Page 108 - Veterinary Laser Therapy in Small Animal Practice

94 Veterinary Laser Therapy in Small Animal Practice

Case no. 10

M., canine, 7 years old, Doberman, FS, 27 kg
• Complaint: swollen limb and soft tissue inflammation.
• History: 2 years prior, she underwent tibial tuberosity advancement (TTA) for left cranial cruciate ligament
rupture. She was also diagnosed with chronic left hip luxation. A year later, she developed surgical site
infection (SSI) signs and the plate had to be removed. She had been OK until a week before, when she
developed left non-weight-bearing lameness, absolute anorexia, hindlimb edema, tumefaction, and later
discharge, starting at the medial stifle. Complete blood count showed leukocytosis with neutrophilia,
lymphocytosis, and monocytosis. Her regular vet had her hospitalized for 5 days with intensive medical
care, including IV fluids, heparin, meloxicam, furosemide, buprenorphin, marbofloxacin, metronidazole, and
cephazolin. Once a slight improvement was noted, she referred her for LT with a differential diagnosis of
necrotizing fasciitis/SSI. Once culture of the exudate retrieved Streptococcus agalactiae, with some resistances
(aminoglycosides and quinolones), cephalexin was continued as antimicrobial therapy.
• Physical examination: 3/5 left hindlimb lameness. Soft tissue inflammation and tumefaction over left femoral
and lower gluteal (Fig. C10.1a, b), caudal abdominal, and inguinal areas (Fig. C10.1c, d), extending down to
the medial stifle, where a 1 × 2 mm open draining tract was present. Limb edema with a diameter of 37 cm at
stifle and 24 cm at tarsus. Overall pain score 6/10.
• Diagnosis: severe and extensive cellulitis due to chronic Streptococcus SSI.
• Treatment:
• Wound management: the owner was instructed to keep the skin around the draining tract clean and dry,
using 0.05% chlorhexidine and sterile gauzes.
• Laser therapy:
• An initial low dose over a large area was used: 2–3 J/cm over 600–700 cm , with a total of 1800 J.
2
2
Because the patient was so sensitive at this point, 0.25 W/cm power density was used, which was
2
later increased to 0.5 W/cm . After the first session, limb diameters decreased to 32 cm (stifle)
2
and 21 cm (tarsus). Inguinal cellulitis showed a slight improvement but was still very evident (Fig.
C10.2).
• After the second treatment, the soft tissue deformity at the gluteal area had disappeared, and
tarsal diameter was 17 cm (Fig. C10.3a). The inguinal inflammation was also decreased
(Fig. C10.3b).
• Treatments were performed on days 0, 1, 3, 5, 7, 10, 14, 18, 23, and 28.
• Others:
• Oral cephalexin.
• Coptis chinensis powder was applied over the inguinal and medial femoral area; this has anti-
inflammatory and antimicrobial properties (berberine alkaloids) and explains the yellow color in the
pictures (Fig C10.4 and C10.5).
• Outcome:
• Full resolution of limb edema and soft tissue inflammation, and wound closure (Fig. C10.5).
• Lameness decreased to 2/5, pain to 2/10 localized at hip joint (chronic luxation). Surgery was considered
but postponed due to the risk of infection.
• Necrotizing fasciitis is a very severe and often fatal disease, which in the canine species is usually caused
by Staphylococcus pseudintermedius, and occasionally from Streptococcus canis and E. coli. Although initially
suspected, necrotizing fasciitis could not be confirmed, since no biopsy was taken, and no necrosis or tissue
loss were evident.

REDONDO PRINT (4-COL BLEED).indd 94 08/08/2019 09:47