Page 154 - Veterinary Laser Therapy in Small Animal Practice

140 Veterinary Laser Therapy in Small Animal Practice

Case no. 17

T., canine, 4 years old, Portuguese Hound, FS, 20 kg
• Complaint: swelling of surgical sites.
• History:
• T. had been hit by a bus a month before. As a consequence, she had an abdominal traumatic hernia
(bladder and intestine), left hip fracture, and right sacroiliac luxation (Fig. C17.1a, b).
• 48 h later she underwent hernia repair with a polypropylene mesh and fracture fixation with a dynamic
compression plate and six screws (Fig. C17.2).
• A week after surgery she was readmitted due to a large fluid collection and exudate from the hip wound,
hindlimb edema, and pain.
• She was put on ciprofloxacin, metronidazole, and cephalexin, but 2 weeks later she developed an infection
and dehiscence in the abdominal wound and the hip area was inflamed.
• She had lost 10 kg (about 30% of body weight) in a month. Blood culture was negative.
• Physical examination:
• There was a 12 cm long dehiscence in the abdominal wound, which was inflamed. The subcutaneous
tissue around it was severely inflamed (Fig. C17.3a).
• The left gluteal area was moderately inflamed, although there was no open wound or discharge (Fig.
C17.3b).
• Diagnosis: surgical site inflammation, chronic wound with dehiscence.
• Treatment:
• Wound management: regular antiseptic lavage.
• Laser therapy:
• Treatment of the abdominal wound included a 5 cm margin around it, with a total area of 175–200
2
cm . Dose was 4 J/cm for the first two treatments, and then increased to 10 J/cm . There was a fast
2
2
clinical improvement (Figs C17.4a, C17.5a, C17.6a, C17.7a, C17.8a) and a week later the inflammation
was so decreased (Fig. C17.5a) that stretch marks were evident.
2
• The gluteal/hip area covered 200 cm and was treated with higher power (5 W) and power density (1
W/cm ). Note how the area shows a concavity after five treatments (Fig.17.6b), even though it does
2
not seem very inflamed in the initial pictures. Since the treatment was focused around the incision
line, the hair grew faster here (Figs C17.6b, C17.7b, C17.8b).
• Others: carprofen, tramadol, ciprofloxacin, metronidazole, and cephalexin were used for a week into the
laser treatment, and then discontinued.
• Outcome: complete resolution of the inflammation. The patient was able to jump on the bed (not advised) a
week after starting LT. No recurrence of inflammation or wound discharge.

Figure C17.1 X-rays of the hip fracture. (a) Ventrodorsal and (b) lateral views. Figure C17.2 Hip after surgery, lateral view.

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