Wound Healing Case Study Septic post surgical mastectomy wound healing with a large area of slough due to purulent under run of skin tissue which was non responsive to the initially selected antibiotic cover in a patient with a febrile state. Thomas J Farrington, MVB MRCVS VetMFHom Practicing Veterinary Surgeon “Allswell”, Barley Hill East, Rosscarbery, Co.Cork, Ireland.
PATIENT: Jasmine Rescue Cat Domestic Short Hair F <1y March 2007 History to Case Jasmine was rescued by the Animal Care Society(ACS) in Cork Ireland she had massively swollen mammary glands on the left hand side and was brought to a veterinary hospital where the mastitic mammary glands removed the wound stapled and antibiotic cover provided by a single long acting injection correct for patient bodyweight of Convenia, a third generation cephalosporin, which has an extended spectrum of activity against selected Gram negatives, Gram positives and anaerobes. It has a half life in cats of 6.9 days in cats claimed to be the equivalent of an infusion of antibiotics for 14 days. In addition the patient was given an injection of Rimadyl correct for patient bodyweight to provide analgesia and anti-inflammatory cover. The patient was returned to the ACS cattery with a clean surgical wound. All her kittens had died despite fostering. Three days later the wound turned purulent and began to develop a foul odour despite the antibiotic cover. The patient was then taken from the rescue centre to my practice in the condition shown in Fig 1. This option was taken as the patient was already on a long acting antibiotic and the carers were not keen to introduce a second antibiotic into the picture and was 5-6 days post surgery.
Jasmine – 25th April 2007 – Initial Presentation
Jasmine on initial examination was found to have a purulent discharge from the wound and an area extending down the inside of the left hind leg that looked like it was developing into a slough – the skin was already hard and appeared dead with purulent material under it. Jasmine was in retrospect dull on examination although friendly and active. Her temperature was found to be 103.5ºF despite it being normal on release from the original practice. Jasmine was started on a trial Anti-Infective homeopathic formulation from Homeopet at a dose as follows
PATIENT JASMINE ACS INV REF 15598 VET TF
DOSE 5 drops TWICE DAILY
ROUTE GIVE BY MOUTH WITHDRAWL PERIOD NIL
BATCH NUMBER 28-03-01 EXP MANUF 03-10 HOMEOPET
In addition to that the entire area surrounding the wound was coated liberally in a trial sample of HP Vet Cream (each stage of treatment, including temperatures was photographically recorded). Appetite was non existent.
Jasmine 26th April 2007 2nd day of treatment
The fever was down from 103.5 ºF to 102 ºF despite being in a warm clinic.
The discharge from the wound had eased and the odour was less offensive and Jasmine was a little brighter. Minimal appetite was present. The trial sample of HP Vet Cream and Anti-infective solution were continued on a twice daily basis.
Jasmine 28th April 2007 – 3 days after initial presentation
Fig 3 – 28th April the wound is starting to dry up and the slough has taken place
By the third day Jasmine’s temperature had returned to normal. Jasmine was much brighter and livelier. Jasmines appetite was still poor. The entire wound area had become cleaner, but healing had yet to take place between edges of the wound. Treatment with HP Vet Cream and Anti-infective solution were continued on a twice daily basis.
Jasmine 29th April 2007 – 4 days after initial presentation
Fig 4 29th April 2007 – 4 days into treatment
At this point the wound had started to heal in the area where the staples were and the mammary glands had been removed and the slough region had already begun to shrink in size. Temperature remained normal and Jasmine now moved as if no problem was present. Appetite was fully back normal. Treatment with HP Vet Cream was continued on a twice daily basis and HP Anti-infective solution was reduced to once a day for the following three days.
Jasmine 2nd May 2007 – 7 days after initial presentation
Fig 5 – 2nd May 2007 – Seven days after initial presentation only treatments HP Vet Cream & HP Anti-infective Solution
By day seven Jasmine had improved sufficiently to stop the HP Anti-infective solution. The stapled area was almost completely healed and the area of the slough had almost halved in width. In the photograph the spiked look of the hair is caused by the liberal application of HP Vet Cream to the entire exposed area. The cream was not removed other than by the patients grooming efforts and absorption into the skin. One point that has become clear with this patient is the non toxicity of both HP products, especially HP Vet Cream which the practice nurse Lesley used to liberally plaster over the entire wound both open areas and the skin adjacent to the wounds (all smooth areas in the photograph above). HP Vet Cream was applied only once daily from this point on.
Jasmine 9th May 2007 – 14 days after initial presentation
Figure 6 – 9th May 2007 Fourteen days into treatment – the entire stapled area was fully healed
By day fourteen the majority of the wound was fully healed the entire length of the stapled region was fully repaired and the slough area had reduced to one third of its original size. HP Vet Cream was only applied to the remaining open part of the slough area.
Jasmine 11th May 2007 – 16 days after initial presentation
Fig 7 – 11th May 2007 – Staple and suture removal done
Jasmine had all her staples and sutures removed on day sixteen and the area of the wound in that region was proved full healed. It had been felt that these could have been removed as early as day ten, but it was decided to wait to ensure total healing of the wound in that region had occurred. HP Vet cream was reapplied to the area of the staples following their removal for a couple of days in addition to the remaining open part of the slough.
Jasmine 16th May 2007 – 21 days after initial presentation
Figure 8 – 16th May 2007 – final photograph before discharge
Jasmine was discharged on the 16th of May twenty one days after first being admitted. All areas were virtually totally healed and Jasmine was re-homed outside Ireland in the United Kingdom from a contact found who had read her story on the ACS website. Albert Kleyn president of the ACS gets regular updates about Jasmine, who continues to do well.
Jasmine Points of Note with this case:-
The response of this patient to just the use of HP Anti-infective Solution and HP Vet Cream in a case which was non responsive to Convenia was to say the least dramatic and provides an opportunity for the treatment of non-responsive cases in the future. Not just did the treatments deal with infection, but they brought this case from a pretty hopeless state to complete cure in less than twenty one days. The healing of the slough area was particularly impressive with the wound healing visibly on an almost daily basis. The patient tolerated the application of HP Vet Cream to what appeared very sensitive areas with no problem and the administration of the anti-infective solution was equally easy. No problems with toxicity were seen despite the patient having been very ill with the mastitis, surgery and subsequent infection. Contact with Jasmines new owners continues right to date and she remains healthy. The Convenia did not interfere in anyway with the action of the HP products nor did they interact adversely with it.
Jasmine An Owners Perspective – Final Word
Jasmine in her new home in the United Kingdom with a couple of wonderful owners, who continually update Albert Kleyn in the ACS, says enough about the success of this case.