Elle's Chest Wound Healing

Here are the photos of Elle's chest as it's been attended to here.  They are accurate but graphic photos of the wound progression so proceed only if you're comfortable with these sorts of photos.

Elle's been extremely well behaved for all the cleaning, lasering, bandaging, and temperature taking!  She stands quietly while tied in the stall and occasionally nibbles on the hanging ball of hay for entertainment while I work.  Taking cookies gently at the end of each treatment is her favorite part.

These photos are going in chronological order so we can see the progression of the wound. This first photo is from 11 Aug 2021 when she first arrived.  The bald patches are where the tissue isn't getting good blood supply because of damage from the original wound, so the hair has fallen out in that area.  Because of this we knew that the suture line would break down there.

This next photo is from 13 Aug 2021, and you can see that the edges of the wound are healing, but not together.  That means the body is not going to close the wound up where it was originally opened, and it will have to heal from the inside out by building good granulation tissue inside the cavity. 

In order to encourage the cavity to grow good granulation tissue, I began packing the wound with Calcium Alginate padding.  This pad encourages the granulation tissue to grow.  I also want the cavity to remain uninfected by bacteria, so I've been soaking the pad in honey, which is an excellent natural antibacterial.  So the wound is remaining open, and I'm stuffing it with honey soaked CaAlg to get it to fill in with healthy tissue.  The red tape going around Elle's chest/shoulder is to hold the padding in place.  The tape never touches the open wound, it just gently holds the bandage over the wound.

 

This photo with the red tape is from 14 Aug 2021, and if you look closely you can see the honey soaked padding inside the cavity.  Unfortunately with these types of wounds, they often look worse before they look better.  This is because the outer tissue dies and sloughs off, while the inner tissue grows and fills in. 

 

This next photo is from today, 15 Aug 2021.  The wound is looking much better, with a big difference from yesterday to today.  The edges have healthy pink tissue coming in, and the cavity itself is continuing to heal from the inside out and produce the healthy granulation tissue we want.  The wound is also starting to constrict, getting smaller as the body is repairing the damage.  I did gently palpate inside the cavity and it is appreciably more shallow and smaller in diameter today than yesterday.

I've continued to use the laser on it twice daily, the first five minute treatment is on setting 2 to stimulate the tissue to grow, and then five minutes with setting 3 for pain relief for Elle.  I can definitely tell that the two settings must feel different to her, as she is a little fidgety with the setting 2 treatment though she tolerates it well.  When I switch to setting 3 she closes her eyes and lowers her head.

This last photo is of the new bandage placed today, 15 Aug 2021.  I have packed the cavity with honey-soaked CaAlg padding, then applied a hydrophilic foam pad.  The blue tape is going over the padding so it never touches the wound itself, and gently secures the bandage in place.  I do put a shoulder guard over the whole thing to keep it clean and in place.
 

Here is a photo of the treatment sheet from this week as I've filled it in with notes, observations, and documenting everything I've done to care for Elle over the past week.  It's really important to have these records just in case something goes sideways in the process of healing a wound like this.  That way I have notes to refer back to and the attending veterinarian (Dr. Landes in this case) can review everything that has occurred in the process.

This next photo is from 16 Aug 2021, and you can see the suture line breaking down as expected.  As sutures came out I removed them, and ones that were tearing through the skin I also removed.

On 17 Aug 2021  the last of the sutures were removed, so now I'm caring for it as a regular open wound since our biologic bandage of sorts has broken down.  It's still getting lasered twice daily, coated in honey, with some swat insect repellent ointment applied around the wound on the healthy tissue.  I have a new shoulder guard that should arrive any day now, which hopefully will work to put a plastic liner on it and then keep the wound covered with that as well.