proud flesh in a dog

RE: proud flesh in a dog

Virginia Campbell — Wed, 17 Feb 2016 22:48:18 GMT

Really useful to know about the heel allevyn, that might be perfect! Interesting that the info in your link says that hypochlorite solutions can bugger up the structure of the dressing- we were using vetericyn when it was still manky and we had plain old wet to dry swabs with a bit of Dermisol on but just honey now as it is so clean.

RE: proud flesh in a dog

Virginia Campbell — Wed, 17 Feb 2016 22:39:54 GMT

"Before" pictures from today's redress- medial, caudal, lateral and another medial. It has epithelised appreciably more even in 2 days. These pictures are before I trimmed the proud flesh down level with the skin. It wasn't overly raised on the medial side so I did very little there- I think it'll heal itself. You can just about appreciate the raising of the granulation tissue in the proximal portion of the lateral surface and I think today's trimming flush with the skin will allow the skin to grow here. I expect by the time the skin gets to the point of the hock where the most exuberant proud flesh was, the proud flesh may have risen and need trimmed again but I went ahead and gave it a good trim today as I don't want to let it become too fibrous- it already felt slighly more solid to cut through. The whole thing bled, but not as much as expected and stopped with pressure from adrenaline soaked swabs within 5 minutes or so. Sorry forgot to get "after"pics. I redressed with honey and allevyn and will redress again on Friday.

RE: proud flesh in a dog

Michael Woodhouse — Wed, 17 Feb 2016 22:34:40 GMT

I'd stick one of the thick spongy Alleyvin on that and leave it for a week - maybe fill that hole with hydrogel first. They even make a special heel one that fits nicely on hocks;

https://www.weldricks.co.uk/product/2601714_allevyn-heel-wound-dressing-10-5cm-x-13-5cm?utm_source=google&utm_medium=shopping&utm_campaign=GoogleShop&gclid=CKHzgbft_8oCFcfgGwod_XMDtA

RE: proud flesh in a dog

Virginia Campbell — Wed, 17 Feb 2016 22:22:49 GMT

RE: proud flesh in a dog

Virginia Campbell — Tue, 16 Feb 2016 12:00:17 GMT

It's interesting to hear people's experiences with taking the dressings off. In the initial stages when the skin from groin to metatarsals was drum tight, various shades of red and purple and oozing serum with areas of stinking necrotic mankiness, we kept her in the clinic and didn't dress it (cos I reckoned even dressing with fairies' wings would have risked already compromised skin and lead to a larger area of necrosis), just applied Flamazine tid as Eamon mentioned.

When the skin around the necrotic bit calmed down and looked like it would take a dressing we sent her home with one (it would have been pretty horrible without in the early stages as the stinky discharge was soaking through layers and layers of cotton wool) and redressed eod with particular attention to the "good" skin which has managed the dressings admirably well.

I'm in two minds about dressings after trimming the proud flesh. The wound is still reasonably large and she tends to lie on the affected leg. I know redressing can affect fragile baby epithelial cells round the edge so we just cleaned the worst of the discharge off the middle, left the edges alone as far as possible and we stopped the wet-to-dry dressings as soon as they started to stick in favour of nice non sticky manuka alginate dressings. I'm keen to stretch the frequency of redresses but up till now the amount of discharge has warranted eod dressing. I have read elsewhere that being open to the air discourages exuberant granulation tissue and this ties in with your experiences of speeding healing by leaving dressings off. I'm just a bit worried that this arthritic old dog lying on the open wound, frequently shifting position and getting Golden Retriever belly hair stuck to it will cause more disturbance to fresh epithelial cells than will dressing, at least at this stage [quote user="dave reid"]a 5p piece area is sounding small to me[/quote] sorry I meant the only bit that hasn't achieved granulation is a bit smaller than a 5p - the rest of the wound is considerably larger and affects lateral and medial hock).

[quote user="dave reid"] I have seen 2% hydrocortisone used for xs granulation tissue in human medicine.[/quote] Interesting - a couple of threads on VIN mention this, and also haemorrhoid cream containing phenylephrine to cause some vasoconstriction within the granulation tissue and slow it down. Might experiment with a little topical steroid on the granulation bed. Does anyone know if it would slow the epithelial tissue too - ie can I slow granulation tissue without slowing epithelisation too?

Plan for tomorrow is:

Sedate or light GA and trim back proud flesh - yes the granulation bed is not sensitive, but the edge of the wound is and she has a tendency to twitch her leg if it is inadvertently touched. She is very sweet and lies on her side for redresses, but in a worried kind of way and tries to get up if she hears any noise, of if we're not quick enough and she starts to get bored or anxious. I need to work around all the contours of the hock and would like to get as close to the edge as possible with the scalpel blade to remove the little hill of proud flesh that is forming, without debriding any good epithelial tissue. Apply pressure with adrenaline soaked swabs for 5-10 minutes to staunch bleeding. Possibly squirt a bit of hydrocortisone cream onto it, or injectable dex if we haven't any pure HC (I don't want to muck about with canestan HC or Isaderm on an open wound). Redress with non adherent dressing to soak up any further blood. Revisit Thursday or Fri to take dressing off, assess and probably [quote user="Michael Woodhouse"] immobilise for a week or even 2 if you dare. You could go with a RJ, but don't rule out a cast.[/quote] if not too much discharge is forming and it isn't going to stew in its own juice.

If this doesn't work and the proud flesh just reforms quickly without allowing the epithelial tissue to make progress, then I'll take a deep breath, leave the dressing off and see what happens. If healing stalls again then it's probably time for a graft. [quote user="Michael Woodhouse"]don't rule out a cast.[/quote] This is a good idea and will bear in mind. Don't know if we even have any casting material in the practice, modvets that we are (Anthony T would be APPALLED).

Thanks all for your thoughts and for reading my big long explanations. Will let you know how things progress and get some pics if possible (really should have done photo series from the start, though you would have needed smell-o-vision for the full dramatic effect).

RE: proud flesh in a dog

Gillian Mostyn — Tue, 16 Feb 2016 09:01:52 GMT

[quote user="Eamon McAllister"]I would try to leave the dressing off and apply Flamazine three times daily. Keep an Elizabethan collar on.[/quote]

I had a BMD with a similar problem- large leg wound that refused to heal and kept getting too much granulation tissue- I trimmed back the proud flesh etc (I did it conscious....no nerves in it anyway), just dressed for a day until the blood dried up and then left the dressings off completely.....healed so much quicker than it had been doing with dressings on!

RE: proud flesh in a dog

Michael Woodhouse — Tue, 16 Feb 2016 02:21:49 GMT

You need to leave it alone if it's a clean granulation bed. People want to keep changing dressings, clean things and it delays the healing.

Personally I'd trim back anything proud (as you would in a horse) and immobilise for a week or even 2 if you dare. You could go with a RJ, but don't rule out a cast.

RE: proud flesh in a dog

Eamon McAllister — Tue, 16 Feb 2016 00:01:37 GMT

I would try to leave the dressing off and apply Flamazine three times daily. Keep an Elizabethan collar on.

RE: proud flesh in a dog

dave reid — Mon, 15 Feb 2016 22:54:13 GMT

a 5p piece area is sounding small to me, if you have achieved a healthy granulation bed, I think leaving the dressings off can reduce the rubbing and allow epithelialisation. I would urge cautious re-evaluation but have found frustrating non healing wounds speed up when I removed their dressings. Apply the manuka with a collar to keep the dog off it! I have seen 2% hydrocortisone used for xs granulation tissue in human medicine. I tend to hit it with a scalpel blade with horses.