Sam is a 13 year old neutered male Jack Russell terrier who presented to REACH for injuries sustained from being hit by a car. Upon arrival Sam was in shock and a great deal of pain. His injuries were severe and quite extensive. His abdomen exhibited a large de-gloving wound to the lateral left abdomen. The wound essentially had the skin torn and peeled back from the abdominal wall, exposing the muscles and fascia beneath giving it the “degloving” appearance. In addition, Sam had what appeared to be a broken right rear leg. Immediate stabilization would be required before an appropriate treatment plan could be formulated.
Priority was to stabilize Sam upon initial presentation. Therefore, he first received an intravenous (IV) access catheter. Once the IV catheter was placed, he received an IV injection of an analgesic, or pain killer. Controlling pain promptly is very important in trauma cases; not only is it an act of compassion but it also helps with the healing process. Therefore, we wanted to get Sam’s pain under control as quickly as possible; this was a crucial step towards getting him stable. We also began administering IV fluids at a high rate of infusion; this would help maintain circulation while his body was in shock. Immobilization of the apparent fracture, as well as the de-gloved laceration, were also assessed and managed initially to prevent any further damage or contamination. Prior to repair, the wounds and fractures had to be temporarily protected. A loose fitting bandage was placed over the abdominal wound to prevent further contamination as well as protect the remaining viable tissue. The fractured leg was placed in a Robert Jones bandage, a firm bandage that is made in order to immobilize an apparent fracture. The fractures although apparent in view, still needed radiographs (or x-rays) in order to properly set and repair them. In addition, blood work would help to rule out any internal injuries to Sam’s organs as well as blood loss or abnormalities. These diagnostic tests were performed STAT (or immediate priority) and in house so a treatment plan could be prepared.
Radiographs revealed an oblique fracture to Sam’s right tibia and fibula; other radiographs showed extensive soft tissue trauma to the abdominal/inguinal area with the thorax and pelvis showing no abnormalities. Sam’s blood work was normal for the most part except for one liver value that was elevated. This may have been a result of the trauma; so IV fluid therapy would be an integral part of his treatment and would help maintain circulation, hydration, and flush out his body’s systems. In addition to IV fluids Sam would also be put on antibiotics and anti-inflammatory medications to control infection and inflammation. Once this portion of the treatment brought Sam to a more stable condition, surgical repair of the de-gloved laceration could commence.
Surgery to repair the major laceration would require Sam to be put under general anesthesia. While under anesthesia he was still maintained with a continuous rate infusion of IV fluids, maintaining his circulation. He was also placed on heat support to maintain body temperature (anesthesia can drop blood pressure and body temperature so the appropriate measures are taken with every anesthetic case to prevent this). Once Sam was in a safe anesthetic plane he was prepped for the doctor to perform the repair. Prepping the wound involved clipping the hair and cleaning the tissues with a bactericidal solution and sterile saline.
When the preparation was completed the doctor commenced surgical repair of the wound. This involved suturing tears in the deep muscles of the medial left thigh together. Drains were placed to allow adequate drainage of unwanted material that could cause an anaerobic infection. The large flap of the de-gloved tissue remained viable, so it was debrided and reconnected to the base tissue; the skin was closed with sterile staples. Following the laceration repair a more permanent splint was placed on the fractured tibia/fibula. Sam’s anesthetic recovery went well and he was maintained with supportive care until he transferred to his regular veterinarian the next morning.
After discharging from REACH Sam had to have some further procedures done to repair his fractured leg. After a few days his drains were removed along with his staples. Sam has endured some extended healing time to mend his wounds and broken bones but for the most part has been doing well since his horrible ordeal with the car.