Marly is a happy, bouncy 2 year old yellow Labrador retriever. She was out on a walk having a wonderful game of ball with her family. She chased the ball into long grass then gave a loud scream and came dashing out bleeding heavily from a huge gash in her chest. Marlys owner could see a large flap of skin hanging off and not waiting for anything raced her down to Riverside Small Animal Hospital.
True to her nature, when we first saw Marly she was still friendly and wagging her tail, but she was looking a little pale, showing us she had lost quite a bit of blood. She was still bleeding and the wound was too painful to explore properly.
The first thing we did was to put in a catheter and get intravenous fluids running into Marly. This helped support her blood pressure and gave us a route to get medications and if needed a blood transfusion into her. It was very quickly apparent she would need a general anaesthetic to investigate the extent of the wound and repair it.
We assessed that we didn’t think the presumed stick had penetrated right into her thoracic (chest) cavity, but we were ready to start ventilating (breathing for her) when we induced anaesthetic. This is because the lungs need the thorax to be sealed for them to work properly. If there was even a small hole it would become more and more difficult for Marly to breath. Sometimes a hole can be partially covered with a blood clot and we don’t find it until we start cleaning up the wound. Luckily for Marly we had been correct and her thorax was intact.
The stick had punctured her skin and muscle layers just behind her elbow and torn around to her sternum. The laceration was quite deep and penetrated through almost all muscle layers exposing ribs. – WARNING THESE PHOTOS ARE GRAPHIC)
The next job was to clean the wound. We cleaned hair, grass, soil and little pieces of stick from Marlys wound. We cleaned with the same solution we use to sterilize the skin prior to surgery then flushed and flushed with sterile saline. There was no way we could get this would sterile, but the closer we got the less her chances of developing an infection in the wound in a few days.
Once the wound was clean, the surgeon had to assess what tissue was damaged beyond repair and remove it and put the remaining tissues back together. They had to consider which way the muscles pull to maintain their original functions and how to get enough skin to cover over everything. Marly didn’t lose much muscle, but a large portion of skin had been torn too far from it’s blood supply to ever survive. This required the surgeon to move skin round from other parts of her body in order to close the wound. What was very helpful for Marly was the short time between the injury occurring and us repairing it. With all wounds, the longer they’re left the more tissue has to be removed, due to drying and infection, and the more difficult they are to close.
During closure three drains were stitched into the wound and left exiting through new holes in the skin. These rely on gravity to pull any fluid that oozes from the healing tissues away from the site of injury thus reducing the risk of infection and abscess formation. These were particularly vital given how dirty the wound was when we started.
The skin was finally closed with staples, which although are not pretty for the first 10 days are very useful for large skin closures as they are quick and they significantly reduced Marlys anesthetic time.
After surgery Marly recovered well and was sent home that night with antibiotics, painkillers and sadly wearing a buster collar to keep her from licking her incision or pulling her drains out. Her drains were removed after 4 days and the healing was well underway. After 10 days the staples were removed from a fantastic looking incision with no concerns about infection or further die back of damaged skin or muscle. Marly was good as new with the exception of the “bad hair cut”.