Page 282 - Cote clinical veterinary advisor dogs and cats 4th

Bite Wounds 120.e3

• Puncture wounds • Perform emergency celiotomy if any wounds PROGNOSIS & OUTCOME
○ Do not force lavage fluids into a puncture penetrate the abdominal cavity. • Good to excellent prognosis for minor wounds
VetBooks.ir ○ Simple puncture wounds require only the ○ Perform copious lavage of abdominal • Varies with severe injuries, mauling, BDLD Diseases and Disorders
○ Assess all intra-abdominal organs for
wound because it can push bacteria deeper
into tissues and cause cellulitis.
with appropriate wound management
damage, and treat as necessary.
cavity.
surrounding skin to be widely clipped
○ 15.4% mortality rate associated with
and scrubbed. Start broad-spectrum ○ Assess for abdominal wall muscle viability; ○ < 10% mortality rate overall
antibiotics. debride any devitalized or severely thoracic bite wounds
○ Do not suture puncture wounds; leave damaged (i.e., shredded) tissues. Close the
open to drain and heal by second inner muscle layers intraabdominally. PEARLS & CONSIDERATIONS
intention. ○ Obtain samples for aerobic and anaerobic
○ If subcutaneous pockets are present, incise culture and susceptibility before closing Comments
the pocket open, and then lavage. the abdomen • The extent of injury may not be immediately
• Open wounds (lacerations) (p. 1189) ○ Consider placing a closed-suction drain apparent.
○ Copiously lavage wounds, and debride (Jackson-Pratt drain) to monitor abdomi- ○ Ischemic damage can take up to 5 days
devitalized tissues and debris. nal effusion. to manifest.
○ Assess for closure; if clean and healthy, ○ After abdominal closure, address the • Wounds that appear small on the surface
consider primary closure with or without superficial aspects of any penetrating may have extensive deep tissue damage.
drain. wounds. This may involve wound flushing, • Avoid forcing flush into a simple puncture
• Cover wounds with an appropriate bandage. open wound management, additional wound; leave punctures open to drain.
• Start broad-spectrum antibiotics. closure, and SQ drain placement. • Cover all wounds/drains with appropriate
Severe wounds: • Wounds penetrating the thorax bandages.
• Assess for hemodynamic stability for ○ A lateral thoracic approach to evaluate • Double check rabies vaccination status of
animals with severe wounds, and stabilize if thoracic structures may be achieved by patient, and if possible, the other animal (p.
needed (pp. 911 and 1169). large wounds/rents. 861).
○ Place intravenous (IV) catheter, and ○ Simple punctures may not require thora-
administer fluid support (crystalloids, cotomy; however, the patient must be Prevention
colloids, blood products). monitored for development of pneumo- Avoid situations where animal fights/attacks
• Administer pain medication: hydromorphone thorax, hemothorax, or pyothorax. might occur.
0.1 mg/kg IV q 4-6h, buprenorphine • Wounds penetrating joints should be
(cats) 0.01-0.02 mg/kg IV or buccally q explored, and the joint should be lavaged Technician Tips
8h, + nonsteroidal antiinflammatory drug with sterile saline by open arthrotomy, • Always wear gloves when handling animals
(NSAID) if no gastrointestinal, hepatic, or arthroscopy, or closed (using ingress and with wounds.
renal involvement egress needles). • Clip widely (at least 4-5 cm) around all
• Start broad-spectrum antibiotics (e.g. wounds.
ampicillin sulbactam 22 mg/kg IV q 8h) Chronic Treatment • Be familiar with bandage management and
• Once stable, assess and treat the wounds • Monitor closely for infection. care.
under general anesthesia using sterile tech- • Monitor closely for evidence of tissue necrosis
nique (p. 1169). (up to 5 days after injury). SUGGESTED READING
○ Perform a generously wide clip and aseptic • Open wound management Holt DE, et al: Bite wounds in dogs and cats. Vet
scrub of skin surrounding wound(s). ○ Serial debridement of devitalized tissues Clin North Am Small Anim Pract 30:669-679,
○ Using sterile mosquito or Kelly hemostats, ○ Bandage changes 2000.
gently probe the wounds for extent of ○ Closure when wound is clean and tissues
subcutaneous pocketing and depth of are healthy ADDITIONAL SUGGESTED
wound penetration. • Antibiotic therapy based on culture results READINGS
○ Debride wound if needed and copiously • Pain management Cabon Q, et al: Thoracic bite trauma in dogs and
lavage (if no body cavity penetration). • Severely injured patients require intensive cats: a retrospective study of 65 cases. Vet Comp
○ Obtain samples for aerobic and anaerobic monitoring: vitals, blood pressure, protein Orthop Traumatol 28:448-454, 2015.
culture and susceptibility after the wound and albumin levels, fluid/colloid/blood Frauenthal VM, et al: Retrospective evaluation of
is cleaned. product therapy, serial CBC, chemistry, coyote attacks in dogs: 154 cases (1997-2012). J
○ Assess for ability to close large wounds. electrolytes, +/− blood gases to monitor for Vet Emerg Crit Care 27:333-341, 2017.
Primary closure is warranted only if sepsis and toxic shock Jordan CJ, et al: Airway injury associated with cervical
■
wounds can be adequately flushed and • Repeat FeLV/FIV testing 6-8 weeks after bite wounds in dogs and cats: 56 cases. Vet Comp
Orthop Traumatol 26:89-93, 2013.
debrided. Place a drain to close dead incident. MacPhail CM, et al: Surgery of the integumentary
space, and monitor effusion. system. In Fossum TW, editor: Small animal
Treat contaminated wounds or wounds Nutrition/Diet
■ surgery, ed 4, St. Louis, 2013, Mosby, pp
with questionable viability using open • Feed a normal diet (p. 1199). 190-288.
wound management until tissues are • Anorexic patients may benefit from feeding Mouro S, et al: Clinical and bacteriological assessment
healthy. tube placement (pp. 1106 and 1107). of dog-to-dog bite wounds. Vet Microbiol 144:127-
○ Severe or multiple puncture sites 132, 2010.
should be enlarged to allow adequate Possible Complications Risselada M, et al: Penetrating injuries in dogs and
lavage. • Infection cats: a study of 16 cases. Vet Comp Orthop
○ Place an appropriate bandage over the • Loss of tissues Traumatol 21:434-439, 2008.
wounds. Tie-over bandages may be neces- • Sepsis AUTHOR & EDITOR: Elizabeth A. Swanson, DVM, MS,
sary in some locations. Always cover drains • Shock/death from massive tissue necrosis or DACVS
with a bandage. sepsis

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