Bite Wound

Severe and extensive bite wound on the flank and abdomen of an Irish Wolf Hound. The treatment was managed using delayed primary closure and VetGold cream.

SEVERE EXTENSIVE BITE WOUND IN IRISH WOLF HOUND TREATED
BY IMPLAMENTING DELAYED PRIMARY CLOSURE AND OPEN
WOUND MANAGEMENT USING VETGOLD CREAM

Nitzan Kroter BVSC (Pretoria) MRCVS

PRESENTATION & HISTORY
A three-year-old male neutered Irish Wolf Hound weighing 64kg presented with a severe and large bite wound on the left flank and left abdominal area. The wound measured 40×15 cm across the left abdomen including some of the inguinal area and
the craniomedial thigh. The dog was presented to our veterinary practice one hour after he was been bitten by a Greyhound.

CLINICAL EXAMINATION & INVESTIGATION
The dog was in distress, panting and restless. He had slightly pale mucous membrane and had tachycardia. The wound appeared fresh and very traumatic with large tissue deficit. A large de-gloving injury emerged and it was unclear as to the future of this large flap of skin. No other pathologies noted apart of this extensive wound.

PROBLEM LIST/ DIFFERENTIAL DIAGNOSIS
Traumatic wound with large deficit
Cardiovascular compromise
Risk of sepsis without prompt treatment

PRE-OPERATIVE MANAGEMENT
Fluid therapy was initiated using ringer’s lactate solution at 90ml/kg/hr for the first 15 minutes then 10ml/kg/hr. Clavulanic/Amoxicilin anibiotic 20mg/kg was given IV, and the wound was protected temporarily with a sterile dressing. After an hour the dog was sedated for a close inspection, cleaning, debridement and irrigation of the wound.

The large skin flap was suture in place trying to preserve as much skin as possible. After several days, the true extent of the injury was evident. The wound was managed as an open wound, with initial surgical debridement and daily irrigation. Enterococus caecofaecalis was cultured from this wound. The wound was managed until negative culture, and no necrosis seen. The antibiotic was replaced to Enrofloxacin and Metronidazole based on culture and sensitivity. The wound size reduced substantially and healthy granulation bed could be seen twelve days post injury.

Wound appearance twelve days post-initial injury. This was managed with daily irrigation and tie-on bandage.

SURGICAL PROCEDURE
Twelve days post initial presentation the wound bed allowed closure. The vast skin deficit was closed, using a sub-dermal plexus rotational skin flap.

Postoperative image – Delayed primary closure using sub-dermal plexus rotational flap.

POST-OPERATIVE CARE
The distal aspect of the flap dehisced three days post surgery, and the flank area became open, due to excessive motion and self-mutilation. This was managed as an open wound with regular irrigations and VetGo/d cream for few days. A second delayed closure was planed for the following week, utilising an axial pattern flap from the caudal superficial epigastric artery. VetGold cream was continued three times a day over the weekend and the wound was protected from self-trauma.

Wound appearance before the weekend with reasonable granulation and very little epithelization.

POST-OPERATIVE OUTCOME/COMPLICATIONS
The wound was examined early the following week. Its size reduced dramatically, the granulation tissue appeared very healthy, and advanced epithelisation was evident. It was decided to abort the planed surgery, and continue with open wound management.

Wound appearance four days later. Health granulation bed, strong wound contraction and advanced epithelization.

FOLLOW-UP
The dog was discharged home with VetGo/d cream, applied three times a day. The wound healed completely after further two weeks.

DISCUSSION
Bite wounds are often misleading when presented shortly following the incident. The nature of this injury is very traumatic and hiding vast tissue compromise and infection. These wounds should be managed as open wounds until the true extent of the lesion determined. In most cases, infections should be dealt with, before final closure. In this case, the large skin flap did not survive despite its initial healthy appearance.

The last 10-15% of the skin flap used to close the wound dehisced, mostly due to movement at the flank area and self-mutilation as the dog managed to reach the wound despite its protection. The distal part of a sub-dermal plexus flap is usually the most vulnerable part of the flap, and proved to be unreliable in this case.

VetGold cream was applied until the wound was inspected prior to a second skin flap for closure. Due to the rapid wound contraction and healthy granulation bed, it was decided to allow the wound to heal as an open wound. This reduced costs substantially, eliminated the necessity of anaesthesia and reduced total hospitalisation time. This was both advantageous for the owner and animal. VetGold cream had dramatic impact in the healing of this wound, and would be recommended in similar circumstances where alternative options are limited.

Copyrights © 2007 Nitzan Kroter 6