Non healing pressure sores

RE: Non healing pressure sores

Julian Earl — Thu, 23 Jan 2020 10:01:32 GMT

Is there any feasibility of marked debridement followed by primary closure. If so, that is your best chance of getting it to heal. Downsides = extra cost, risk of further breakdown with or without secondary infection. underlying neoplasia as indeed others have indicated. Suitable bandaging/dressing will still probably be required to minimise trauma to the wound site. But still the best option I think.

RE: Non healing pressure sores

Joyce Whitehead — Mon, 20 Jan 2020 16:46:17 GMT

I’m afraid it’s another malignancy vote. I had a similar Irish Wolfhound many years ago when I was a new grad, and we tried all sorts to get it healed. The owners always wanted home visits which limited us too. Finally got a lunch biopsy and came back as a sarcoma.

RE: Non healing pressure sores

George Cooper — Sat, 18 Jan 2020 19:09:13 GMT

Thanks to all for your responses to this. My intention has always been to allow "fresh air" to do its work on resolving the lesions - as it usually does in my experience. Sooooo - on Monday after a weekend with intrasite applied, that will probably be the next assault, accompanied by an assertive pep talk with the poor client.

RE: Non healing pressure sores

Bob Russell — Sat, 18 Jan 2020 10:24:50 GMT

Sorry, my vote would be for neoplasia as well. Toe lesions seem particularly nasty as they don't usually look 'cancerous'. Inflamed, non-healing and 'spiteful' tumours in my experience.

We did have an Irish Water Spaniel that had two toes amputated (different years) with histopath suggesting osteosarcoma. Died of old age end of last year so you can get lucky!

RE: Non healing pressure sores

janine redman — Sat, 18 Jan 2020 09:33:20 GMT

I like the colloidal silver dressings too but I think a recent lecture said that granulating wounds rarely benefit from anti biotic treatment and I would definitely consider neoplasia as I have had squamous cell carcinomas look like that and start in the pad tissue. I would be in favour of just leaving open and using a buster collar or neck brace

RE: Non healing pressure sores

Lindsey Edwards — Sat, 18 Jan 2020 00:17:14 GMT

If bandage care is poor then likely doing more harm than good - try leaving open, bathing after walks and iodine/chlorhex/hypochorite of your choice? Drying wound up may see dramatic impact compared to urine soaked dressing of any type

RE: Non healing pressure sores

Beats — Fri, 17 Jan 2020 22:07:05 GMT

My last equine boss used to swear by silver dressings (Acticoat I think it was?) - seeing was believing and healing was very rapid. After checking the instructions, I pointed out that was all the more remarkable as he was applying them upside-down... This was a reminder to me how hype regarding an expensive dressing can cloud one's objectivity.

I truly hope you find a solution, these cases can be sooooo draining as a vet when there is no end in sight in spite of such efforts. I find managing open wounds with dressings a very time-consuming chore, and never more frustrating than when it began with a surgical wound. I am just about to phone one of my own surgical complications with yet another suggested schedule and plan of attack that I can only hope works, so I'm feeling extra sympathetic this evening! Good luck!

RE: Non healing pressure sores

George Cooper — Fri, 17 Jan 2020 21:36:46 GMT

Beats - thank you SO much for your thoughts and contribution. We have not as yet biopsied for malignancy, though given the breed and age it must be a possibility. What you described is just about de-rigeur for this sort of issue - and we've been doing that for 2 months with intermittent periods. Next step must be histo, to seek cancerous problems.

Thanks for the link to "dry boots" - and while O ability, dog compatibility, size and weather impacting - it is something we will probably instigate - because we are at the final furlong for him.

RE: Non healing pressure sores

George Cooper — Fri, 17 Jan 2020 20:04:26 GMT

Metatarsus - smaller lesion is lateral, larger is medial; opposite each other above the amputation incision site. Extraordinarily tricky to take a photo of the lesion that is always hidden by the way the dog positions itself. Eventually solved the problem by taking a "selfie" of the lesion so that I could see what I was photographing. When an 85 kilo dog sets its mind on being less than cooperative there aint a lot one can do!

RE: Non healing pressure sores

Beats — Fri, 17 Jan 2020 19:00:19 GMT

I'm struggling to orientate myself with those pictures, George.

My first thought would be to be sure that this did not start as a neoplastic lesion and you are not on a mention doomed to failure - if the bit removed was still available, I'd consider histopathology, but I appreciate that adds expense...

I don't have any particular thoughts on dressing type to helpfully share I'm afraid. I would probably sedate and clean up and clip etc and then tape the largist allevyn (or equivalent) pad around the foot and then dress with soffbann and k/band / vetwrap to above the carpus and apply some elastoplast at the top [and possibly a couple of strips crossing over at bottom of foot also) and change weekly. If it's moist and exudative that is - hard to be sure from photo. If I thought it was still infected I might use some flamazine for a period of time.

Then the issue is keeping the dressings dry - I'd probably try something like this https://www.vetsend.co.uk/medical-pets-boot/?gclid=EAIaIQobChMIjsGk-KeL5wIVQbDtCh2uRgfpEAQYAyABEgJStvD_BwE (though note I've never used that specific brand and can't be sure would fit over bandage over great dane foot).