Have you ever seen anything like this?

RE: Have you ever seen anything like this?

Eilidh Corr — Wed, 04 Jan 2017 22:00:24 GMT

Just an update - I removed sutures today 2.5 weeks post op, and the wound has healed beautifully. The owner is happy, the dog is happy. I am not happy but relieved it's been straightforward to deal with. Extra care is being taken now.

RE: Have you ever seen anything like this?

Anthony Todd — Tue, 20 Dec 2016 20:17:14 GMT

Before we go here is the previous thread so get your nurses to have a read 'cos it'll happen to someone again for sure.

[Still think this one happened at home!]

https://www.vetsurgeon.org/uk/small_animal/f/9/t/4129.aspx

RE: Have you ever seen anything like this?

Eilidh Corr — Tue, 20 Dec 2016 19:48:54 GMT

Thanks Anthony but I just explained to the client that while we couldn't be sure (and we would never know for certain) we also couldn't rule out iatrogenic injury, and there was enough suspicion that we didn't feel we could charge for any related treatment. He is a long-standing and sensible client and he at least appreciated our honesty.

Interestingly the dog wouldn't have been wet there, and we never use unwrapped hot water bottles. Extra covers coming for them all though, it's definitely been a wake up call.

RE: Have you ever seen anything like this?

Gillian Mostyn — Tue, 20 Dec 2016 19:24:45 GMT

[quote user="Anthony Todd"]What? Linear and along the whole of the dorsal spine and the tail; love to see a picture....[/quote]

Sorry, don't have a picture as it was a colleagues case, and a few years ago. The colleague initially thought it was due to an injection reaction as they saw a funny patch of fur on the top of the scapular spine....until they started clipping!!! I remember it affected a very extensive area running down the majority of its back. Ended up wearing one of those net body stocking things for months to keep dressings in place. It healed...eventually.

It happens.

RE: Have you ever seen anything like this?

Anthony Todd — Tue, 20 Dec 2016 18:56:00 GMT

Yes, apart from the bickering, I'm sure you all make sure your staff know that a "burn" is, as Gillian reiterated, a function of time and temperature, and the temperature hasn't to be very hot at all!

If the patient is on a wet pad the heat will disseminate over the whole we area too.

RE: Have you ever seen anything like this?

Anthony Todd — Tue, 20 Dec 2016 18:42:06 GMT

[quote user="Gillian Mostyn"]I've only seen one, and it looked the same as in this case,[/quote]

What? Linear and along the whole of the dorsal spine and the tail; love to see a picture....

RE: Have you ever seen anything like this?

Rob Davis — Tue, 20 Dec 2016 17:59:07 GMT

I agree it looks like a burn, seen a very similar one in a cat several years ago after a cystotomy with cat on heat pad. Took a surprisingly long time for the extent of the injury to become apparent and required weeks of dressings and several surgical procedures to get it to heal.

RE: Have you ever seen anything like this?

James Dunne — Tue, 20 Dec 2016 17:33:01 GMT

Sadly, we have dealt with a similar case in our own practice around 1 year ago. The dog had a large burn injury on the side that was not on the surgical heat pad, so we were confused to start with. We postulated that a well-meaning staff member had placed a heating device on the dog postop while it was recovering and this came into direct contact with the dog's skin rather than a barrier being present to prevent burning. The initial lesion 5-7 days postop looked innocuous enough. another week later, it had a large, dinner-plate sized eschar similar to what your dog has. 6 weeks of surgery, bandaging and wound management in hospital got it to heal. I have also seen 2 severe cutaneous reactions to medicines while seeing practice at a referral centre many years ago. They were more extensive and not confined to one specific area, but only 2 cases so that might not be everyone else's experience. A vascular occlusion would be unlikely given the anatomy of the blood supply to that region of skin. My guess would be treat this the same way you would treat any other burn or cutaneous necrosis - debride the necrotic tissue, support the healing tissue and be prepared for the long haul given the size of the lesion.

RE: Have you ever seen anything like this?

Gillian Mostyn — Tue, 20 Dec 2016 17:23:22 GMT

[quote user="Anthony Todd"]Having been through a few "practice" burns I'm very familiar with their distribution[/quote]

I've only seen one, and it looked the same as in this case, but I acknowledge your greater experience.

We'll have to agree to disagree on this one though.

RE: Have you ever seen anything like this?

Anthony Todd — Tue, 20 Dec 2016 17:12:05 GMT

[quote user="Gillian Mostyn"]it pretty much has to have been burnt during or soon after surgery[/quote]

Well nobody seems to be able to explain it differently and my explanation hasn't been challenged, in fact it seems to have been confirmed, at least in principle.

Sometimes, just sometimes, and rarely, a dinovet, even me, just might be right.

Having been through a few "practice" burns I'm very familiar with their distribution and the surrounding physics and this isn't one.

RE: Have you ever seen anything like this?

Gillian Mostyn — Tue, 20 Dec 2016 17:03:19 GMT

[quote user="Anthony Todd"]I certainly wouldn't blame "your" heat source....![/quote]

It is lovely, and very supportive, that you are trying to find a way for this not being the OP's practice's fault. However, to have a dorsal burn, it pretty much has to have been burnt during or soon after surgery. It happens - and isn't necessarily negligent. However, denying blame at this stage would have been likely to lead to an angrier client. It sounds like the OP has been very honest, is dealing with it, and the client has understood (as most reasonable people would) that these things happen sometimes.

RE: Have you ever seen anything like this?

Gillian Mostyn — Tue, 20 Dec 2016 16:51:58 GMT

[quote user="Anthony Todd"]The pathology should match the heat source at least to a logical extent......[/quote]

Not necessarily.

The problem often isn't the heat itself. It is a combination of factors, including time, but with the biggest being water. Water between the pet and the heat means the heat conducts more readily to the skin, hence why you often get an odd shaped burn. You'd often be fine if the animal hadn't got too wet during prep, or urinated during the op.

(Try it yourself Anthony...Wet just one hand, then place both on a warm, but not hot, radiator. You can feel the difference very quickly. Alternatively, try using a wet oven glove. Or not!!! )

RE: Have you ever seen anything like this?

Anthony Todd — Tue, 20 Dec 2016 15:54:53 GMT

[quote user="Eilidh Corr"]heating procedures to make sure this can't happen again.[/quote]

The pathology should match the heat source at least to a logical extent......

I certainly wouldn't blame "your" heat source....!

RE: Have you ever seen anything like this?

Eilidh Corr — Tue, 20 Dec 2016 15:01:37 GMT

Thanks all for your help. She's doing OK - part of the wound from Saturday's debridement is possibly going to break down but the rest looks better than anticipated. Having spoken to the staff involved it's possible a hot water bottle was to blame. I've talked to the owner, who's being incredibly reasonable. Now we need to review our heating procedures to make sure this can't happen again. And cross our fingers that she gets there in the end.

RE: Have you ever seen anything like this?

Sarah Mark — Tue, 20 Dec 2016 09:18:43 GMT

+1 for the burn theory, sorry. I've seen this happen - lesion revealed itself about 10days after the initial op, black lab hit by car and laying in snow, had an elbow lux which was reduced closed, but lots of warming went on as the poor thing was stone cold. As I recall it was the metal tray type head mats used. the burn had one very straight edge but the rest as quite irregular - possibly the coat causing the heat to diffuse?

Also, my own Devon Rex cat used to love to sit on top of the radiator and gave herself a burn from the metal edge which ran from her axilla to the groin. Was a nasty mess but did heal fine (with a scar) - I learned to put blankets on there as she would still insist on self immolation if allowed.

RE: Have you ever seen anything like this?

Claudia Niehoegen — Tue, 20 Dec 2016 01:32:11 GMT

I can believe the radiator theory: A few years ago I woke up with a migraine but decided to get dressed. I spent most of the day sitting and sleeping with my back against a radiator. This resulted in a 6cm squ full thickness burn on my back, caused by the metal hooks and eyes of my bra. It had been hot, but not painful enough to warn me.

With regards to blisters in burns and scalds: I think they often get missed because the lesion is only spotted, or deemed to be "vet worthy", once the hair has fallen out.

RE: Have you ever seen anything like this?

Anthony Todd — Mon, 19 Dec 2016 22:31:45 GMT

Oh dear, last try, this may help from my citation; you are now warned. don't get inebriated and fall asleep with a hot water-bottle...

"Contact injuries present more insidiously as in most circumstances the patient losses consciousness, most commonly falling asleep, or have some degree of sensory deficit in the region of the body that the bottle is in contact with. This results in a reduced ability to recognise and respond to painful stimuli. Hence, these patients are less likely to recognise burn injuries until they have caused a significant degree of injury. In our study there were 3 cases of pure full-thickness burns with an average TBSA of 0.43%, all of them caused by prolonged contact with a hot water bottle due to sensory deficits."

[TBSA =Total Body Surface Area]

The radiator may not have been hot enough to alert/wake the dog, but still, over time, have been hot enough to cause the burn which resulted.

Of course the hotter the contact the shorter the time and the converse.

I'm trying to help here, before the owner thinks it might be down to the vet as happened in your DM quote!

RE: Have you ever seen anything like this?

Kate Richardson — Mon, 19 Dec 2016 21:58:25 GMT

Were they under the influence of drink or drugs? I'm a hot water bottle addict and always move away from it no matter how many vinos I've had!

RE: Have you ever seen anything like this?

Anthony Todd — Mon, 19 Dec 2016 21:49:59 GMT

[quote user="Kate Richardson"]

But the difference is Anthony Todd that a sleeping animal can wake up and move and an anaesthetised or recovering from GA animal cant

[/quote]

My understanding was the dog was at home and had recovered from surgery and the anaesthetic after a fortnight............

Depends how hot the temperature of the radiator is and duration of contact. the dog may not have woken if the radiator wasn't hot enough to waken the dog [did try and explain that....]

Would explain the distribution of the burn nicely I think.

Many people get burnt when they go to sleep with a hot water bottle:

Plast Surg Int. 2013; 2013: 736368.

Published online 2013 Dec 22. doi: 10.1155/2013/736368

It may have been nothing to do with the anaesthetic or surgery and have happened at home, and by accident.

RE: Have you ever seen anything like this?

Kate Richardson — Mon, 19 Dec 2016 21:37:25 GMT

But the difference is Anthony Todd that a sleeping animal can wake up and move and an anaesthetised or recovering from GA animal cant

RE: Have you ever seen anything like this?

Anthony Todd — Mon, 19 Dec 2016 16:50:21 GMT

[quote user="ruths"]the one I saw didn't blister - it looked exactly like the picture[/quote]

Yes, brain fade I'm afraid...

But if the dog had got cold, lay against a wall mounted central heating radiator which then came on full blast at 6am while the dog was asleep on it's padded cushion; about the right height and temperature times time gives the burn??

RE: Have you ever seen anything like this?

ruths — Mon, 19 Dec 2016 08:31:28 GMT

[quote user="Anthony Todd"]

And, with a burn usually the skin blisters then necroses. ie you get massive skin changes before it sloughs. Google dog burns, there's lots!

This looks like the skin has just lost the blood supply and sort of mummified without any local reaction??

[/quote]

the one I saw didn't blister - it looked exactly like the picture

RE: Have you ever seen anything like this?

Anthony Todd — Mon, 19 Dec 2016 00:11:20 GMT

[quote user="Gillian Mostyn"]Even the daily fail shows a decent example:[/quote]

Yes, you're right, but we had one with one of those green plastic plug in ones that just blistered the skin. [put one of those remote fridge thermometers in your "wrapped" heat pads you may get a surprise at the temp.!]

Actually the DM picture of the skin is very similar to the one in question.....

RE: Have you ever seen anything like this?

Gillian Mostyn — Sun, 18 Dec 2016 21:41:51 GMT

Not with the type of burn (lowish heat, extended time) you get from direct heat sources like heat mats etc. Even the daily fail shows a decent example:

http://www.dailymail.co.uk/news/article-3024647/Vet-left-elderly-widow-s-pet-dog-Rosie-degree-BURNS-routine-operation-remove-spleen.html

RE: Have you ever seen anything like this?

Anthony Todd — Sun, 18 Dec 2016 21:06:06 GMT

And, with a burn usually the skin blisters then necroses. ie you get massive skin changes before it sloughs. Google dog burns, there's lots!

This looks like the skin has just lost the blood supply and sort of mummified without any local reaction??