General Introduction and Comments
Fistulated Tissue: fistulation normally means a hole or tunnel in the body, but I am using the term to indicate the fibrous, reactive, spongy tissue changes under the skin that sometimes forms in reaction to infected wounds. This reactive tissue is full of tunnel like channels and holes (like a sponge) that trap pus. It greatly hinders wound healing and the ability of antibiotics to get to the infection.
Crepitus refers to gas or bubble sounds under the skin...not a good sign.
Gangrene is the general term I use to describe a wound that has become septic not just with pus but also gas (from gas forming organisms) and necrotic (dead and/or rotten) tissue.
Lethargic: tired, listless, mopey, weak, low energy, sluggish etc
Cuts, Wounds, Punctures, Lacerations, and Abscesses:
Bite wounds, lacerations, and other punctures that then become infected (abscesses) are one of the most common problems we see in veterinary medicine.
We treat several a day at our clinic.
They are especially common and potentially deadly in cats.
Many people don't realize that their pet has an abscess because the swelling is often hidden under the fur, but they're bring their pet into the vet because it lame, not eating, or lethargic. Or has some of my clients would say, "just ain't right"
Of course, many wounds are obvious, afterall, there's blood and goo all over the place.
At Our Hospital: What to expect if your pet has an infected wound:
(Of course, other vets may do things differently)
A good Examination: In addition to our normal whole body exam, once we know we have or suspect an infected wound, we pay special attention to fever (often very high), enlarged lymph nodes, pupil clarity, foreign bodies left in the wound, the presence of maggots, the texture of the wound for hints of fistulation or reactive tissue. We check for crepitus and gangrene and the extent of tissue damage or necrosis.
We are very concerned, of course, with the general condition of the patient.
Is it a strong healthy pet with a wound that needs attention?
Or is it a dibilitated, sick, dehydrated patient that needs attention in addition to the wound?
Based on what we find on exam, we decide whether the wound or abscess is minor and likely to heal with just cleaning and antibiotics or is more serious and would be better treated with surgical draining, flushing, debridement, and repair in addition to antibiotics.
Here's What We're Likely to Do for minor wounds unlikely to need surgery but bad enough that they probably won't heal with simple home treatment:
Inspect and clean: It's difficult to accurately guage how bad a wound is until the hair is clipped off and all the surface crud removed.
Keeping the wound clean until it heals is paramount: your vet will send you home with a good antiseptic wound cleaner. If at all possible, a wound should be gently massaged, flushed, and cleaned at least twice daily as long as there is visible discharge. At our hospital, we like a mixture of Nolvasan, dexamethasone, & gentocin.
Antibiotics given by injection and/or by mouth are needed and appropriate in most cases. Your vet will choose which antibiotic is best for your pet's wound based on several factors. A culture and sensitivity test may be recommended to help choose the best antibiotic for the job, especially if the wound is unusual in appearance or odor ... or if previous treatment failed. Click here to go to our interesting and brief page about the discovery of antibiotics
Steroids & Antihistamines: either or both are appropriate for some wound cases and can help make your pet more comfortable, reduce inflammation, swelling, and itching of the wound site. But steroid use needs to be carefully considered on a case by case basis; something you need to trust to the experience and skill of your veterinarian.
Wound Healing Aids, Bandages, E Collars, Repellents: Your vet will recommend whatever may be appropriate to keep your pet from over licking, chewing, or making the wound worse. And some vets love to dispense herbal or enzyme wound healing gels or compounds. Such compounds are designed to either soothe the wound, make it heal better (preventing scarring or granulation) and/or to speed the healing process. None of these things are probably needed for most pets with simple or minor wounds but can be quite helpful in many situations. And many pets are hyper or nuts or otherwise difficult, so more aggressive treatment may be indicated.
Tranquillizers for a few days to allow wound care are sometimes a good idea.
Follow through: Be prepared to return for more aggressive treatment, possible surgery, or other change in treatment plan if the problem is not improving. No vet likes to hear later that a client is bad mouthing said vet because some minor problem didn't heal on initial treatment. Of course 100% of medical problems don't resolve perfectly with simple, cheap care. Keeping things cheap and simple is appropriate for many common health problems, but when it doesn't work, you're supposed to COME BACK.
Here's what to expect if your pet has a wound bad enough to need surgical treatment:
Cats and dogs have very elastic skin with a fair amount of fatty tissue between the skin and the underlying muscle. This tissue is known as the subcutaneous tissue (SubQ). This important tissue, unfortunately, is fairly reactive (easily inflamed) and a warm, nutrient rich place for bacteria to thrive.
In cats, the problem of bacterial growth is especially bad because cat skin often heals too quickly over a puncture...trapping the bacteria under the skin so that instead of draining out of the body...it reeks local destruction, tunneling thruough the tissue (fistulous tracts), forming endotoxins formation which are absorbed into the blood stream, and producing impressive amounts of pus.
Once this occurs, it's unlikely that antibiotics alone will cure the problem...you first have to open the area to drainage and clean out all the necrotic (damaged and rotten) tissue. Except in very tiny wounds, this needs to be done using either local or general anesthesia.
So, Here's our Protocol in such cases:
Whether or not all the steps are perfomed will depend on the severity of the case, the underlying health of the pet, and the budget.
Examination: same as above except we will also be concerned with detecting any problems (dehydration, anemia, respiratory distress etc) that will affect anesthesia safety.
Start antibiotics: Injectable antibiotics get on board quickly
Lab work: PreAnesthetic blood work is usually appropriate prior to any anesthetic procedure to make sure we know the status of the kidneys, liver, glucose levels etc
I.V. Fluids: in addition to safety issues (having an immediate route for emergency medications should anything go wrong during anesthesia), IV fluids make a big difference in helping tissues heal.
Anesthesia: to allow painless wound prep and surgery.
Surgery: What we're trying to accomplish with surgery is simple: we need to remove as much pus and necrotic tissue while at the same time being very careful not to damage important nerves, sphincters, major vessels, and so forth. Depending on the type and severity of the injury, your vet may implant surgical drains
Post Op Stuff: every case will require different amounts of post op care, but likely considerations are:
Post op wound care & drain management
hospitalization for awhile
post op medications to maybe include antibiotics, antiseptics, wound treatment gels, antihistamines, fly repellents
restraints such a E collars, crates, and tranquillizers as appropriate
Patient and Wound monitoring: Be watchful for no appetite, poor energy level, and obvious poor wound healing. Be prepared to return to the clinic. Sometimes it takes several tries to get successful wound healing. There are lots of reasons why a wound might be difficult to cure. Don't be too quick to blame the vet.
Return for suture or staple removal if needed in 10-14 days.
Family Safety Note: It's not likely that the bacteria in most dog and cat wounds/abscesses will be a danger to you, but do wash well after cleaning out and treating infections. And note that the bacteria in some other species, including rabbits and reptiles...can be dangerous.
c Roger Ross DVM