cut on top of foot

[kaos]

Hi all

My kaos has injured her foot (in the house of all places.....?) It is the back right foot; top inside above the last toe, well up on the foot. I originally thought it was just a scrape so I left well enough alone and just reminded her to leave it alone.

 

Now, however, we have examined it more closely and its more than a scrape, she seems to have a dime sized flap of flesh (fur,skin, tissue too!) that is hanging on partially, occasionally covering the injury.

 

Both the skin flap and the underlying tissue look allright, reddish, pink and dry no sign of infection. It is obviously far too late to even think about stitches so should we....

1.leave it and keep an eye on it?

2.bind it and check it regularly?

3. go to the vet and have the flap cut off?

 

I guess I'm wondering if it will work like a blister and the top flap of skin will just shrivel up and fall off, or if the flap will just try to repair (not reattach to the injured area underneath) but heal up and stay attached? Or worse yet the flap will encourage infection by covering and uncovering the wound so often.... what do you all think?

sara

[AK dog doc]

Hi Sara

It may not be too late to think of stitches; your vet would be able to tell you. Whether or not the flap will dry up and fall off depends on whether or not there is adequate circulation to the flap - if it looks pink or red, probably there is, and it has a chance of surviving. If it is not infected, it might be able to re-attatch to the underlying tissues. Again, your vet can best advise you (since I can't see it).

 

On the foot there is only so much tissue to draw together to close a defect; also, the shape of wound that is most likely to scar and/or have trouble closing entirely is a circular wound. A small one would probably do okay even if it is round. A bigger one might be a bit slower to heal or have a problem. My personal take is that if I don't have a lot of skin to close up a defect, and there is a viable flap, I'd prefer to use that to close the wound rather than cutting it off and then tightening the nearby skin to close the defect.

 

Meanwhile, if you need to clean the injury, no alcohol or peroxide, as these injure cells and delay healing (a handy rule of thumb is not to put anything in an open wound that you wouldn't put in your own eye, since the tissues are of about the same degree of delicacy)... so water and saline are best, and if you want some antiseptic activity, add some betadine solution to the liquid to make it about the color of iced tea. Neopsporin or the generic equivalent makes a good basic dressing to control infection and keep the tissues moist, and in human studies it has been shown to speed up healing. Bag Balm is too thick and gooey, and inhibits cell migration to close the wound (while this is sometimes desirable, it probably isn't in this case). Also, it's meant for chapped udders and has some antiseptic properties, but not antibiotic ones, like the Neosporin does. If Kaos will tolerate a wrap, you could put a bit of Neosporin on the wound, wrap it so the flap lies as closely as you can get it to the original anatomical position of the skin, and ask your vet to have a look at it to decide if continued wraps, suturing, or excision would be the best course of action.

 

It sounds like a small injury and might do fine no matter what course you take; but if in doubt, seek professional advice.

[kaos]

HI Doc

Thanks for the speedy reply, the wound is actually several days old now, so I'd say stitches are definitely out, the flap is rather thickish so I AM worried that it may just heal that way, I don't think it is too likely that the flap will re-attach at this point.

 

It still looks fine, no sign of infection and she is fairly good about leaving it alone, she is a very tough little dog, has always been very stoic about injuries, unlike my peculiar weenie little hound X.

 

I think we will give it a few days, see how it goes and then if I'm in any doubt at all I will call up the vet.

sara

[AK dog doc]

Actually, it's not always the case, but sometimes when the tissues are all thickened like that it's because the body is building a granulation bed, which is heavily infiltrated with capillaries and white cells - so it's thick, but in good shape for healing. These sometimes respond very well to suturing. But they may also respond very well to bandaging and basic nursing care. "Freshening" the granulation bed and skin edges (something the vet would do surgically) can often make it so the flap will stick down and re-adhere beautifully (this works best with sutures, IMHO, but sometimes bandaging does a fine job.) But, you can see it and I can't, so I'm basically guessing at the appearance of it, and the viability and condition of the tissues involved. So you may well be right.

 

You're right that since the wound is several days old watching it for another day or two or three with good nursing care isn't likely to do any harm - and it may very well make it obvious which path is best for healing. Your plan to observe and see what it does sounds fine under the circumstances. Barring surgery, it *might* heal with a "notch", in which case reconstruction might be the way to go (a skin flap might just end up getting repeatedly traumatised on an active dog)... but I've actually seen all kinds of things where I thought, "THIS will never heal" and I turned out to be completely wrong. The body is amazing. Sometimes if you just give it a little time and support it'll sort out the most horrendous-looking stuff and heal it all up. Since this wound sounds really pretty non-horrendous (basically healthy tissue on a healthy dog), I think you have options.

[kaos]

Update:

 

Well, I called the vet today, as we are into november and I figure the ground is only going to get more slushy and soggy and muddy from here on in, so...... long story short Kaos goes in for surgery tommorow to have the wound freshened and the flap sutured down. This way we are told the wound will heal in a weeks time rather than a months and will be much cleaner etc etc etc. I hate putting my girls under for anything but I really do trust this vet s opinion (even though this was our first meeting , always heard wonderful things about her no-nonsense do whats best for the dog approach!) so here we go. She goes in tommorow morning and fingers crossed all goes well she will be home and stoned by lunch!

thanks for all the wonderful advice and help it is really appreciated!

sara