Vet School 101 Incision site madness post-op in pets (and five ways I handle it)
I have a relative whose two adult dogs were both neutered last week. So I knew to expect the cross-country phone calls––in spades. But nothing prepared me for the onslaught of incision site issues that awaited me in the wake of this simple procedure.
Sure, they’re nervous nellies. But they’re really no different than you and me when it comes to watching out for the minutest signs of an unhappy suture site. Redness, puffiness and weeping is not a pleasant sign and I would hope that any pet owner would be on the lookout for these symptoms post-operatively.
That’s why I’ve been fielding photos from afar, checking the site remotely due to their own [wonderful] veterinarian’s 1.5 hour distance (you know she’s beloved if they’re willing to travel so far for her care).
Before:
After:
Her take? Haul ‘em in for a close-up look-see. It’s best, after all. Mine? Here’s my basic recommendation for any angry-looking incision site:
1-Avoidance Part 1
Make sure the E-Collar fits well. Can she get around it? Is he licking it when you’re not watching? Is it just long enough to bang into the surgery site and undo all our good work?
2-Avoidance Part 2
Try a light, loose cotton T-shirt, some boxer shorts or a clean sock, depending on the area affected. A light dressing, changed often, will sometimes be indicated if the area allows.
3-Pack it
Alternate applications of warm and cool packs on the affected area (with a clean kitchen towel soaked in comfortably hot or cold Epsom salts works for me). Though you should know that many veterinarians despise the idea of any wetness on their suture lines.
4-Meds?
Sadly, antibiotics are sometimes necessary. We often culture the affected area to make sure we’re killing the right bugs with our choice of drugs.
5-Movement restriction
Crate ‘em, please! No exercise for a week or two (unless your surgeon recommends more careful, lengthy restrictions, as for orthopedic procedures). And for some areas, especially after mass resections in highly mobile spots (underarm or inner thigh, for example) we recommend keeping your pet in hospital for a few days so we can watch pets carefully and limit their movements.
***
After dealing with all this neuter-site stress, another family member underwent eyelid surgery. More careful attention to sutures, swelling and local antibiotic application.
And then, the kicker: A second-opinion case (I hate these). A local surgeon had refused to see him due to the lack of a direct referral from the original veterinarian (this is typical). So he was all mine. (Gee, thanks, Dr. Surgeon.)
After one month and three surgeries (a mass removal on his right flank) the dog’s sutures had continued to open up...completely, every time. The long incision (about 8 inches!), was a scary sight. Thankfully, the large dog’s capable healing mechanisms had led to a nice, dark pink bed of granulation tissue.
“Let it heal all by itself,” I’d said, after cleaning the area, culturing it and changing his [too-small, non skin-specific dose] of antibiotics. Hot packs for three days, some crating for a week, and the site should be three times as pretty by next week’s re-check. If I’m lucky.
Pets are tough on suture lines, it’s true. They’d love nothing better than to lick the wound into submission, lie in the dirt, roll in carcasses and run around like silly creatures after surgery. Meanwhile, you and I would be feeling sorry for ourselves in bed. Pets are just special that way. Too bad they can’t be a little more like us on these occasions.
April 24th, 2009
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Add Comment25 Comments
I have a picture of a cat neuter after it was licked a little too much you might like, but I haven't had much luck posting pictures.
It's nice of you to care for relative's dogs upclose and long distance.
Dogs like to get dirty...I'll bath mine and sure as anything the second they go outside, it will be to the nearest rabbit or deer poop they can find.
LorriM April 24th, 2009 10:52:00 AM
Wow, LorriM, that's the nastiest feline neuter reaction I've EVER seen. Badness. Sorry. Hope he's all better now.
Dr. Patty Khuly April 24th, 2009 11:44:17 AM
Has to be a challenge. Our two female felines (the girls) sailed through their post fix recovery with no problems with the incision. From what we observed when we brought them home the incisions we're incredibly clean and precise. Snugs didn't like the staple sutures and did a little bit of licking here and there but nothing excessive or swuggesting discomfort. Her sister had standard sutures and acted like she hadn't even had surgery. But she was a laid back and relaxed girl anyway.
What are the pros and cons of staples versus standard sutures anway?
Evet April 24th, 2009 11:47:20 AM
The scrotal sac in picture #1 looks a bit swollen and sore too. We had a rescue turned over to us from a nice local shelter a few months ago. Dog was neutered by one of the low cost s/n groups and returned to the shelter a few days earlier. When we picked him uphe was walking like a cowboy who had spent waaay too much time on his horse. His sac was nearly grapefruit sized and oozing blood. The shelter attendants were aware of the problem but couldn't return him to the vet for follow up (likely was a weekend situation). We couldn't get him to a vet fast enough!
Another thing that helps if a dog is worrying an incision is to wrap a healthy paw with a stocking and masking tape as a way to re-direct the licky bitey behavior.
Airedalelover
Airedalelover April 24th, 2009 11:50:17 AM
Airedalelover: Great idea!--never thought of the "distraction" angle. On the scrotal swelling: This is more common in mature, larger dogs due to the bleeding of many tiny vessels in the area. Neuters are always more complex in these patients and they do invariably swell. I always inform clients that the area WILL swell. If they swell to beyond the normal size of the pre-neuter scrotum they're to come see me for a recheck (no charge, ever, so they don't try and risk it). The swelling is always more pronounced in active, jumpy dogs. That's why crates are best for big, mature dogs post-neuter.
Dr. Patty Khuly April 24th, 2009 11:56:19 AM
Evet: On staples: I like them for the speed. "Time is trauma under anesthesia" is a common maxim. If you can get out faster by using staples it's a good thing. But I don't use 'em anymore. They seem to bother the pets more. And since I took up knitting again about 8 years ago I've become a much faster stitcher, so I don't think the teensy bit of extra time saved is worth the potential discomfort. In other words, the pros and cons all depend on the individual surgeon.
Dr. Patty Khuly April 24th, 2009 11:59:31 AM
So in your head when it comes time to close up you think . . . "okay now just a little knitting left here and we are in excellent shape" ?? LOL I could appreciate that.
Oh and by the way thanks for helping me get over the Otomax paranoia. This evening is the last set of drops, his ears are looking clean and fantastic, no discomfort, not a single glitch to mention. In fact our technique became so polished this past 10 days we're pretty pleased in fact.
Evet April 24th, 2009 12:24:20 PM
Dr. K,
He is all better now, but he did require an additional surgery. It was the first time I'd ever had a s/n go bad, but he just wouldn't leave it alone. And wow did it hurt. I know this of course because I cleaned up the infection with a little betadine before we went back for the second surgery and my normally sweet boy, fanged my hand but good. Funny after the second surgery he left it alone totally and it healed up quite quickly.
LorriM April 24th, 2009 02:13:21 PM
You will probably say, "Here goes that old fart Luddite again." In my experience ( a little over 45 years of practice), I have the strong impression that there were not nearly as many nor as severe incision problems when the interior (ligations, peritoneum, linea alba, subcutaneous) were done with catgut (of course it is really "sheep gut)and the skin closed with stainless steel wire or polyamide. I still use that approach. As a locum tenens, I see a significant number of closure problems where all lines are done with PDS or similar sutures that are intermediate in their absorbability. I like to do the part that is covered up using suture that will definitely be absorbed at the time that the tissue is strong by itself and the skin with suture that will stay strong until I am ready to remove it. SS wire has other advantages. (1) The stiff ends serve as a "tongue repellant." (2) Being monofilament and nonpervious, it is non-wicking and cannot itself act as a culture medium. (3) Putting a roll of SS wire in the pack means you don't need to decide whether to open another packet of suture when you really need one or two more stitches. (4) It remains in good condition even if re-sterilized many times (although the wooden spool may start to fall apart after a few hundred autoclavings). (5) It is inexpensive.
Dr. Steve Dubin April 24th, 2009 02:14:25 PM
Great tips! As usual. We recommend the Bella's Pain Relief Pack for a hot/cold compress that actually stays put on your pup. Readers can see our product review video here. I've also added a link to this entry in our Tripawds blog post about incision seromas after amputation surgery, which can get pretty nasty.
While we're on the topic, perhaps you might consider a future post addressing your feelings about stitches vs. staples and the post-op madness related to each. Thanks!
tripawds.com April 24th, 2009 03:02:02 PM
Yipes! Don't you hate the scary healers? Having had just females that were all spayed at pups (and kittens - had cats too) it was a real education the first adult male dog I had in my house as a rescue. Holy Cow! Are you SURE they took something OUT!?! The swelling was frightening. (I was told it was normal for an adult dog - eeek!) i was relieved when my 6 month old male puppy healed uneventfully!
I have a rescue that had a mass removed from her hip, it was diagnosed as a mast cell tumor, and was closed up with stitches. We were so careful to keep the lampshade on her - took it off for 2 minutes and she yanked out a stitch. Ha - we ran her to the vet and she got a staple. We were much more careful after that. I tell you there is nothing scarier than staples in skin. (my mother had a whole line of them when she had her hip replaced - YOWZA! And I thought the dog's were frightening! EeeeeW) Same dog had further surgery - first vet didn't take enough tissue - long story! - this time closed with staples. Yuck, but with the e-collar healed uneventfully.
I am a firm believer in USING those E-collars! People, LISTEN to your vet - they don't want to deal with a badly healed incision! Yes, bless their hearts, they WILL - but that doesn't mean they WANT to!
robinsdogs April 24th, 2009 03:16:34 PM
Dr K... have you ever tried honey on open areas like your granulated wound? Especially if made locally it speeds healing like nothing I've ever seen. My poor Cairn (attacked and almost killed by a Shar Pei who came into OUR YARD to get him) had huge wounds, two drainage tubes and an area of skin/hair the size of my palm you could lift straight off the muscle. The routine was easy. Clean the area, apply honey, hold dog for 10 minutes to let it heat up and soak in. Release dog who promptly smeared honey on you, the floor, the walls and then tried to lick it all off. Repeat 2x a day.
Beth Patterson April 24th, 2009 03:31:09 PM
Raw honey has been getting more and more attention as a healing tool for wounds. I've never used it but it doesn't mean I'm averse to it.
Dr. Patty Khuly April 24th, 2009 03:57:06 PM
honey is naturally bacteriostatic and it works wonderfully in many human applications. Particularly hard to heal wounds, so I would imagine if you can take the mess and they aren't spending time outside where the honey would attract even more dirt and insects, it would be very useful.
People who own pets, don't really care about things like furniture anyhow...<.lol>
LorriM April 24th, 2009 07:07:31 PM
My cats/dogs have been pretty lucky (except one) regardless of stitches, dissolvable stitched, wire or staples. The unlucky one had nothing to do with stitches or "licking". One cat "removed hers" when mostly healed.
Barbara A. Albright/NH April 24th, 2009 07:21:52 PM
For the scarier, granulated wounds, I always recommend hydrotherapy - warm water, moderate spray on the area for 5-10 minutes once or twice a day - it really speeds up the healing, and has both mechanical (tissue healing) and cleaning action. You can use a hand-held shower, a hose or anything similar. I haven't recommended it for blue bags (scrotal swelling) but I bet it would work well in some dogs, maybe with the water a bit colder.
brebis noire April 25th, 2009 02:26:16 PM
Should have mentioned that. The last time I hospitalized a patient for a non healing flank wound (fence injury) the twice a day hydrotherapy did the trick. I like to use a simple spray nozzle as from a kitchen sink. The pressure is just perfect.
Dr. Patty Khuly April 25th, 2009 03:02:39 PM
Honey could however be a risk for botulinum spores, and other clostridia, that's why it's recommended not to give honey to children below one year.
Clostridia in a sluggish wound....a recipe for gangrena.
stefafra April 25th, 2009 03:09:43 PM
When one of my cats had linear foreign body removal surgery last summer, they didn't send him home on antibiotics. Long abdominal incision -- not like a neuter!
Now, I like these vets (really) but it's not beyond me to do something without medical directive. When that incision site got VERY red and puffy, and hot . . . I used the antibiotics I had at home.
I confessed it later, but I did it all the same. Way too worried.
I think the vet told me on follow/up he likely had an incision site reaction, not infection (lots of thickening too) but I have no regrets because whether it was placebo effect or not, 48 hours after starting the antibiotics, he looked a lot less red and angry.
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