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Wound Dehiscence after Pelvic Fracture Repair in an 8-month-old Shetland Sheepdog

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An 8-month-old castrated male Shetland Sheepdog was presented to the Emergency Service at the Cornell University Hospital for Animals after being hit by a car in December 2016. The patient had been seen by 2 veterinarians prior to arrival and was hemodynamically stable on presentation. Based on radio graphs taken by the referring veterinarian, the patient had suffered multiple pelvic fractures and traumatic amputation of the distal half of the tail. The entire remaining length of the tail had also been degloved. The area surrounding the wound and remaining caudal vertebrae had been clipped and cleaned but left uncovered due to its proximity to the anus. Intravenous pain medications and antibiotics were administered overnight. A computed tomography (CT) scan and surgery were scheduled for the following day. On CT, fractures of the ilium, ischium, pubis, and left sacral wing were identified, as well as subluxation of the left sacroiliac joint. A large volume of gas and fluid within the subcutaneous tissues was visible surrounding the degloving site and extending down the right and left caudal thighs. Surgical repair required application of a single dynamic compression plate to the left ilium to restore the weight-bearing surface of the left pelvic limb. Amputation of additional caudal vertebrae, followed by copious lavage and wound debridement, were performed to facilitate closure of the degloving site. Dehiscence of the site of primary wound closure and extensive skin necrosis were noted approximately 5 days after surgery. The patient was subsequently transferred to the Soft Tissue Surgery Service for further assessment and surgical resection of the nonviable tissue. The patient recovered well following excision of much of the affected skin, and development of additional necrosis was minimal. This case discussion will serve to highlight important considerations and challenges associated with emergent wound closure in patients with degloving and shearing injuries.

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2017-03-08

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dehiscence, trauma, fracture, wound, degloving, shearing

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case study

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