Elbow wound in an old dog

RE: Elbow wound in an old dog

Neil Wheadon — Sat, 01 Aug 2020 13:33:59 GMT

[quote userid="6297" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29263/elbow-wound-in-an-old-dog/224629#224629"]I would agree with Michael, this could end up costing a fortune in repeat bandage changes[/quote]

Never underestimate an owner, especially with small areas that they can change bandages and do it correctly under supervision. The costs roll up due to vet visits.

I'd almost argue that a proficient owner changing every few days is better than leaving a bandage on for 4-5 days with all the sweating/dirty issues that ensue

Neil

RE: Elbow wound in an old dog

Thomas Johnson — Sat, 01 Aug 2020 13:28:06 GMT

[quote userid="10466" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29263/elbow-wound-in-an-old-dog/224636#224636"]but its healing , it will take time. So there is no skin I can move around, that s why we cant do more surgery , there is no necrotic tissue anywhere, not even on the elbow. [/quote]

Thank you for explaining what you've done already. I misunderstood your original post and thought the reason for not doing more surgery was because the dog wasn't insured and therefore the owner couldn't afford further surgery. I would agree with Jill's post that it is amazing what will heal if given enough time and very careful wound management.

RE: Elbow wound in an old dog

Katarina Lakatova — Sat, 01 Aug 2020 12:42:20 GMT

I removed 1kg of soft tissue sarcoma from this dog pectoral muscle which was partially attached to the inner side of the right front leg, the mass was growing for 3 years and the owner didn't really wanted surgery, then his family got involved and convinced him it needs to happen. I explained all the possible risks and removed the mass, it was long difficult surgery and I had to do pedicle advancment flap and also transposition flap to get all the skin back together ,chest healed lovely, removed the stitches on Thursday, but had skin tension on inside of the leg and 48 hours after the surgery decided to remove the stitches and let it to heal by second intention with loop tie bandages it is a big wound going from the elbow up into the axilla , but its healing , it will take time. So there is no skin I can move around, that s why we cant do more surgery , there is no necrotic tissue anywhere, not even on the elbow. The dog is in the hospital as his owner is in the hospital too since February, so there is no concern about aftercare, of bandage care, bedding or excessive exercise.

RE: Elbow wound in an old dog

Thomas Johnson — Sat, 01 Aug 2020 09:13:38 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29263/elbow-wound-in-an-old-dog/224624#224624"]Sometimes surgery can work out cheaper than repeated bandage changes. Wound management is expensive.[/quote]

I would agree with Michael, this could end up costing a fortune in repeat bandage changes, and with the amount of movement at the elbow healing is probably going to be difficult and slow. What surgery has been performed so far? I have had very good results with closing wounds over elbows (mainly after mass removals) with a transposition skin flap using the skin fold behind the elbow, you'd need to be happy that all the necrotic tissue was gone first. If you've got a copy of Fossum see Fig. 15-23.

RE: Elbow wound in an old dog

Jill Butterworth — Sat, 01 Aug 2020 07:52:24 GMT

I love these. If the skin is very thin and there's nothing to move, surgery can be really difficult anyway. Have you debrided the necrotic stuff? You can do a lot conscious if the skin's dead and then use daily saline wet to dry dressings to get the rest off until you start to see epithelialisation. My old favourite dressing for this is Granuflex, preferably once the infection is under control: it's cushioning and can be left on for up to 5 days, and you usually see a great improvement at each redress. Use a completely sterile technique. Could you teach the owner to redress and tell them what to expect? Also make sure they understand it's important where the dog lies down as a skinny dog on hard bedding will traumatise the wound constantly. Think skate board pads. It's absolutely amazing what will heal by second intention, I've seen huge wounds get better, but it's slow. If you can redress every 5 days and see some progress each time, you should be ok.

RE: Elbow wound in an old dog

Michael Woodhouse — Fri, 31 Jul 2020 23:26:34 GMT

[quote userid="10466" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29263/elbow-wound-in-an-old-dog"]We cant do any more surgery,[/quote]

Sometimes surgery can work out cheaper than repeated bandage changes. Wound management is expensive.

RE: Elbow wound in an old dog

Neil Wheadon — Fri, 31 Jul 2020 22:53:45 GMT

As above

I remember a lurcher a few years ago that had a 3cm x 1cm tear on the forearm that the owner didn't want stitched. Repeat dressings were as good as a stitch up 4 weeks later and almost no sign 8 weeks later

Patience and keep the client onboard, just be honest

Neil

RE: Elbow wound in an old dog

janine redman — Fri, 31 Jul 2020 21:26:31 GMT

Allevyn elbow bandage , manukau honey and an MPs Forelimb sleeve.