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Toe amputation in a dog

A 1.5-year-old dog was presented to the clinic with soft tissue and bone lesions at the lower extremity of the right hind limb, traumatic in origin. Degloving of the wound was observed shortly after presentation, and the dog was confirmed to have comminuted fractures of the metatarsal bones on digits II and III, which were amputated. The resulting wound was partially covered with bandages and changed every 3-4 days, with no improvement. The dog was treated with Meloxicam for the first 3 days and Amoxicillin and Clavulanic acid for the first 7 days after the trauma. Thereafter, treatment consisted of a triple antibiotic ointment (Tetracycline, Erythromycin, Neomycin) with woven gauze as a secondary layer and self-adhesive wrap as the exterior layer for a week. This treatment showed no improvement and the patient was referred to the university clinical and treatment with medical grade honey (MGH) was started.

Products: L-Mesitran Soft, non-woven gauze 

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

 

A wound lavage was performed after each bandage change, using Ringer’s Lactate. Bandages were changed every 2 to 3 days, along with a new application of L-Mesitran Soft.  A non-woven gauze was applied as a secondary bandage, followed by a tertiary layer of Soft Orthopedic Cast Padding, and gauze wrap and self-adhesive cohesive wrap for fixation. These materials were used till complete healing. From day 19 to day 35 the owners applied the bandages at home following the same pattern as performed in the clinic. No antibiotic was given during the treatment with L-Mesitran.

Figure 1: Wound healing progression of a traumatic wound on the lower extremities of the right hind leg. 

 

The wound had necrotic tissue and was heavily exudating on day 1 of treatment with MGH. Additionally, the wound showed signs of being heavily infected. On day 9, granulation of the wound was clearly visible with necrotic tissue and signs of infection being resolved. Further epithelization of the wound continued on day 14, with additional collagen formation. Granulation was in an advanced stage on day 19 and on day 35 the wound was fully closed. HAAR.

The NSAID Meloxicam and antibiotics Amoxicillin and Clavulanic acid were administered subcutaneously, along with a triple antibiotic dressing (Tetracycline, Erythromycin, Neomycin) prior to treatment with L-Mesitran Soft, with no improvement. Because the wound showed signs of heavy infection and the wide-spectrum antibiotics not being effective, the wound possibly was infected with multiresistant bacteria. After application with L-Mesitran soft (which contains Medical Grade Honey (MGH)), the infection was fully resolved. L-Mesitran Soft is known to exert antimicrobial activities via multiple mechanisms, being able to eradicate (multiresistant) bacteria, even when persisting in biofilms (1-4). Digits II and III of the metatarsal bones were fractured and had to be amputated. In amputee cases, the use of MGH as an earlier line of treatment can enhance healing and prevent exacerbation of the injuries and potential subsequent amputations (4). In another case, MGH products lead to an efficient and rapid healing process, with positive influence on the extent of trauma and hemostasis. MGH also allowed to manage low to medium exudate levels while keeping a moist wound bed for a beneficial wound healing environment (5). 

MGH creates a positive wound healing environment by promoting granulation and skin epithelization. In this case, MGH was shown to be effective for wounds resulting from amputations. Furthermore, MGH was shown to be effective against infected wounds which could not be treated with antibiotics or might contain multiresistant bacteria.

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