Traumatic leg injury in 3 year old miniature mule
A 3 year old female miniature mule presented to the Cornell University Large Animal Surgery Service for wound management or potential amputation and prosthesis following an injury sustained to her right hind limb one week prior. The limb was trapped between a stall door and door frame for an unknown amount of time resulting in severe compression of the soft tissue structures surrounding the metatarsus. Treatment efforts on the farm included debridement, bandaging, flunixin meglumine and trimethoprim sulfa. Due to increasing pain and an unmanageable quantity of discharge, the case was referred to Cornell. On presentation the patient was bright, alert, responsive and tachypneic, which was attributed to stress. She was grade 4/5 lame (AAEP scale) on the right hind. A complete physical exam was not possible due to her temperament. Examination of the right hind limb revealed a deep wound on the plantar-lateral aspect of the mid-cannon and another medially just proximal to the fetlock joint. Much of the soft tissue structures surrounding the distal 2/3 of the cannon bone appeared devitalized and the common digital extensor tendon appeared severed. Radiographs revealed no bone lesions in the metatarsus or fetlock. Initial blood work showed a mild leukocytosis and neutrophila in addition to elevated an AST and CK. Computed tomographic contrast angiography was performed to evaluate blood flow to the distal hind limb. Although a short disruption was noted in the lateral plantar digital artery, sufficient laminar flow was present to the entire hoof. Surgical debridement of the wound was then performed and the extensor tendon was confirmed as severed, while the flexor tendons were intact. A custom splint was made in order to maintain extension of the limb to prevent the patient from knuckling and to prevent flexor tendon contracture. The patient was treated with antibiotics, anti-inflammatories, and gastroprotectants. Strategies were employed to help increase the speed of wound healing including utilizing wound VAC® technology. The patient was discharged from the hospital after sufficient granulation tissue covered the cannon bone, 24 days after admittance. This case report describes the full-work up and hospitalization of the patient following a severe injury to the distal limb. The discussion focuses on wound healing and management, complications of second intention healing, and therapies to enhance wound closure.
Senior seminar paperSeminar SF601.1 2013
Mules -- Wounds and injuries -- Case studies