SURG3LEC ME: L2.2 - Pressure Sores

PRESSURE SORES

Animals’ incapable of or unwilling to change positions are prone to __ __ because pressure is exerted on bony prominences when animals lie down.

1. Paralysis  

2. Fracture  

3. Injuries  

4. Illness 

It forms when animals (especially large dogs) are recumbent for long periods because of:

True

T/F: All intervening tissues are compressed when pressure is exerted on a bony prominence. 

callus

Repeated trauma and inflammation are mild, and protective ___ develops. 

1. Lateral humeral epicondyle 

2. Tuber calcaneus 

3. Greater femoral trochanter 

4. Tuber coxa 

5. Ischiatic tuberosity

5 Common Sites

1. Scapula acromion 

2. Lateral tibial condyle 

3. Lateral malleolus 

4. Olecranon 

5. Sternum

5 Less Common Sites

Grade 1

Identify the Classification: Dark red erythema with superficial to partial thickness skin loss

Grade 2

Identify the Classification: Full-thickness skin loss (ulcer) extending into the subcutis

Grade 3

Identify the Classification: Ulcer extends through subcutis to deep fascia overlying bony prominences; edges may be undermined

Grade 4

Identify the Classification: Ulcer extends to bone; osteomyelitis or septic joint (or both) may be present

Grade 1

Identify the Classification:

1. Wound cleansing

1. Debridement

2. Bandaging

3. Secondary Intention Healing

Grade 2

Identify the Classification:

1. Wound Cleansing

2. Surgical or Bandage Debridement

3. Bandaging

4. Secondary Intention Healing/ Wound Excision and Delayed/ Delayed Primary

Grade 3

Identify the Classification:

Treatment as for Grade 2, but drains may be necessary with 

• undermined edges, 

• muscle flaps or 

• myocutaneous

Partial excision of the bony prominence may be necessary

Grade 4

Identify the Classification: Treatment as for Grade 3, but sinus tracts and pockets may need to be excised or opened

1 to 5

Prevention: Change animal’s position every __ to __ hours. Rotate from right lateral, to sternal, to left lateral 

2 to 4

Prevention: Place in a sling for __ to __ hours daily. Support pelvic area in wheeled carts

doughnut

Apply properly padded and fitted bandages, splints, and casts. Use ___ type of pad

Pad Toughening Compound

Apply skin toughening agents

• Amputation, 

• wedge osteotomy, 

• arthrodesis or 

• phalangeal fillet techniques for nerve or musculoskeletal abnormalities 

4 Surgery for Pressure Sores

Acemannan products

Stimulate macrophages to produce 

• cytokines and 

• growth factors

D-glucose polysaccharide

- antibacterial, 

- bacteriostatic, and 

- provides glucose for cell metabolism 

Tripeptide-copper complex

Attracts mast cells and macrophages to stimulate healing

flaps

Allow healing by 

1. secondary intention or 

2. transpose __ to cover wound

1. Elbow hygroma 

2. Lick granulomas 

3. Dermoid sinus (Pilondial sinus) 

4. Interdigital pyoderma

4 types of Pressure Sores

ELBOW HYGROMA

• Most common type  

• Painful when infected  

• Small, painless hygroma are cosmetic problems that persist if not treated.  

• Occurs bilaterally as painless swelling

6-18

ELBOW HYGROMA Occurs in young dogs (__ to __ months) of large and giant breeds before a protective callus form over the bony prominence

large

Why do Dogs get HYGROMA?

1. Lying on hard surfaces  

2. Sedentariness  

3. Weakened joints  

4. Being a ___ breed  

5. Too much crate time  

6. Having short hair

True

T/F: Most acute lesions regress slowly if repeated trauma is eliminated

Aspiration

__ of hygroma is of little benefit and may introduce bacteria.

Penrose drains

Infection requires drainage by using close suction (preferred) or __ __ in administering antibiotics.

fenestrated closed

For non-ulcerated (Infected or Sterile), Place one or more __ __ suction drains in the hygroma cavity and secure them

non-adherent, adsorbent

Apply __, __ bandage with a “doughnut” to 

• relieve pressure, 

• absorb drainage, and 

• prevent trauma

infection

When all conservative treatment has failed, hygromas are occasionally surgically excised if fibrous tissue, fistulae, __develops without a large fluid cavity.

True

T/F: Elbow Hygroma recurrence is common

True

T/F: Surgical treatment of Elbow Hygromas may result in significant complications; however, surgery may be necessary in recurrent and complicated hygromas.

Small Hygromas

can be excised, and the defects closed by undermining and advancing local tissue until skin edges can be approximated with interrupted sutures. Complete excision of fibrous tissue is ideal.

 large hygromas

It is difficult to excise __ __ and close the wound without using skin flaps (axial pattern, pedicle or myocutaneous)

• Elbow seroma or 

• Olecranon bursitis

ELBOW HYGROMA aka these 2

LICK GRANULOMAS

• Self-induced by continuous licking or chewing  

• Single or unilateral that may occur anywhere

• acral lick dermatitis, 

• acral pruritic nodule, 

• acropruritic granuloma, 

• psychogenic dermatoses, and 

• neuro dermatitis.

LICK GRANULOMAS aka these 5

1. Cranial and medial aspects of the carpus-metacarpus  

2. Cranial and lateral aspects of the tarsus-metatarsus

2 Most Common Sites of LICK GRANULOMAS

1. Stifle 

2. Tibia 

3. Flank 

4. Tail base

4 Less Common Sites of LICK GRANULOMAS

1. Labrador retriever  

2. Golden retriever  

3. German shepherds  

4. German shorthair pointers  

5. Great Danes  

6. Saint Bernard  

7. Staffordshire terrier

LICK GRANULOMAS Commonly occurs in older, male, and large dogs such as these 7: 

Psychogenic

Although wounds, foreign bodies, infections, and musculoskeletal pain may be initiating factors, most lick granulomas are believed to be 

1. __ (obsessive-compulsive disorder) and 

2. associated boredom, inactivity, or environmental changes

DERMOID SINUS

Tubular skin indentation that extends ventrally as a blind sac from the dorsal midline. A neural tube defect caused by incomplete separation of skin and the neural tube during embryonic development.

PILONDIAL SINUS or CYST

DERMOID SINUS aka

dura mater

DERMOID SINUS: Sinus depth varies; some are superficial, whereas others extend to the supraspinous ligament or __ __

Type I

Classification of Dermoid Sinuses: Tract extends as far as the supraspinatus ligament or nuchal ligament and attaches there.

Type II

Classification of Dermoid Sinuses: Tract does not extend to the ligament but is attached by a fibrous band.

Type III

Classification of Dermoid Sinuses: Tract does not extend to or attach by fibrous band to the ligament.

Type IV

Classification of Dermoid Sinuses: Tract attaches to the Dura mater

Type V

Classification of Dermoid Sinuses: Sinus has no connection to the skin surface; closed epithelial-line sac

Type VI

Classification of Dermoid Sinuses: Tract extends to supraspinatus ligament and connects to dura mater by a fibrous cord.

Subtype A

Classification of Dermoid Sinuses: Dorsal Midline

Subtype B

Classification of Dermoid Sinuses: Head, except nose

Subtype C

Classification of Dermoid Sinuses: Nose

1. Golden retrievers, 

2. Spaniels, 

3. English bull terriers 

Congenital dermoid sinuses have also been reported on the dorsal nasal midline of these 3 dog breeds

INTERDIGITAL PYODERMA

Frequently seen in:  

1. West highland  

2. Scottish terrier  

3. Pekingese 

4. English bulldog

• granuloma, 

• acne, 

• furunculosis, 

• folliculitis

INTERDIGITAL PYODERMA aka these 4

bacterial pododermatitis

INTERDIGITAL PYODERMA is a __ __ that may coexist with other conditions such as:  

1. Parasites  

2. Allergies  

3. Mycoses  

4. Irritants  

5. Neoplasms  

6. Metabolic, 

7. Neurologic, or 

8. Autoimmune diseases

• Demodicosis  

• Allergy 

• Hypothyroidism 

• Hyperglucocorticoidism

INTERDIGITAL PYODERMA Bacterial infections usually occur secondary to these 4

Staphylococcus pseudintermedius

INTERDIGITAL PYODERMA Primary bacterial pathogen

1. Proteus spp.  

2. P. aeruginosa  

3. E. coli

INTERDIGITAL PYODERMA Secondary opportunistic bacteria include these 3

24-48

INTERDIGITAL PYODERMA Medicated with antibacterial agents and Bandaged for __ to __ hours

15 to 20

INTERDIGITAL PYODERMA Soaked in antibacterial solution for __ to __ minutes bid daily

6 to 8

INTERDIGITAL PYODERMA Oral antibiotics for __ to __ weeks

fusion podoplasty

INTERDIGITAL PYODERMA Lesions that fail to respond to this treatment may require __ __