Development of a new wound
Although the original wound had healed, by 20 July a small, moist area had developed just below the original wound. The decision was made to leave the leg undressed and use only the leg coverings the owner had made at home. Unfortunately, 9 days later, the moist area had developed a small wound( Figure 11).
Conclusions
This case highlights the complexities inherent in managing wounds complicated by multidrug-resistant bacterial infections and challenging anatomical locations. The pivotal role of the VN in coordinating care, implementing treatment protocols and supporting owner engagement is evident. Successful outcomes in such cases rely not only on clinical expertise but also on effective communication and collaboration with owners, whose active participation in wound management is essential.
Although the ultimate outcome of this case was not as those involved in the patient ' s treatment had hoped, it underscores the importance of a multidisciplinary approach and demonstrates that, with dedicated nursing care and owner compliance, even challenging wounds can be managed successfully.
Figure 11. A new wound, which also developed a pocket.
On 9 August, surgical closure of Maddie ' s new wound was offered, with the owners informed of the high risk of dehiscence. The procedure was performed under local anaesthesia due to Maddie ' s age. However, wound breakdown occurred within 3 days, followed by complete dehiscence, although granulation resumed 6 days later.
The owners, having been closely involved throughout, felt able to continue dressing Maddie ' s leg at home, with professional checks every 5 days. However, despite their dedication, dressing slippage occurred, and a subsequent recheck on 4 September revealed wound malodour and bone exposure, necessitating renewed intervention.
EXCLUSIVE
DIGITAL CONTENT
AVAILABLE ONLY IN THE DIGITAL EDITION
Appendix 1 – Timeline of the case
Further complications and quality-of-life decision
Shortly afterwards, Maddie developed gastrointestinal signs, but blood tests were unremarkable. Symptomatic treatment was provided with maropitant( Prevomax, Dechra). Over the ensuing 2 weeks, Maddie ' s demeanour declined: she became lethargic, required encouragement to mobilise and experienced possible seizures. Another new wound developed on the contralateral elbow, which was considered likely to progress to a decubitus ulcer.
Given Maddie ' s deteriorating condition, the development of additional wounds and the anticipated need for ongoing intensive care, on 9 October the decision was made to euthanase her. She had tolerated frequent dressing changes over several months, but the owners, in consultation with the VS, determined that further treatment was no longer in her best interests.
REFERENCES
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2 Braden B, Bergstrom N. Braden Scale – For Predicting Pressure Sore Risk. 1988. Available from: https:// www. in. gov / health / files / Braden _ Scale. pdf [ Accessed 28 October 2024 ].
3 Davis J. Decubitus ulcer: risk factors, prevention and treatment. The Veterinary Nurse. 2011; 2( 3): 130 – 139. Available from: https:// www. theveterinarynurse. com / content / clinical / decubitus-ulcer-riskfactors-prevention-and-treatment / [ Accessed 28 October 2024 ].
4 Stokes RA, Coleman MC, Rogovskyy AS, Dickerson VM, Thielman Mankin KM. Comparison of bacteriologic culture results for skin wound swabs and skin wound biopsy specimens. Journal of the American Veterinary Medical Association. 2021; 259( 12): 1416 – 1421. Available from: https:// doi. org / 10.2460 / javma. 20.10.0568.
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