February 2014 Case of the Month – Meet Smokey!!!

Two week recheck

Smokey at his two week recheck!

Smokey was transferred to the surgery department from the overnight emergency service after being attacked by a larger dog the night before. His injuries were multiple and severe. He sustained multiple bite wounds over his thoracic and abdominal body cavities. Thoracic radiographs revealed multiple left sided rib fractures and multiple defects (tears) into the chest wall. The bite wounds over the abdomen were superficial with no evidence of penetration in the abdomen.

Note the multiple rib fractures and the multiple thoracic wall defects.

Note the multiple rib fractures and the multiple thoracic wall defects.

Smokey was stabilized by the emergency service and prepared for surgery once transferred in the morning. Based on the injuries, Smokey had a thoracic exploratory to evaluate the thoracic wall wounds and subsequent internal injuries. Surgery revealed a large thoracic wall defect and multiple fragmented ribs, some of which needed to be removed. Interestingly, the left caudal (posterior) lung lobe had a large laceration caused by one of the rib fragments, necessitating removal of the lung lobe. The remaining thoracic wall defect was too large to close primarily.

The white arrow denotes the diaphragm, the red arrow is showing the muscle of the thoracic wall and the caudal edge of the heart and the black arrow denotes the great vessels (caudal vena cava and caudal aorta).

The white arrow denotes the diaphragm, the red arrow is showing the muscle of the thoracic wall and the caudal edge of the heart and the black arrow denotes the great vessels (caudal vena cava and caudal aorta).

The thoracic wall defect was repaired using porcine small intestinal submucosa extracellular matrix sheets (Vetrix ECM). Note the placement of the ECM in the defect. The overlying muscle was freed and placed as a muscular flap over the ECM. Following the repair a thoracic tube was placed to maintain negative pressure in the chest following surgery. Smokey recovered well from surgery and was released 48 hours following surgery. Two weeks later at his suture removal and he is doing great!

This is demonstrating the placement of the Vetrix ECM sheet for repair of the thoracic wall.

This is demonstrating the placement of the Vetrix ECM sheet for repair of the thoracic wall.