Plus-Hex CLINICAL
Maddie was able to fully weight bear on her right foreleg, although her general mobility was unstable. The differential diagnosis was a possible pressure sore with secondary infection, a foreign body or infection / neoplasia with bony involvement.
Full haematology and biochemistry analyses were completed and found higher than normal levels of alanine aminotransferase( ALT) and alkaline phospatase( ALP) activity and a lower albumin: globulin ratio( Table 3), with all other parameters being within their normal ranges.
Maddie had previously been prescribed paracetamol, which might have contributed to changes in her liver function. The raised ALP could have been secondary to osteoarthritis or neoplasia.
The owners consented to Maddie undergoing a general anaesthetic to take biopsies and swabs of the wound, and to take radiographs of the elbow to rule out neoplasia.
The radiographs showed general degenerative joint disease of the elbow but no visible bony association with the wound( Figures 2 and 3).
Swab and biopsies
To assess the reliability and accuracy of culture specimens in human medicine, a comparative analysis of two sampling methods, swabs and tissue biopsies, is recommended [ 4 ]. Although some studies have demonstrated equivalent efficacy in bacterial recovery between swabs and tissue biopsies for woundassociated pathogens, contrasting evidence from other studies suggests swabs yield lower bacterial recovery rates than tissue samples. Within veterinary medicine, however, there remains insufficient clinical evidence to definitively advocate one method over the other [ 4 ].
Microbiological evaluation can be important in the management of infected wounds. Information on the species of microorganisms present in the wound is helpful in establishing antibiotic choice and forecasting response to treatment. However, these results are substantive only if interpreted in the context of a wound that is infected, as non-pathogenic, colonising bacteria will also be identified [ 5 ].
The area should be swabbed only if there are clinical signs of infection and the wound is worsening, increasing in size or failing to heal.
Table 3. Maddie ' s biochemistry results that were outside the normal ranges.
Medication Unit Result
Reference range
Comments
Albumin: globulin ratio – 0.68 0.70 – 1.40 Low Alanine aminotransferase( ALT) U / l 184.6 19.8 – 124.0 High Alkaline phosphatase( ALP) U / l 419.0 < 130 High
Figure 2. A healthy elbow with no degenerative changes. Figure 3. The changes taking place in the patient ' s olecranon.
Volume 40( 4) • August 2025
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