UT-VMC emergency room tails: Too Close for Comfort

UTVMC ER TAILSBy Dr. Amanda Rainey

It had been a quiet Saturday so far when our ER technician’s phone rang signaling that a patient may be on its way in.  After speaking to the reception staff, she turned to discuss the call with a very concerned expression.

“It’s a cattle dog that was kicked in the face by a horse.  Not sure how bad it is, the owners just wanted to say they were on their way in.”  I was worried too, because I’d seen dogs suffering the same injury in various conditions, from fractures of the bones that make up their muzzle to traumatic brain injuries caused by the force of the kick.  Our students took the call seriously too, and were waiting up front when the patient arrived.

I think we all breathed a sigh of relief when Gippy trotted into the triage room as if nothing were wrong at all.  If you looked at him from the right side of his body you would never know anything had happened, but an obvious abnormality was present and identified just by a glance at the left aspect of his face.  All things considered, he had been very fortunate to escape such an encounter with just a large, hoof shaped gash on his muzzle, although it was very deep and we could easily identify what looked like the bones of his face from across the room.  

According to his owners, Gippy had been helping work some horses when he got just a little too close and one particularly ornery herd member tagged him as he zipped between the animals.  He had been briefly stunned by the blow, but quickly jumped up and went right back at it.  In fact, the owners hadn’t known he was hurt until the job was completed due to his strong work ethic and sense of duty.  We discussed with them after doing a cursory examination of Gippy that we would need to heavily sedate him, explore the wound and then determine how to close it after evaluating the condition of the tissue.  We also recommended performing a CT of his muzzle and skull to look for any fractures that might need to be repaired.  The owners preferred if we just did what we could, based on our investigation of the wound, and wanted us to stitch Gippy up to the best of our ability.

It took a good bit of sedation to relax Gippy enough for us to get a look at his wound and clean it, as he was a manly guy and we could tell he was used to toughing out most any situation.  After he was asleep, we clipped all the hair from the wound and flushed it with copious amounts of sterile saline.  We applied a final scrub with antiseptic solution and then started making decisions about how to put the laceration back together.  

Thankfully for Gippy, most of the muscle and skin of his muzzle was left behind and we were able to appose the edges of both aspects to correct the defect.  Sometimes it’s hard to know which tissue goes with what, especially after a trauma has occurred, but we had high hopes that our efforts would be successful.  

Gippy recovered from his sedation without incidence, and we sent him home shortly afterwards on antibiotics and oral pain medications.  Several weeks later we received a Christmas card from the owners, and inside was a photo of Gippy in action with the horses, taken only a few days before.  He was doing great and hadn’t missed a step despite his injury.

(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.)

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