Clyde**

Clyde is a 5 year old neutered male schipperke dog who was mauled by a couple of larger dogs who wandered into his yard. Although Clyde had normally been safe within the confines of his own yard, the other two dogs unfortunately invited themselves to cause trouble. That trouble almost cost Clyde his life. Fortunately his owners rushed him to R.E.A.C.H. in time to have him patched back together before any further complications could arise.
 
Clyde suffered severe wounds from the vicious attack. He had puncture wounds and lacerations to his right rear leg, but the largest wound was an extremely large laceration that included a significant skin flap stretching across the dorsal side of his neck. To repair the wounds he would endure a lengthy and complex surgery. However, the initial pain would have to be managed. In addition he required preliminary diagnostics and stabilization treatment prior to anesthesia; this helped to ensure he was a safe candidate for surgery.
 
Patient Stories: R.E.A.C.H. At first therapy consisted of providing Clyde with medication to eliminate pain he may have been experiencing. Therefore he was given a Morphine injection subcutaneously. Subsequently an intravenous (IV) catheter was placed for access of medications and fluids. In addition blood work was performed to ensure there were no organs compromised from trauma or other metabolic reasons; this is what helped ensure Clyde’s safety for anesthesia when his wound repair was to be performed. Fortunately all of his blood values returned within the normal limits. Yet, he was still in the initial stages of his ordeal; further complications could develop if no preventative measures were taken. Such a complication would be infection setting in. With a severe wound as this one, preventing infection immediately was crucial. Not only could it have spread very quickly but it could also result in tissue necrosis, something Clyde couldn’t afford to have. Therefore he was immediately given IV antibiotics prior to surgery. After roughly 1 hour of preliminary IV fluids and medications Clyde was taken to surgery.
 
Clyde’s surgery commenced with an anesthetic induction that brought him into a safe anesthetic plane; this would be maintained throughout the duration of the procedure. Next the wounds were prepared by clipping the hair away from the site and then aseptically lavaged with a bactericidal solution and scrub. They were then cleared of any debris within the fascia and muscles since foreign material can be a wick for infection. Following wound preparation the laceration repairs were performed.
 
The larger laceration repair consisted of a few individual procedures being carried out within the entire surgery; these separate procedures were done to set up for the next maneuver, hence resulting in a healthy healing process for the tissues. These measures included additional debridement of compromised margins of the skin flap, suturing the lacerated skin flaps together, and placement of drains. Among these drains were Jackson-Pratt drains, specialized drains that use negative pressure to draw out unwanted fluid from the wound site and collecting it in bulbs to be quantified. Any unwanted fluid, if left in the wound, could cause anaerobic infection; therefore keeping these drains maintained with adequate negative pressure was important for proper healing. In addition to the Jackson-Pratt drains, Penrose drains were placed across the dorsal neck and exiting out of Clyde’s lateral neck surface. These drains were sutured in along with the lacerations. Additional suturing was performed on the right rear leg and the right shoulder to repair the smaller lacerations received in the attack. After all surgical repairs were performed Clyde was recovered from anesthesia. Upon recovery his temperature was low which can be common in anesthesia cases; due to this hypothermia he was placed on heat support until a normal temperature was reached.
 
After Clyde had recovered from anesthesia he continued the IV fluids with antibiotics and pain medication being administered appropriately when needed. For the remainder of the time he was here Clyde began to sit up in his recovery cage and was quite attentive to his surroundings; he may have been a bit groggy from the medications but overall he had one of the best attitudes in the hospital despite his ordeal with the larger dogs. After he was discharged from R.E.A.C.H. it was reported a few days later that Clyde was feeling better and seemed quite comfortable. He was eating and drinking on a regular basis but still moved around a bit slowly. The overall wound fluid quantitated in the drain reservoir was around 30 milliliters; that’s quite a large amount of fluid that could have posed a problem. Fortunately Clyde received treatment just in time, and he is expected to make a full recovery.