The Tale of Sir Theodore FancyPants
Heather Towle Millard, DVM, MS, DACVS-SA
The Tale of Sir Theodore FancyPants began on a chilly night, October 26, 2022. Hobbling alone and afraid, he was found at a busy intersection in Wichita. He was scooped up by a Good Samaritan and brought to the Emergency Department at Veterinary Emergency and Specialty Hospital of Wichita.
At presentation, he was puny 2.6 kg with a fulminant odor. He was flea-infested, covered with matted fur and plant stickers with copious dried diarrhea. An infected, large degloving wound was present on his left hindlimb from the hock to the distal metatarsal region. The entire distal calcanean tendon was exposed but intact. No medial to lateral collateral instability was palpated. The wound was clipped and cleaned. He was given pain medications, antibiotics, and dewormed. Basic wound management was initiated.
Granulation tissue and some contraction of the wound occurred over the following weeks, but the progression of the wound was halting. A surgical consultation was obtained.
December 23, 2022
At this time, all of the dorsal and lateral metatarsal degloving injury had epithelized. A small circular medial metatarsal wound and a large hock defect remained with a beautiful bed of red granulation tissue (Photo 1). A non-rewarding wound culture was obtained. For the next several weeks, topical coverings varied from Restore by Noxsano, Calcium Alginate, and Medi-Honey with splinted bandages, but the epithelium would not budge.
After three weeks, the hock wound had contracted/epithelialized a minimal amount. The metatarsal wounds were all healed. A full-thickness unmeshed skin graft was performed on January 10, 2023. A full-thickness unmeshed skin graft has been cited to be more ideal for distal limbs and over joint surfaces, compared to a full-thickness meshed graft (Johnston and Tobias). A small opening was left open on the medial distal surface to allow for drainage.
Sterile bandage changes were performed according to graft protocol using topical Gentamycin followed by Adaptic and splinted bandage changes. Just when the Tale of Sir Theodore FancyPants was looking brighter, the doom set in with an infection. Despite rigorous care, the battle was being lost, and partial graft failure occurred. With a remaining limited budget and a fight to save the leg, Dr. Millard contacted friends at a regional children’s hospital for assistance using human wound products. Dakin’s solution was recommended for the local infection, and we were given donated silver foam dressings. The Dakin’s solution promptly cleared up the infection, and the thick silver foam dressings helped speed up the final healing. With their help, Sir Theordore FancyPants wounds healed!
Dakin’s solution is effective against MRSA, and it can also be made at-home easily. Interestingly, this solution was invented during WWI and although it can be purchased commercially, you can also make it at home.