This is Violet when she first arrived at OC Pound Hounds. She was sent to PETSURG & ER4PETS after she was rescued from a shelter in Riverside, where she was transferred from an Emergency Services Clinic. When she was found, the purple and yellow staining was hiding a terrible secret...
The secret that the staining was hiding was that her skin was falling off. It is believed that a large dog or coyote bit the little pom-pom, and with no medical treatment, the flesh necrotized and began to slough off. The rescue's veterinarian recommended Dr. Jones, who has extensive experience in bite wounds, and the PETSURG staff to have a consult done.
The main question was, is there enough skin left for a skin graft? Skin used for a skin graft is often taken from the scruff of the neck, where Violet does not have skin.The verdict was that there was enough skin elsewhere to cover her wound. So the rescue brought her down to San Diego into the expert hands of Dr. Jones.
This is what Violet looked like when she arrived at PETSURG & ER4PETS. On November 11th, 2012, the procedure started and for over 4 hours, Dr. Jones worked tirelessly to patch up the sweet pooch.
This is the result of Violet's first skin graft. The end result looked promising. Violet was completely covered using releasing incisions across her back.
To everyone's dismay, the graft began to die, and little by little the graft fell away.
This is after the graft died. The reason for the graft not taking was Violet has very poor veins and thus could not feed blood and nutrients to such a large skin graft; her veins were so poor, she could not receive an IV injection. All was not lost though, the graft closed the skin at her neck and elbows and helped make a fresh clean area to start anew.
By November 29th, Dr. Jones was ready to try again with a new plan. Instead of one large graft, she would take the skin from Violet's stomach and rotate it up her sides to cover her wound with many little grafts, which should be easier to feed.
This time, surgery took 6 hours, and once again, when it was done, Violet was completely covered and looking like a patchwork doll.
Violet liked to show off her new flat tummy after surgery!
Knowing that the ends of the graft may die off, the staff and Dr. Jones watched and waited. A few days later, the graft fell apart at her shoulder blades. The reason being that every time little Violet moved her head to eat, drink, or even lie down, it tugged at her stitches. The skin was moving and could not connect to the flesh beneath.
Another technique was to place loops of suture around her wound, an ointment smeared on her flesh after which a healthy amount of gauze was place and then suture was shoelaced through the loops like a corset to help pull the skin together.
To help prevent Violet from pulling her skin, she was also put into a thick, full body bandage to help keep her head from moving. She was being hand feed and receiving water by syringe. She was kept on a pile of blankets to keep her propped up and comfortable.
Dr. Jones had taken skin from Violet's back, neck, elbows and stomach but she was determined to put Violet back together. On December 19th, Violet had a skin graft taken from the excess skin on her head. Surgery lasted 6 hours and again, Dr. Jones made smaller grafts as there was not a lot of skin to work with.
During surgery, Dr. Jones made a discovery: as she was cutting, a section of flesh barely bled and another bled normally. Upon closer inspection, a large flap of scar tissue had formed under the skin. The scar tissue is what was preventing normal blood supply to the grafts. Dr. Jones removed the tissue, hoping it would do the trick.
Against all efforts, parts of the graft died. Skin adhered to her back and neck once more, but the spot between her shoulder blades was a bane to Violet and Dr. Jones alike. Fresh skin and scar tissue still crept slowly, but creep it did, the wound becoming smaller and smaller with the help of some Manuka Honey (Pictured here. Its the same honey they use on burn victims.)
On January 5th, 2013, Violet went into surgery again, this time, with a new plan- to make one large releasing incision and move the skin forward so the shoulder blades were covered. A wound on the back would heal faster than a wound on the shoulder blades.
The procedure lasted 95 minutes. The graft stuck better with the large releasing incision, but once again, the shoulder blades did not take. the wound closed by over 10 centimeters which was a landmark.
Sometimes, intuition is the best thing a person can have, especially a medical professional; Dr. Jones' intuition sparked and caught fire. What Violet needed was something to prevent her head from moving up or down. After sorting through the alternatives, she came up with a simple idea: a box.
She could wear a small and narrow box like a t-shirt. After finding the perfect fit box and cutting it appropriately, Violet found herself in a type of cast, with a foam neck brace to keep her comfortable.
Dr. Jones decided to let the wound air for a few days, but then she saw that with the combination of oxygen and Violet's immobility, the wound was closing faster! ( this is 4 days after she was put in the box!)
Within a week, the original wound closed over 1 centimeter in length and half a centimeter in width and the releasing incision was closing even faster! A few weeks in her little box, with many wound cleanings, measuring, ointments and good ol' oxygen, the wound made progress getting smaller and smaller.
Violet showing off her box and her foam neck brace. She went through a few box variations but all of them had comfort and head support in mind.
Another box variation, this one was placed on her in at the end of January and boy, does she have a surprise hiding underneath!
Her wound has closed by 4 centimeters in length and 2.5 centimeters in width by January 30th, 2013! She likes to show off how small her wounds are.
After several weeks in her box, her wound has just about closed in between her shoulder blades, the bane of Violet and Dr. Jones is finally healing. The large releasing incision that was on her back has closed and healed as well.
An up close of Violet's healing wound.
Violet's wound as of 2/27/13. The skin between her shoulder blades has stayed! It's closing fast! Violet is still receiving daily ointment treatments and wears one of her new sweaters at night to prevent from over scratching her scars.
Getting closer and closer everyday! Her personality is shining everyday!
03/21/13 The moment everyone has been waiting anxiously for! One shoulder blade is completely covered!
Fully healed, and thriving far better than any of us thought would be possible.
She has the sweetest personality and want to be in your lap all the time. It was an honor to help this precious and courageous pooch get better.