Page 166 - Veterinary Laser Therapy in Small Animal Practice

152 Veterinary Laser Therapy in Small Animal Practice

Case no. 24

O., canine, 5 years old, Spanish Mastiff, MC, 75 kg
• Complaint: limb dragging and open wound.
• History: O. was hit by a car 6 months ago. He had a hip (left acetabulum) fracture and suspected sciatic
damage but did not receive surgery. He has been dragging the leg since then. A month ago he received an
orthosis, but it seems too small for him. The owners manage the wound with chlorhexidine and antibiotic
ointment, but it has not improved. The referring veterinarian took a culture.
• Physical examination: open wound affecting the lateral half of the left foot, with exposure of the bones of
the fifth digit (Fig. C24.1a, b). The left popliteal node is enlarged. No superficial or deep pain perception in the
foot and up to the knee. Sciatic and patellar reflexes are present but not the flexor reflex.
• Diagnosis: chronic infected wound affecting soft tissue and bone. Neurological damage of the distal sciatic
nerve.
• Treatment:
• Wound management: lavaged with 0.05% chlorhexidine. Alginate dressing as a primary layer.
• Laser therapy:
• 5 J/cm covering all the area up to the tarsus, and then increasing up to 10 J/cm .
2
2
• The wound was initially very exudative, so treatments were performed 5 days a week in the first week
(Figs C24.2 and C24.3); frequency of treatment then gradually decreased to just twice a week in the
last week.
• Others:
• The initial antibiotic treatment was cephalexin and metronidazole. The culture results showed
infection with Proteus mirabilis that was resistant to beta-lactamics, clindamycin, and doxycycline, and
sensitive to quinolones, so treatment was changed to enrofloxacin for 2 weeks.
• Support with a custom-made fiberglass splint.
• Outcome:
• Closure of the wound in 40 days (Figs C24.4 to C24.7).
• Recovery of pain perception from the stifle down to the tarsus and improvement of foot posture
correction when he was re-evaluated in week 8; this was related to recovery of function in the sciatic
nerve (but not the fibular or tibial nerves).

Figure C24.1 (a, b) Open wound
before LT. Figure C24.2 Day 1.

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