Manage bite wounds: not just skin deep - DVM
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Manage bite wounds: not just skin deep
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After initial stabilization, a full physical examination, including orthopedic and neurologic evaluation, should be performed. Bite wounds overlying the abdomen, with or without a puncture wound to the overlying skin, can cause significant internal damage, including internal hemorrhage, and gastrointestinal or urogenital perforation.

Soft-tissue trauma All patients with bite wounds penetrating the peritoneal cavity ideally should have a full abdominal exploratory after initial stabilization. Abdominal penetration may be evident by the herniation of abdominal contents, or the presence of free abdominal gas visible on radiographs, or by exploration of wounds with a blunt sterile instrument. All of the vasculature and organs should be evaluated for damage. The liver, spleen and vessels should be evaluated for active hemorrhage — a splenectomy or liver lobectomy may be necessary. If the gall bladder or bile ducts have been damaged, a cholecystectomy may be indicated. The gastrointestinal tract and the pancreas should be evaluated closely for perforation and cyanosis secondary to blood-supply disruption. Dogs that suffer from loss of circulation to a portion of the intestines can appear stable without exploratory until sudden collapse and death from sepsis and endo-toxemia days after the initial injury. Damage to the urogenital tract may require nephrectomy, ureter or urinary bladder repair. Evaluation of the diaphragm is also necessary to rule out a diaphragmatic hernia.

Management of individual wounds: Of course, not all bite-wound patients are affected to this degree, but an exploration of the bite wounds is indicated in every bite-wound victim. Depending on the behavior of the patient and severity of wounds, exploration may be done awake with mild sedation or under general anesthesia. Each penetrating wound should be protected with a sterile lubricating jelly. The area around each wound should be clipped and cleaned. The wounds should then be probed with a blunt sterile instrument to evaluate the depth of penetration and lavaged copiously with sterile saline.

In many cases, wounds that extend under the skin and into muscle will need to be opened further to allow debridement of devitalized fat and muscle.

In contaminated abdominal cavities, J-vac drains can be used and recharged regularly to allow continuous suction of accumulated fluids.
Drains Bite wounds cause dead space and introduce infection. These wounds should be left open or allowed to drain properly. For small areas of dead space, a Penrose drain is effective, or simply leaving the wound open is often adequate. Penrose drains operate via gravity and capillary action over the outer surface of the drain. They should exit through healthy tissue ventral to the wound to facilitate drainage. Penrose drains are normally left in place for three to five days. A bandage should be placed over the drain if possible or the patient should be provided with an Elizabethan collar to prevent removal of the drain by the patient. In larger areas of dead space and in the abdominal cavity, closed suction drains are indicated. In larger subcutaneous areas of dead space, a closed suction drain can be used. These can be made with a fenestrated sterile extension set, a needle and a red-top blood collection tube. The red-top tube creates the vacuum and collects the accumulated fluid. The tube will need to be changed periodically when the vacuum is no longer effective and/or when the tube is full. In contaminated abdominal cavities, J-vac drains (Photo 2) can be used. These need to be recharged on a regular basis to allow continuous suction of accumulated fluids. All closed suction drains exiting the peritoneal cavity should be secured with a pursestring skin suture.

Case study The emergency and surgical services at Red Bank Veterinary Hospital manages a high number of bite-wound patients. Many of these patients are very stable, but many are critically injured. The following case study is an example of a critical patient that was recently managed at the hospital.


Source: DVM360 MAGAZINE,
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