Home care and follow-up
Daily in-home supportive care consisted of subcutaneously administering lactated Ringer's solution (120 ml b.i.d.), administering
the prescribed oral medications (amoxicillin and lactulose), applying hot packs, and washing the suture lines with the Tricide-ampicillin
solution. Fluids were administered for one additional week while antibiotic therapy continued for two weeks. To prevent the
exposed subcutaneous tissues of the elbow and proximal limb from drying out, about 5 ml of an emulsion containing Tricide,
liquid lanolin, vitamin E oil, ampicillin, and deionized water was applied to the affected area twice a day. The emulsion
was prepared by mixing 35 ml lanolin and 5 ml vitamin E (333 IU/ml) with 10 ml deionized water that contained 60 mg of Tricide
(1.2 mg/ml) and 0.5 mg/ml ampicillin. Light bandaging of the shoulder and forelimb restricted movement, irritated the suture
line, and was eventually removed by the cat.
On Day 15, the cat was returned to the hospital for reevaluation. The suture lines were intact and the skin over the thorax
and scapular regions had attached to the underlying granulation bed. The skin on the ventral thorax and axilla, however, had
not reattached because of forelimb movement. About half of the exposed elbow and upper limb tissue had formed a granulation
bed, and the wound margins appeared healthy. We removed the drain and decided to continue at-home wound management, including
administering the amoxicillin, lactulose, and topical Tricide emulsion and placing hot packs.
Figure 4: The contracted wound before closure six weeks after initial presentation (Day 40).
The cat was readmitted to the hospital for examination 25 days later (Day 40). After three and a half weeks of home care,
the open wound over the elbow had constricted to about 1.5 x 2 in (Figure 4), and the skin covering the axilla had reattached except for a subcutaneous pocket on the lateral thoracic wall. This small
pocket was about 1.5 x 2.5 in and was medial to the olecranon. On Day 44, the cat was anesthetized to close the open wound.
The margins of the wound were freshened, the edges were minimally undermined, and the area was sutured in a simple interrupted
pattern. The cat was discharged the next day, and the sutures were removed nine weeks after the initial presentation (Day
63) (Figure 5).
Figure 5: The affected area after suture removal (Day 63).