Page 100 - Veterinary Laser Therapy in Small Animal Practice

86 Veterinary Laser Therapy in Small Animal Practice

Case no. 3

C., canine, 2 years old, mixed breed, MC, 16 kg
• Complaint: bite wounds and limb swelling.
• History: he had been attacked by other dogs 48 h before. The most severe wound was in the right forelimb
and axila. At the emergency clinic they had lavaged the wound, put in several Penrose drains and completely
closed with sutures. His regular vet referred him for LT. He was on tramadol, meloxicam, cephalexin, and
metronidazole.
• Physical examination: C. was brought in unable to stand due to severe pain (9/10). His right forelimb
showed severe inflammation, oozing, edema, and progressive tissue necrosis (Fig. C3.1a, b).
• Diagnosis: bite wound with severe compromise of venous return of the limb due to primary closure of
wounds.
• Treatment:
• Wound management:
• In this case, LT was not the priority. Sutures had to be removed to reopen the wound, release
the proximal tension and allow blood to properly flow. Otherwise, tissue necrosis would have
compromised the viability of the limb, and potentially the patient’s life. Patient was sedated to open
the wound and perform a thorough lavage. A hematoma was present over the pectoral area. Analgesic
treatment was changed to buprenorphine 0.015 mg/kg q6h during the first 24 h.
• The procedure was repeated 24 h later, new drains were placed, and LT was started (Fig. C3.2).
Alginate dressings were used to evacuate exudates and facilitate debriding and granulation, with
changes q48h initially. Patient was comfortable and able to walk from day 2, and drains were removed
on day 3. Wounds were kept bandaged at all times.
• On day 6, only a small portion of moist necrotic tissue remained and the rest of the skin on the limb
was visibly viable (Fig. C3.3). The skin around the axila and proximal limb was still detached from
underlying tissue.
• By day 20 (Fig. C3.4) a good granulation tissue was present. The wound was moderately exudative
and Manuka honey impregnated polyurethane foam wound dressings were then used. Antibiotics
were discontinued.
• An axial pattern flap from the superficial brachial artery was considered but its integrity was
questionable and C. was an extremely active dog for whom bandage protection and rest was very
challenging, so it was decided not to graft the defect either and to continue with second intention
closure and LT.
• Laser therapy:
• Initially (Fig. C3.2), a low dose of 2–4 J/cm was used, with power densities around 0.25 W/cm ,
2
2
covering all the area from the carpus to the axilla and cranial pectoral surface (300 cm ).
2
• As the wound bed became granulated, doses were progressively increased to 15 J/cm and power
2
2
densities to 0.6 W/cm . The treatment area decreased in time, so the treatment time was kept
around 4–5 min (dose increased but so did power). For instance, by day 32 (Fig. C3.5) we were using
2
2
8 J/cm over 100 cm (total amount of energy 800 J) with an average power of 3 W. With 3 W, it
takes 266 seconds (4.4 min) to deliver 800 J.
• The first week, laser was performed q48h; in the second, third, and fourth week, twice a week. Later
on, only once a week.
• Outcome: a total of 20 treatments were performed and patient was discharged with a remaining 3 × 10 mm
epithelial defect (Fig. C3.6). The new skin was flexible, covered with hair for the most part, and no restrictions
in the range of motion were noted.

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