Ear cartilage defect - how would you approach this?

RE: Ear cartilage defect - how would you approach this?

Julie Innes — Fri, 30 Nov 2018 09:02:23 GMT

Not an ideal situation, but I am in the "it is amazing what heals" camp! Yes, you can stitch these up, but in my experience as soon as the dog starts shaking his head and bashing it off the buster collar it will open and you will end up letting it heal by second intention anyway.

RE: Ear cartilage defect - how would you approach this?

kesholliday — Thu, 29 Nov 2018 23:08:50 GMT

Hi all,

Thanks again. Bear in mind I am not working as a clinician currently, but have to make an informed decision on how best to manage this dog with the eventual goal of exporting it.... One practice has suggested removing the affected cartilage and closing primarily (I am aware this will affect the appearance of the ear), another has suggested leaving wound to granulate with an ecollar on and antibiotic coverage.

Obviously there is no ideal solution and nothing is black and white with these type of cases so all the input has been valuable so far

RE: Ear cartilage defect - how would you approach this?

Evelyn Barbour-Hill — Thu, 29 Nov 2018 22:24:24 GMT

[quote user="kesholliday"] it is not in the care of the owner currently so anything over a weekly check up & bandage changes is not practical (that's if the bandage stays on);[/quote]

Sounds as if you might just as well give them some Flamazine to slap on when they can be bothered and leave it to heal entirely naturally.

In the circumstances, clearly

[quote user="kesholliday"]Ideally I would like to find a surgical solution that doesn't compromise the appearance of the pinna too drastically. [/quote]

and

[quote user="kesholliday"] undergo international travel (as cargo) in 2 weeks time...[/quote]

are forlorn hopes.

But otherwise, from the second picture I would guess you could achieve quite a lot of coverage with cunning skin surgery.

But maybe his pinna will always be floppy not upright. Heck, his days as a German Shepherd are over.

RE: Ear cartilage defect - how would you approach this?

Daria McLennan — Thu, 29 Nov 2018 16:16:40 GMT

Just happened to see this in a catalogue today (JAK), so have never used but might help?

https://medicalpetshirts.com/mps-head-cover/

RE: Ear cartilage defect - how would you approach this?

Martin Atkinson — Thu, 29 Nov 2018 15:11:58 GMT

[quote user="kesholliday"]Complicating factors are that the puppy is very active and energetic; it is not in the care of the owner currently so anything over a weekly check up & bandage changes is not practical (that's if the bandage stays on); and it was due to undergo international travel (as cargo) in 2 weeks time...[/quote]None of these are you're concerns its up to the owner to comply with your recommendations and if regular changing of the dressing as it granulates is your advice then they have a responsibility to follow it - someone has clearly been an idiot to allow this to happen in the first place so they need to wise up. The only way it will be fit to travel in 2 weeks is to amputate the pinna. Sounds like the sort of scenario I'd glad to be rid of.

RE: Ear cartilage defect - how would you approach this?

kesholliday — Wed, 28 Nov 2018 22:48:21 GMT

Thank you everyone.

I have included another photo which shows the extent of the wound better.

Complicating factors are that the puppy is very active and energetic; it is not in the care of the owner currently so anything over a weekly check up & bandage changes is not practical (that's if the bandage stays on); and it was due to undergo international travel (as cargo) in 2 weeks time...

Ideally I would like to find a surgical solution that doesn't compromise the appearance of the pinna too drastically. But it seems like this probably isn't feasible due to the extent of skin loss over cartilage.

RE: Ear cartilage defect - how would you approach this?

Evelyn Barbour-Hill — Wed, 28 Nov 2018 13:42:08 GMT

I have abandoned the concept of "covering antibiotics" for wounds that are to heal by granulation, without any noticeable reduction in the rate of healing.

PS..... It's a bit hard to be sure from no more than one photograph, but I think with a little debridement and mobilisation the wound could be closed, or closed quite a lot anyway. That's not to say that going for granulation of the whole thing would be a bad option.

RE: Ear cartilage defect - how would you approach this?

Jill Butterworth — Wed, 28 Nov 2018 10:53:43 GMT

I would go down the second intention route too and just go with whatever happens. Maybe teaching granny to suck eggs:

My typical protocol: Wet to dry saline dressings are good daily in the first instance. There seems to be a little healing already starting at the very edges of the wound. I love Manuka honey dressings and Granuflex (can be left for about 5 days once things are going well) for this purpose as they both help debridement. I also treat each redress in a completely sterile manner with saline, swabs, surgical gloves etc. I think when this heals and the fur grows back it will hardly show cosmetically, but you might get a funny little triangle skin flap appear on the right side that you could trim or leave.

I would use covering antibiotics, with culture and sensitivity if possible.

RE: Ear cartilage defect - how would you approach this?

Beats — Wed, 28 Nov 2018 07:36:48 GMT

Please note I am no expert and have never seen, nor treated, a similar case.

I would clean it up and bandage it to the head in time-honoured fashion with some allevyn (or equivalent) +/- some intrasite (or equivalent) and change every 2 to 3 days initially, decreasing to weekly if appropriate.

I would debride any clearly necrotic tissue with a scalpel between changes, or sedate/GA if extensive debridement required.

ONCE clean and healthy and no necrosis occurring, I'd decide either to continue dressing until healing (most likely) or add some skin from elsewhere (I've never seen it described, but a floppy ear must surely lend itself to distant direct flap if one so wished)

If encountered any MAJOR problems, I would simply cut the pinna/auricle off (it being unnecessary flap of tissue).

PS - If artery going down middle intact, then watch don't do any sharp debridement to affect that.