feline collar injuries to the axilla

Re: feline collar injuries to the axilla

sue dorey — Sat, 11 Feb 2012 16:30:14 GMT

thanks everyone for your ideas.Willl see how it goes medically for a while,

thanks

sue

Re: feline collar injuries to the axilla

Julian Earl — Sat, 11 Feb 2012 11:35:50 GMT

[quote user="Hannah Wynne Richards"]

I'm scared of attempting an omental flap-scared of ascending peritonitis and scared of accidentally devitalising bowel If medical treatment or simple surgery fails, then I would twist the owners arm to refer Bit of a cowardly surgeon I'm afraid

Wynne

[/quote]

I haven't done many but I have it on good authority that ascending infection will not be a problem. The omentum can soak up all sorts of infection and the vascularity transports any bacteria to be mopped up in the circulation. I've operated on a horrendously abscessated prostatic (multiple miliary) that healed fantastically well after being opened out and omentalised and I've no doubt that superficial contamination of an axillary wound would not be an issue.

Re: feline collar injuries to the axilla

Hannah Wynne Richards — Sat, 11 Feb 2012 10:21:47 GMT

Thanks Roboxley I'll dig out the old JSAPs

Wynne

Re: feline collar injuries to the axilla

Rob Loxley — Sat, 11 Feb 2012 09:49:14 GMT

[quote user="Hannah Wynne Richards"]I'm scared of attempting an omental flap-scared of ascending peritonitis and scared of accidentally devitalising bowel If medical treatment or simple surgery fails, then I would twist the owners arm to refer Bit of a cowardly surgeon I'm afraid[/quote]

As per previous posts there are much simpler techniques, reconstructing normal functional anatomy, without flaps or omentum.

Re: feline collar injuries to the axilla

Hannah Wynne Richards — Sat, 11 Feb 2012 09:46:37 GMT

Wynne

Re: feline collar injuries to the axilla

Malcolm Ness — Sat, 11 Feb 2012 09:07:05 GMT

[quote user="Chris Aylott"]The first, a bit to my surprise, healed on it's own in about 3 of 4 weeks. I gave the cat antibiotics but am not convinced that they were necessary. I am very doubtful that intracite or honey or wound powder have had any beneficial effect. There will be a lot of anecdotes "I used it and the wound healed" but then sometime they do just heal.[/quote]

I think this is a good observation. My experience is that many (??most) of these wounds heal spontaneously once the collar is removed. A few, and just how few that is remains a matter for conjecture, fail to heal and need surgical attention. I have seen a number of cases that have not done well following surgery and that is nearly always because of technical errors in the surgery - the JSAP paper is written as if that is a new technique but in fact it is really just an iteration of how these wounds should properly be closed with respect for the functional anatomy. Do that and I think these wounds will heal; fail to do that and no amount of omentalised manuka honey will force a cure.

Re: feline collar injuries to the axilla

Chris Aylott — Fri, 10 Feb 2012 22:18:50 GMT

I treated two cats with these wounds last year.

The first, a bit to my surprise, healed on it's own in about 3 of 4 weeks. I gave the cat antibiotics but am not convinced that they were necessary. I am very doubtful that intracite or honey or wound powder have had any beneficial effect. There will be a lot of anecdotes "I used it and the wound healed" but then sometime they do just heal.

The second case "Donald" looked exactly the same after 4 weeks antibiotics as he had on presentation and I operated on him. I doubt your case is truly "not suturable as there would be too much tension", Cats usually have a lot of skin over the thorax and you should be able to create a flap there and move it into the axilla. I haven't seen the JSAP paper referred to above but i'm sure it would be worth a read - what I aimed to do was create a flap I could fold into the axilla in such a way as to avoid having a suture line in the axilla itself. There is so much movement in the axilla that if you have a suture line going through it it will almost inevitably break down. Two weeks after surgery Donald's flap had healed pretty well- just a 1cm long area of granulation tissue on one of the suture lines, and this healed completely after another 2 weeks.

I know some referral soft tissue surgeons use the omental grafts often but also that others are more doubtful about their benefits.

If you do have to operate it is well worth warning the owner ahead of time that these wounds can breakdown and sometimes more than one surgery can be required.

Re: feline collar injuries to the axilla

Nicola Lawlor — Fri, 10 Feb 2012 21:17:10 GMT

We dealt with one of these a couple of years ago that had an omental graft and still broke down yet again. We resorted to manuka honey (aktivon) dressings and it did brilliantly in the end, though still took a while to heal over. Not only did the poor cat have this wound to heal but he was also FIV positive too which may or not have had an impact on his healing? I saw him the other day for a totally non related issue and he is doing really well and seems to be a very happy cat.

Re: feline collar injuries to the axilla

Rob Davis — Fri, 10 Feb 2012 18:19:53 GMT

I'm sure there was a relatively straightforward technique for these written up a couple of years ago - possibly in JSAP - can anyone remember the reference?

Edit: oops, thanks Rob. Note to self: read to end of thread before posting....

Re: feline collar injuries to the axilla

Rob Loxley — Fri, 10 Feb 2012 17:44:07 GMT

[quote user="Julian Earl"]Whatever you do, don't just suture them unless it is a small and fresh wound, they almost certainly will break down.[/quote]

Agree, but have had excellent success with the fairly simple (compared to grafting / omentalisation) procedure described in the following:

J Small Anim Pract. 2007 Feb;48(2):111-5. Successful closure of feline axillary wounds by reconstruction of the elbow skin fold

Re: feline collar injuries to the axilla

Julian Earl — Fri, 10 Feb 2012 16:25:57 GMT

[quote user="Hannah Wynne Richards"]

Manuka honey and covering antibiosis also metacam as I assume it must be horribly painful-bit I prefer medicine to surgery

Wynne

[/quote]

The trouble with these is that many of them have reached a non-healing phase because they have been present for so long, in which case an omental graft is the way to go. Some require thoracodorsal flaps as well if there is a large deficit and it is best to over-[repare when clipping and scrubbing rather than under-prepare and think that "just" an omental pedicle will do.

Whatever you do, don't just suture them unless it is a small and fresh wound, they almost certainly will break down.

Re: feline collar injuries to the axilla

Hannah Wynne Richards — Fri, 10 Feb 2012 15:47:45 GMT

Manuka honey and covering antibiosis also metacam as I assume it must be horribly painful-bit I prefer medicine to surgery

Wynne

Re: feline collar injuries to the axilla

Mark Rowland — Fri, 10 Feb 2012 15:03:06 GMT

Ive done this also. A nice long omental tunnel easily reaches this area and provides good drainage allowing them to heal.

Godluck

Re: feline collar injuries to the axilla

Robin Grimmer — Fri, 10 Feb 2012 14:59:48 GMT

A colleague had one of these that refused to heal so he ended up doing an omental graft - which did the trick.

Re: feline collar injuries to the axilla

mariette asselbergs — Fri, 10 Feb 2012 14:15:44 GMT

The few I have seen healed miraculously with intrasite or honey.

Mariette