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Necrotic facial laceration

Patient history

Bela, a 5-year-old female Anatolian shepherd was presented in the clinic with a large facial crust of unknown cause. Due to the extent of the crust, delayed primary intention was considered to remove the crust through debridement. Once healthy granulation covered the wound bed, flap surgery was performed. L-Mesitran Soft was used for wound management and for post-op care after the flap surgery was finished.

Products: L-Mesitran Soft

Case study done by: Alexandra Peteoaca DVM Facultatea de Medicina Veterinara Bucureṣti, Romania

Methods

Prior to any treatment, a sample of necrotic tissue was taken for histopathological examination. Via this sample, toxic epidermal necrosis was determined to be the pathological cause of the skin defect. L-Mesitran Soft was applied topically and the wound was
bandaged using a tie-over bandage. The dressing was changed daily while performing minor mechanical debridement of the detaching necrotic scab without general anesthesia. After two weeks, Bella was hospitalized to maintain wound care due to home care alone being unable to lead to adequate wound healing.

Results

On day 0, Bella was presented to the clinic with a necrotic scab on the wound. The wound underwent mechanical and surgical debridement under sedation. To reconstruct the large defect on Bela’s muzzle, a local subdermal plexus rotation flap extending from her cheek to her ear was performed. To increase the success rate of auto-skin grafting, medical grade honey (MGH) was applied and a drain was placed before closing the defect surgically. After three days, L-Mesitran Soft debrided the necrotic scab and stimulated the formation of healthy granulation tissue ready for auto-skin transplantation. The wound bed showed adequate granulation and the animal was prepared for surgery by using general anesthesia. The drain was removed 3 days post-surgery. On day 6 post-surgery, part of the sutures at the caudal aspect of the upper lip dehisced. Yet, regrowth of the hair on the graft was visible from day 6, indicating graft acceptance and healing. Slight swelling occurred particularly at the flap’s pivoting point near the suture line but visibly reduced by day 15 post-surgery. Epithelialization of the graft margins was visible and thus the wound was considered healed at this point. On day 40 post-surgery, about 90% of the graft surface showed hair. Follow-up at day 73 post-surgery showed complete graft acceptance and restored cosmetic results.

 


Discussion

The growing body of research for the veterinary application of (MGH) supports its application in wound healing (1). Especially
in the surgical field, MGH has been shown to improve wound healing, even in species prone to hyper granulation or prolonged wound healing, such as horses and cats, respectively (2). Generally, flap grafting procedures are common to repair large defects which are surrounded by loose skin. The use of MGH promotes healing; it is effective, comfortable for the patients, safe, and results in excellent cosmetic outcome and makes an ideal dressing for skin graft donor sites (3). In total, about 15 grams of L-Mesitran Soft was used to debride the necrotic tissue and prepare the wound bed for auto-skin transplantation. Although MGH is primarily used for treatment of wounds and burns via a topical application, MGH has also shown to have subcutaneous applications. In a prospective blinded randomized controlled clinical study, MGH was shown to be safe and effective in abdominal incisions during surgery and may significantly decrease the prevalence of incisional infections in horses undergoing colic surgery (4). The rapid formation of granulation tissue after debridement and graft site preparation shows the effectiveness of L-Mesitran MGH-based formulations in stimulating debridement and augmenting the healing progress when applied subcutaneously (5, 6). MGH dressings are a safe and effective modality gaining renown for their infection prevention and wound bed preparation (7).

Conclusion

This case shows that L-Mesitran Soft can be used for wound bed preparation for flap surgery. Furthermore, L-Mesitran Soft did not interfere with graft acceptance and healing, nor led to any discomfort or side effects.

 

References

  1. Subrahmanyam M. Honey Dressing Accelerates Split-Thickness
    Skin Graft Donor Site Healing. Indian J Surg. 2015;77(Suppl
    2):261-3
  2. Maghsoudi H, Moradi S. Honey: A Skin Graft Fixator Convenient
    for Both Patient and Surgeon. Indian J Surg. 2015;77(Suppl
    3):863-7.
  3. Subrahmanyam M. Honey Dressing Accelerates Split-Thickness
    Skin Graft Donor Site Healing. Indian J Surg. 2015 Dec;77(Suppl
    2):261-3. doi: 10.1007/s12262-012-0789-9. Epub 2012 Dec 7.
    PMID: 26730006; PMCID: PMC4692859.
  4. Gustafsson K, Tatz AJ, Slavin RA, et al. Intraincisional medical
    grade honey decreases the prevalence of incisional infection in
    horses undergoing colic surgery: A prospective randomised
    controlled study. Equine Vet J. 2021;00:1–7.
    https://doi.org/10.1111/evj.13407
  5. Mandel HH, Sutton GA, Abu E, Kelmer G. Intralesional application
    of medical grade honey improves healing of surgically treated
    lacerations in horses. Equine Vet J. 2020 Jan;52(1):41-45. doi:
    10.1111/evj.13111. Epub 2019 Apr 15. PMID: 30895637.
  6. Pleeging CCF, Wagener FADTG, de Rooster H, Cremers NAJ.
    Revolutionizing non-conventional wound healing using honey by
    simultaneously targeting multiple molecular mechanisms. Drug
    Resist Updat. 2022 May;62:100834. doi:
    10.1016/j.drup.2022.100834. Epub 2022 Apr 5. PMID: 35427872.
  7. Gustavson
  8. Nair HKR, Tatavilis N, Pospíšilová I, Kučerová J, Cremers NAJ.
    Medical-Grade Honey Kills Antibiotic-Resistant Bacteria and
    Prevents Amputation in Diabetics with Infected Ulcers: A
    Prospective Case Series. Antibiotics (Basel). 2020 Aug 19;9(9):529.
    doi: 10.3390/antibiotics9090529. PMID: 32825100; PMCID:
    PMC7558111.

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