Monday, 15 July 2019

Pet of the month hall of fame -Max

Max is our brave pet of the month after a dog attack left him with a nasty injury. 

Vet Celia was on duty when she received a telephone call from Max's concerned owners and arranged  to immediately see him. It was apparent that he'd sustained a large wound on his back. Celia assessed Max's condition by firstly evaluating his airway, breathing and circulation. She listened to his heart and lungs and checked his limbs and abdomen for signs of trauma. Although Max had received nasty bite wounds to the skin and soft tissue layers, they had not damaged any vital structures in his neck or chest and his condition was stable. Celia clipped the large wound on his back and discovered that Max also had some smaller puncture wounds. The puncture holes on the skin are often only a small portion of the significant damage that may have occurred to the muscles and tissues underneath the skin. Max would need to be monitored for further signs of swelling and bruising. Celia cleaned and flushed the wounds and prescribed Max some pain relief medication and antibiotics. Because a dog's mouth is full of bacteria, a bite  can introduce infection into the wound and underlying tissue. With the risk of infection high, Celia decided to initially treat the wound as open (not stitched). This allows any infection to clear before deciding if surgery is required to close the wound. Max's owners bathed his wounds at home and gave him his antibiotics as instructed by Celia, but at his check up a couple of days later, Celia was concerned about some swelling under the skin. She suspected that the infection was progressing so she introduced a combination of different antibiotics to help fight it. 

After another few days, Celia assessed Max's wounds again and at this stage she could see that some of the skin tissues were beginning to die. Necrosis (tissue cell death) can occur after a serious injury or infection. Despite this, there was also some promising progress. Max's owners had done a wonderful job of cleaning his wounds and giving him his medication and Celia could now see some healthier underlying tissue developing. The infective discharge had cleared up. The next step was for Celia to give Max a general anaesthetic so that she could surgically repair the wounds. 

Celia needed to remove the necrotic, damaged tissue and assess the remaining tissue health - a procedure called debridement. An area of dead space can form with these types of wounds. This is where the skin is pulled away from the underlying tissue creating a space in which fluid can accumulate under the skin. Celia inserted a drain; a latex rubber tube that allows fluid to drain out of the wound. Celia then closed the healthy wound edges together using walking sutures, a stitching technique that helps to reduce tension of the skin.

Max recovered well from the general anaesthetic and was allowed home the same evening. Unfortunately the drain came out so we needed to observe the wound for signs of swelling that could indicate the formation of a seroma. A seroma is fluid (serum) that has accumulated in a dead space in the tissue. It is the product of tissue inflammation and the body's defence mechanisms.

Max's owners did really well to keep him rested and his wound clean whilst it healed .After ten days, Celia was very pleased with how well Max's wound had healed and removed his stitches. However, she could see that the area looked puffy. With no signs of infection, Celia diagnosed a seroma. She opted to leave it alone rather than intervene as often the body will slowly reabsorb the fluid and it will eventually shrink and disappear.
Max was kept quiet and rested for a further 10 days and his owners ensured that he remained bright and comfortable.

After another 10 days, Celia checked Max. It was brilliant news -  she was able to sign him off as his wound had completely healed! Max had really missed his walks and it was great that he could now start to enjoy them again. 
After six weeks of treatment, we are so happy to see that Max has recovered.

For his patience and bravery, this lovely boy is our much deserved pet of the month!