A Technique for Management of Bite Wounds of the Thoracic Wall in Small Dogs

Bite wounds of the chest wall in small dogs can extend into the thorax and can be associated with severe damage to chest wall muscles, ribs, and lungs. Two major problems associated with the management of these wounds are lack of sufficient muscle tissue for chest wall reconstruction, and difficulty draining the extensive dead space created in the chest wall. We describe a simple method to overcome these problems. The bite wound areas were surgically explored and all devitalized soft tissue was debrided. The pleural cavity was explored, intrathoracic injuries repaired, and a thoracic drainage tube was placed. Ribs in the injured area were stabilized in anatomic position by means of heavy gauge sutures passed around pairs of adjacent ribs, thus creating a scaffolding for soft tissues. Viable muscle and subcutaneous tissues were apposed as much as possible and the skin closed over the defect. Eleven small dogs were treated using this technique. All dogs had severe injuries to the thoracic wall muscles and eight dogs had multiple rib fractures. There was no evidence of chest wall instability in any of the dogs after surgery. Nine dogs survived the injury and were reevaluated 3 to 32 months after surgery. All were clinically normal. One dog developed wound infection and pyothorax, caused by insufficient debridement of injured muscle tissue, and died 10 days after surgery. A second dog died 24 hours postoperatively of undetermined causes.     

Omentum-Enhanced Reconstruction of Chronic Nonhealing Wounds in Cats: Techniques and Clinical Use

The greater omentum was used to aid in the reconstruction of nonhealing wounds in five cats. In each cat the cause of the nonhealing wound could not be determined. A vascular omental pedicle was created at laparotomy by dividing the dorsal leaf of the omentum at its pancreatic attachments (four cats) or by dividing the ventral leaf at its gastric attachments (one cat). The pedicle was then passed through either the ventral or lateral body wall into the nonhealing wound via a subcutaneous tunnel. The wounds were closed over the omentum after local tissue mobilization. All the wounds healed uneventfully and have remained healed with a mean follow-up period of 2.5 years. Complications included intestinal herniation through a ventral midline exit hole (one cat), presumed abdominal fat herniation through a ventral abdominal exit hole (one cat) and seroma formation (one cat). All of the complications were treated successfully. The omentum should be considered a useful adjunct in the treatment of nonhealing wounds in cats.     

Nonhealing subcutaneous wounds in the cat and proposed surgical management techniques

Nonhealing wounds in cats are a source of frustration for veterinarians and pet owners alike. These wounds are known for their insidious onset and tendency to recur after standard surgical closure. The presence of a feline wound that fails to heal in the face of appropriate therapy should initiate an extensive diagnostic evaluation for an etiologic agent. Initially animals should be screened for causes of immunosuppression or systemic disease. The local wound environment should then be evaluated through a combination of wound exploration, cytology, histopathology and tissue culture for evidence of a foreign body, neoplasia, or other less common etiologies of these wounds. Many of the less common etiologic agents require specific tissue handling for successful microscopic identification and culture. It is therefore essential for veterinarians to be familiar with the various causes of nonhealing wounds in cats so that laboratories can be alerted of the need for specific diagnostic techniques. Recent surgical and medical advances have the potential to facilitate the successful treatment of these wounds. With improved veterinary awareness of the potential etiologies of nonhealing wounds in cats and improved medical and surgical management techniques many wounds can now successfully be treated.     

High rise syndrome with impalement in three cats

Three cats were presented for management of impalement injuries sustained following falls from second storey windows onto spiked metal railings. Two cats presented with penetrating thoracic wounds and extensive pulmonary parenchymal trauma, while one presented with abdominal impalement and splenic rupture. Following stabilisation, all three cats underwent exploratory surgery. A good outcome was achieved in two of the cats: one with thoracic and one with abdominal penetration. Impalement injury secondary to free fallis a previously unreported variation of 'high rise syndrome' in cats.     

Capnocytophaga canimorsus infections: a possibly fatal complication of bite wounds

Practising veterinarians and their assistants run the risk of being bitten by their patients, mostly cats and dogs, and many have experienced that bites and bite-wound infections can have unpleasant consequences. In recent years, more insight has been gained into a 'new' bacterial infection of bite wounds that not only has severe local effects but also potentially fatal systemic consequences. The bacterium involved is Capnocytophaga canimorsus. All bite wounds should be treated adequately, but this is especially so when wounds are infected with C. canimorsus. In this article, dog and cat bites are briefly described and then an overview is given of current knowledge of C. canimorsus and appropriate prophylactic measures.     

Comparison of the role of the subcutaneous tissues in cutaneous wound healing in the dog and cat

Objective— To describe and compare the contribution of the subcutaneous tissues to 1st and 2nd intention cutaneous wound healing in the dog and cat.
Study Design— Experimental study.
Animals— Domestic shorthaired cats (n=6) and 6 beagle dogs.
Methods— Paired wounds were created on either side of the dorsal midline; the subcutaneous tissue was removed on 1 side and left intact on the other. Square, open wounds of the dorsal aspect of the thorax were observed for 21 days to monitor granulation tissue formation, wound contraction, epithelialization, and total healing (contraction+epithelialization). Breaking strength of sutured linear wounds was measured 7 days after wounding. Laser-Doppler perfusion imaging (LDPI) was used to measure cutaneous perfusion.
Results— First intention healing: subcutaneous tissue removal had no consistent effect on sutured wound strength at 7 days in dogs or cats. Second intention healing: removal of subcutaneous tissue reduced wound perfusion, granulation, contraction, epithelialization, and total healing. Granulation tissue formation and wound contraction were delayed to a significantly greater degree in cats than in dogs ( P <.05). Two dogs (33%) had minor wound infections.
Conclusions— The subcutaneous tissues make an important contribution to 2nd intention cutaneous healing. Dog and cat wounds had delayed 2nd intention healing when subcutaneous tissues were removed; wounds in dogs, but not cats, had largely recovered from this delay by 21 days.
Clinical Relevance— Extensive debridement of subcutaneous tissue may delay wound healing particularly in feline patients. A higher risk for wound infections may accompany extensive removal of subcutaneous tissues in dogs.     

Use of omental pedicle grafts in the management of non-healing axillary wounds in 10 cats

A retrospective analysis of the clinical case histories of 10 domestic shorthaired cats that underwent omentalisation, using a vascular pedicle of greater omentum, of chronic non-healing axillary wounds was carried out. Wounds were debrided and closed in a primary fashion following omentalisation. The cats had undergone a modal number of three previous repair attempts over a three- to 18-month period (mean 11 months) before referral. Further dehiscence occurred in eight cases, requiring a modal number of one further attempt at closure of the wound. Other complications included incisional herniation (two cats), serous exudate from the axillary wound (two cats) and paracostal abscessation (one cat). Long-term cure was achieved in seven of the 10 cases, with wounds finally having healed at a mean of 24 days post-omentalisation. Chronic axillary wounds are particularly difficult to treat and there are no reports of consistently successful techniques for their repair. This report suggests that omentalisation of these wounds may be a step towards such a repair procedure.     

Why your housecat's trite little bite could cause you quite a fright: a study of domestic felines on the occurrence and antibiotic susceptibility of Pasteurella multocida

Approximately four to five million animal bite wounds are reported in the USA each year. Domestic companion animals inflict the majority of these wounds. Although canine bites far outnumber feline bites, unlike the dog, the cat's bite is worse than its bark; 20-80% of all cat bites will become infected, compared with only 3-18% of dog bite wounds. Pasteurella multocida is the most commonly cultured bacterium from infected cat bite wounds. Anyone seeking medical attention for a cat-inflicted bite wound is given prophylactic/empiric penicillin or a derivative to prevent Pasteurella infection (provided they are not allergic to penicillins). In an effort to establish a carriage rate of P. multocida in the domestic feline, bacterial samples from the gingival margins of domestic northern Ohio cats (n=409) were cultured. Isolates were tested for antibiotic sensitivity as prophylactic/empiric use of penicillin and its derivatives could potentially give rise to antibiotic resistance in P. multocida. The high carriage rate (approximately 90%) of P. multocida observed was found to be independent of physiological and behavioural variables including age, breed, food type, gingival scale, lifestyle and sex. High antibiotic susceptibility percentages were observed for benzylpenicillin, amoxicillin-clavulanate, cefazolin, and azithromycin (100%, 100%, 98.37% and 94.02%, respectively) in P. multocida isolates. The high prevalence of P. multocida in the feline oral cavity indicates that prophylactic/empiric antibiotic therapy is still an appropriate response to cat bite wounds. Additionally, the susceptibility of P. multocida to penicillin and its derivatives indicates that they remain reliable choices for preventing and treating P. multocida infections.     

Brain abscess in seven cats due to a bite wound: MRI findings, surgical management and outcome

PRESENTATION AND LESION LOCALISATION: Seven adult domestic shorthair cats were presented with a 1- to 6-day history of progressive neurological signs. A focal skin puncture and subcutaneous swelling over the dorsal part of the head were detected on physical examination. Neurological examination indicated lesion(s) in the right forebrain in four cats, multifocal forebrain in one cat, left forebrain in one cat, and multifocal forebrain and brainstem in the remaining cat. In all cats, magnetic resonance imaging revealed a space-occupying forebrain lesion causing a severe mass effect on adjacent brain parenchyma. CLINICAL APPROACH AND OUTCOME: All cats were managed with a combination of medical and surgical treatment. At surgery a small penetrating calvarial fracture was detected in all cats, and a tooth fragment was found within the content of the abscess in two cats. The combination of surgical intervention, intensive care and intravenous antimicrobials led to a return to normal neurological function in five cats. PRACTICAL RELEVANCE: As this series of cases indicates, successful resolution of a brain abscess due to a bite injury depends on early recognition and combined used of antimicrobials and surgical intervention. A particular aim of surgery is to remove any skull and foreign body (tooth) fragments that may represent a continuing focus of infection.     

Combined Omental Pedicle Grafts and Thoracodorsal Axial Pattern Flaps for the Reconstruction of Chronic, Nonhealing Axillary Wounds in Cats

OBJECTIVE: To assess the results of an omental pedicle graft in combination with a thoracodorsal axial pattern flap for the reconstruction of chronic nonhealing axillary wounds in 10 cats caused by forelimb entrapment within a collar. STUDY DESIGN: A prospective, clinical trial. ANIMALS USED: Ten client-owned domestic shorthair cats. METHODS: Routine biochemical and hematologic evaluation was performed on each cat, and all were tested for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV). Microbial culture was performed on samples from the wounds. After surgical debridement, omentalization using a vascular pedicle of greater omentum, and closure of the chronic axillary wounds, using a thoracodorsal axial pattern flap, was performed. All excised tissue was examined histologically. RESULTS: The sex distribution was 7 males and 3 females, with a mean age of 3.5 years. The cats had undergone a median number of 3 previous repair attempts over a 1.5- to 25-month period before referral (mean, 10.2 months). No hematologic or biochemical abnormalities were noted apart from moderately elevated creatine kinase and aspartate transaminase concentrations in some cats. All cats were negative for FIV and FeLV. Histologic examination of resected tissue revealed hair (foreign body) in 2 cats and an unidentified foreign-body reaction in 3 other cats. Complete healing occurred in all cats (mean follow-up period of 21.7 months), with 2 cats requiring further surgery: 1 for flap dehiscence at 4 days after surgery, and 1 for donor-site dehiscence at 4 days after surgery. One other cat developed a large seroma in the axilla that resolved by 10 days following surgery. CONCLUSION: The use of an omental pedicle graft in combination with a thoracodorsal axial pattern flap is the first consistently successful 1-step technique for the management of chronic nonhealing axillary wounds in cats.     

Thoracic bite trauma in dogs: a comparison of clinical and radiological parameters with surgical results

OBJECTIVES: Canine bite wounds may cause severe underlying tissue trauma even with no clinically evident puncture wounds. In order to assess the ability of pre-operative diagnostic parameters to predict the extent of internal damage inflicted by a thoracic bite wound, the clinical, radiological and surgical data of 45 dogs that sustained thoracic bite trauma were recorded. METHODS: Clinical, radiographic and surgical parameters from 45 dogs of various breeds with thoracic bite trauma, were analysed (P<0.05). All dogs were treated according to a previously described protocol and had exploratory surgery including a thoracotomy. RESULTS: Mainly small-breed dogs were traumatised. Clinical and radiological data were suggestive of internal trauma but not reliable as accurate indicators for internal lesions. Only radiological evidence of lung contusion was significantly associated with the presence of surgically confirmed lung contusion (P=0.006). Dogs with postoperative wound complications had a significantly higher risk of dying than those without complications (P=0.04). CLINICAL SIGNIFICANCE: This study concludes that according to protocol an optimal management of thoracic bite wounds in small dogs includes surgical exploration of the wound and the thoracic cavity in the presence of flail or pseudo-flail chest, fractured ribs, radiological evidence of lung contusion, pneumothorax or any combination of these.     

Bite wounds involving the spine: characteristics, therapy and outcome in seven cases

Medical records of five dogs and two cats with bite wounds to the spine were reviewed. All dogs were bitten in the cervical spine and presented as quadriparetic. Both cats were bitten at the lumbar spine; one was paraparetic and the other paraplegic. Concomitant injuries to structures other than the spine were seen in two cases. Radiographic findings included vertebral fractures in all cases. Medical therapy included antibiotics (7/7), methylprednisolone sodium succinate (4/7) and analgesia (7/7). Five cases underwent minor (4/5) or extensive (1/5) surgical debridement. All cervical fractures were stabilized with fiberglass casts and animals with lumbar injury were cage rested for a month. Six of the cases survived, five of which regained good to excellent ambulatory ability within the first month. Although, the numbers of reported cases are limited, this study shows that adequate surgical debridement and wound drainage combined with external coaptation can be sufficient to manage bite wounds that involve the spine.     

Dog-bite wounds: bacteriology and treatment outcome in 37 cases

Bite wounds in 37 dogs were prospectively evaluated. Ninety-five percent of animals presented within 12 hours of injury. The most common wound locations were neck, limbs, head, chest, shoulder region, and abdomen. Eighty-six percent had wounds to multiple locations. Fifty-seven percent of wounds were Class 4 (i.e., most severe). Based on results of all samples, 65% had positive aerobic cultures, 15% had positive anaerobic cultures, and 33% had negative cultures. The most commonly isolated aerobic bacteria were Staphylococcus intermedius, Enterococcus spp., Staphylococcus coagulase negative, and Escherichia coli. Most common anaerobic isolates were Bacillus spp., Clostridium spp., and Corynebacterium spp. Severe bite wounds had a high rate of bacterial contamination at presentation. No single antibiotic or antibiotic combination was effective against all bacteria that were cultured.     

Seroprevalences of feline leukemia virus and feline immunodeficiency virus in cats with abscesses or bite wounds and rate of veterinarian compliance with current guidelines for retrovirus testing

OBJECTIVE: To determine the seroprevalences of and seroconversion rates for FeLV and FIV infection in cats treated for bite wounds and cutaneous abscesses and to evaluate compliance with recommendations to determine the retrovirus infection status of cats at acquisition and 60 days after a high-risk event. DESIGN: Prospective study. ANIMALS: 967 cats from 134 veterinary practices in 30 states. PROCEDURES: Cats with bite wounds or abscesses were evaluated by use of a point-of-care immunoassay for blood-borne FeLV antigen and FIV antibody. Veterinarians were asked to retest cats approximately 60 days later to determine whether seronegative cats had seroconverted after injury. RESULTS: The combined FeLV-FIV status of only 96 (9.9%) cats was known prior to wound treatment. At the time of treatment, 187 (19.3%) cats were seropositive for 1 or both viruses. Age (adult), sex (male), history of cutaneous wounds, and outdoor access were significantly associated with seropositivity. At 73 of 134 (54.5%) veterinary practices, retesting of cats for retrovirus infection status was recommended to owners of 478 cats. Only 64 (13.4%) cats were retested; of these, 3 of 58 (5.2%) cats that were initially seronegative for FIV antibody seroconverted. CONCLUSIONS AND CLINICAL RELEVANCE: A high proportion of cats with abscesses or bite wounds were seropositive for FeLV antigen or FIV antibody. Compliance with recommendations to test cats for retrovirus infection status at acquisition or after treatment for injury was low. The FeLV-FIV infection status of cats with potential fight wounds should be determined at time of treatment and again 60 days later.     

Lymphangiosarcomas in cats: a retrospective study of 12 cases

Clinical, macroscopic, and histologic features of 12 lymphangiosarcomas in cats are described. Nine tumors were located in the subcutaneous tissue at the caudoventral abdominal wall (eight cats) or in the neck (one cat). The remaining three cats had lymphangiosarcomas around the cranial mesenteric artery (two cats) or precardial in the mediastinum (one cat). Macroscopically, the tumors were noncircumscribed, white, edematous, and intermixed with fat tissue. Histologic features varied from cleft-forming and cavernous growth to papilliform and solid patterns. Follow-up data were available for seven cats with subcutaneous lymphangiosarcomas. All these cats died or were euthanatized within 6 months after surgery because of poor wound healing, local recurrence, or distant metastases. The cats with abdominal or thoracic masses were either euthanatized at surgery or within 6 months after the first surgery because of recurrent chylothorax, chyloperitoneum, or distant metastases.     

Successful use of short‐term mechanical ventilation to manage respiratory failure secondary to profound hypokalemia in a cat with hyperaldosteronism

Objective – To report successful management of respiratory failure due to severe hypokalemia in a cat with hyperaldosteronism, including short‐term mechanical ventilation strategies and aspects of medical and surgical treatment. Case Summary – A cat presented with bilateral pelvic limb weakness that rapidly progressed to tetraparesis and respiratory muscle failure. Point‐of‐care testing revealed severe hypokalemia (1.9 mmol/L) and mild azotemia. Initial management included endotracheal intubation, mechanical ventilation, and aggressive potassium supplementation. Spironolactone was started due to a high index of suspicion for hyperaldosteronism. A right adrenal mass visualized during abdominal ultrasonographic examination and a serum aldosterone level greater than 3329 pmol/L confirmed the diagnosis. The cat made a full recovery following surgical removal of a right adrenal adenoma. New or Unique Information Provided – We report successful management of respiratory failure in a cat with hyperaldosteronism using short‐term mechanical ventilation. Respiratory failure due to severe hypokalemia should be considered a complication of hyperaldosteronism in cats and may require mechanical ventilation. However, full recovery is possible.     

Survival of a feline isolate of Tritrichomonas foetus in water, cat urine, cat food and cat litter

Feline intestinal trichomoniasis caused by Tritrichomonas foetus is associated with large bowel diarrhea in cats from many parts of the world. It has long been recognized as an economically important sexually transmitted disease that causes early abortion in cattle. Isolates of T. foetus from cattle are infectious for the large intestine of cats and isolates of T. foetus from cats are infectious for the reproductive system of cattle. The parasite is maintained by fecal-oral transmission in cats. The present study was conducted to examine the survival of a feline isolate of T. foetus, AUTf-12, under various conditions that are relevant to fecal-oral transmission in cats. Trophozoites were grown in TYM medium and then exposed to water, cat urine, dry cat food, canned cat food, clumping cat litter, or filter paper for various lengths of time and then re-cultured in TYM medium. Trophozoites survived exposure to distilled or tap water for 30 but not 60 min, while they survived for at least 180 min in urine. Trophozoites survived for 30 min on dry cat food but survived for 120-180 min in canned cat food. No survival of trophozoites was observed on cat litter but trophozoites survived for 15 min when placed on filter paper. Our results indicate that T. foetus can survive and be potentially infectious in water, urine, dry cat food and canned cat food.     

Successful closure of feline axillary wounds by reconstruction of the elbow skin fold

This report describes the successful closure of five chronic feline axillary wounds. The aetiology was known to be forelimb entrapment in a neck collar in three cases and was suspected in the others. Each cat underwent a single surgical procedure during which the wound was debrided, the normal structure of the elbow skin fold was restored and the remaining skin defect was closed primarily. None of the cats had undergone any previous reconstruction attempts. No postoperative complications were observed and the wounds healed uneventfully. Cats have well-developed elbow skin folds, allowing a wide range of limb motion to occur. Having a forelimb trapped in a neck collar not only creates a wound in the axilla but also disrupts the normal anatomy of the skin fold. This report demonstrates that restoring the elbow skin fold before closing the wound may improve the chances of a successful reconstruction at the first surgical intervention.     

Diagnosis and treatment of pyogranulomatous panniculitis due to Mycobacterium smegmatis in cats

Four cats with extensive pyogranulomatous panniculitis and dermatitis due to Mycobacterium smegmatis were evaluated over an eight-month period. All were treated initially with doxycycline (50 mg per cat every eight to 12 hours) for several weeks, then subjected to radical surgical excision of infected tissues. Reconstructive surgery utilising advancement flaps was required to close wounds without undue tension. Postoperatively, the cats received parenteral gentamicin (2 mg/kg every eight hours) for three to five days, followed by orally administered ciprofloxacin (62.5 mg per cat every eight hours or 125 mg per cat every 12 hours) for three to six months. Infection was eradicated in all the cats, with no signs of recurrence 15 to 23 months after surgery.     

Cutaneous wound healing in the cat: a macroscopic description and comparison with cutaneous wound healing in the dog

OBJECTIVE: To describe the macroscopic features of first and second intention cutaneous wound healing in the cat and compare with the dog. STUDY DESIGN: Experimental study. ANIMALS: Domestic shorthaired cats (6) and beagle dogs (6). METHODS: Square, open cutaneous wounds created on the dorsal aspect of the thorax were evaluated for 21 days for temporal and spatial development of granulation tissue, wound contraction, epithelialization, and total healing. To evaluate first intention healing, breaking strength of sutured linear cutaneous wounds was measured at 7 days post-wounding. Laser-Doppler perfusion imaging was used to measure cutaneous perfusion. RESULTS: First intention healing: sutured wounds in cats were only half as strong as those in dogs at day 7 (0.406 versus 0.818 kg breaking strength). Second intention healing: cats produced significantly less granulation tissue than dogs, with a peripheral, rather than central distribution. Wound epithelialization and total wound healing (total reduction in open wound area from contraction and epithelialization) were greater for dogs than for cats over 21 days. Wound contraction on day 7 was greater for dogs, but not on day 14 or 21. Cutaneous perfusion was initially greater for dogs than for cats, but no differences were detected after day 7. CONCLUSIONS: Significant, previously unreported differences in cutaneous wound healing exist between cats and dogs. In general, cutaneous wounds in cats are slower to heal. Cats and dogs also appear to use different mechanisms of second intention healing. In cats wounds close mainly by contraction of the wound edges, whereas in dogs wounds close more from central pull, and epithelialization. CLINICAL RELEVANCE: Surgeons should view the cat as a unique species, which presents its own special challenges in wound healing, and should take this into account when planning treatment of feline wounds, either by primary closure, or by second intention healing.