservatively. Swabs were taken for culture and sensitivity and appropriate antibiotics prescribed along with pain relief and topical cleansing solutions. We also had to take measures to ensure that there was no possibility of Jake licking the wound, as this is a very common cause of delayed wound healing. We were fortunate that Jake’s owners were competent and committed to this approach, and appreciated that there may still be a need for a second surgery once the wound contracted in the future.

The initial healing process was slow, and we had regular check ups where we discussed when might be appropriate to perform a second surgery. But then suddenly, after approximately 3 weeks, the wound started to contract and heal beautifully. We decide to hold off on further surgery and continued conservative management. The owner has kept a wonderful photographic record of this wound healing, and has asked us to share this with our clients, and you can clearly see below the accelerated healing towards the end of the period.

Jake’s owner writes: ‘I was sorting out the files on my work computer earlier and I came across the attached timeline of photos I took of Jake’s leg and I realised that I never shared it with you.

It just shows what an amazing job you guys did to get him all healed up in such a short space of time, especially given how nasty it was. Thanks again team :)’

From the team at St Vincent’s Veterinary Surgery – Providing Personal Care for all your  Pets.

 

Photograph timeline of Jake’s wound healing: