The surgery was carried out in August 2018 and is, they say, the first time it has been performed on a companion animal anywhere in the world. The dog, a five-year old spaniel called Gigha, has now made a full recovery.
Gigha’s surgery was carried out by Dr Guy Killick and featured in a recent episode of The Yorkshire Vet. Guy said: "Gigha provides vital companionship to her owner, Mrs Taylor. She fell into a drainage ditch last summer and this caused a tiny cut on her elbow.
"The initial wound did not seem severe, however, despite intensive decontamination and treatment with broad spectrum antibiotics, the wound proved to have been infected with a resistant Haemolytic E. coli infection, causing a significant loss of skin from the medial aspect of the elbow. During this time, Gigha was hospitalised and was at significant risk of DIC and septicaemia."
"The skin loss was full thickness and, once the compromised tissue was debrided away, she was left with a large wound.
"We managed the wound in hospital for four days with daily dressing changes and an irrigation device to provide local anaesthesia and the delivery of topical antibiotics.
"Unfortunately, skin grafting in her case was not suitable given the infection and a lack of sufficient loose skin to donate. As such, we elected for healing by second intention but, given the large area, we felt it was important to explore novel methods to accelerate the healing process and reduce Gigha’s pain.
"Surgery using Tilapia fish skin grafts was pioneered at UC Davis in the USA and was used successfully on a horse with acid burns in the UK last year. It is still very rare, however, and had not been used to treat an infected wound before. Nor had it been used on a dog.
"Having done our research though and finding that these grafts have a natural anti-infective and analgesic effect, while also reducing the frequency of bandage changes that would cause discomfort and distress to the patient, we felt it was an appropriate treatment for Gigha and carried out the surgery a week after the initial wound."
Guy says the surgery was straightforward and simply involved tacking the skin in place. It adhered to the developing granulation bed, accelerating its growth and providing an antiseptic and analgesic effect. After application, Gigha’s owner reported that she was much brighter and seemed to be in less pain. Pain-scoring during check-ups confirmed this to be the case despite pain relief being voluntarily withdrawn by the owner.
This initial graft stayed in place for two weeks before breaking down and being removed. By this stage, granulation of the wound had been completed and around one cm of neo-epithelisation had occurred. A further graft was then placed which remained for a further two weeks until the wound was 50% of its initial size. No further grafts were placed as the team did not have access to further supplies so they simply bandaged the wound with traditional bandages. It was completely healed within nine weeks. Eight months on, Gigha has made a full recovery and the wound has healed completely.
Guy said: "Given the large wound area and risk of further infection we decided on this novel approach to improve the quality of life for the patient while the wound was healing. While we were naturally apprehensive of making the first attempt at this potentially revolutionary technique, what we knew about fish skin grafts and suggested that they could work in her case so we were determined to give it a try.
"Looking at her now, you wouldn’t believe that she’d been days from death just a few months ago. Her case is a demonstration of the efficacy of fish skin grafts as a treatment for large wounds where there are no other suitable methods of closure – and for their use in dogs. We hope her story and her recovery will be useful to colleagues treating dogs with similar wounds in the future and are happy to discuss the case with them if this would be helpful.
"I would also like to thank Dr Jamie Peyton, Chief of Integrative Medicine Service at UC Davis for her invaluable help and advice during this case and her assistance in the use of the Tilapia graft."
Julian said: "People are turning to surgeries where there are more cats, dogs and rabbits, as there is a general perception that a small animal job is easier. There are often less out-of-hours complaints, you don’t have the 2am cow to calve and you don’t have to spend three hours in the mud and rain.
"In mixed practice, you have stretches of 19 days without a day off and 11 nights on call, rain lashing down. People don’t want to do that any more."
He added that a few years ago, there would have been 50 applicants for a job at the Skeldale Veterinary Centre, whereas a recent advertisement drew just 10.
Responding in a Facebook post, Danny Chambers MRCVS, an equine locum vet who has worked in mixed practice at E.C. Straiton & Partners, argues that the problem isn't a lack of enthusiasm amongst new grads for working in mixed practice, but that: "...any practice that expects people to work those types of hours for that level of income with minimal support should consider themselves lucky to get even 10 applications for a position."