Crushing Injury Evolution

Rex(2) Here's Rex.  Despite her name, Rex is a girl.  She is a house-dog, except for the day she escaped and ran off for a couple of hours.  She came back with her left hind leg wounded.  The next day she came in to see me.

Rex Day 2 (2) This wound is obviously infected.  It looks like there are several cuts.  It also looked to me like there might have been some crushing of the tissue involved, like maybe she got her leg hung up in a fence or something.  If it weren't all infected, you could sew this back together.  Of course, it IS all infected, so we started with antibiotics, pain meds and a nice bandage with tissue-friendly dressing and a secondary layer to soak up drainage.

PreOp Day 9 (2) Good thing we waited to sew it up, because we sure would have wasted a lot of time.  When tissue is crushed, it loses circulation.  It may look okay initially, but over the next three to five days, things can change drastically.  Sometimes we sew it together anyway (when it isn't as grossly contaminated as Rex's wound), but we have to be prepared to see all our hard work dry up and fall off a few days later.  Here is Rex's leg after everything that was crushed and going to die had gone ahead and died.  This is nine days after the initial injury and (after many bandage changes) we are down to healthy tissue, with a nice granulating bed in the middle.  Granulation tissue is half capillaries and half fibroblasts.  It's the body's "fill in the gap" tissue — nature's spackling compound.

Post-op 1, day 9 (2) There's not much loose skin to play with here down low on the leg.  So, I'm pretty happy with the amount of reconstruction I was able to do on the leg.  We've got skin covering almost all of the area.  Of course, we'll have to wear a heavy padded bandage to protect this while it heals.

Mostly healed (2) Here we are ten days after reconstruction with  just a 5mm raw spot.  I'm happy.  We took out the stitches and rebandaged "one last time".

 

Oct 24 closeup(2) Here we are seven days later with just a tiny little 2mm raw spot.

Six weeks (2) And here we are with hair, five and a half weeks after reconstruction.  It's all good.

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