Postoperative Complications in Dogs
Surgery is commonly performed on animals to treat injury and illness, such as excision of tumors or foreign objects, repair of broken bones or lacerations, and repair of torn ligaments or hernias. Though there are a wide variety of reasons for surgery, all surgeries have one thing in common: an incision – a cut into the skin to gain access to the area in need of repair. Excessive licking or chewing at sutures
After surgery has been completed and the animal has successfully recovered, complete recovery is not assured until the incision has completely healed. An uncomplicated incision usually heals within 7 – 10 days, and during that time, careful monitoring is necessary.
Most incisions are surgically sutured with more than one layer of stitches; this depends on the type of surgery and the depth of the wound. As with many surgeries that require multiple layers, there is typically an initial strong closure of deep tissues. Second, a middle layer of sutures is placed in order to bring the edges of the skin closer together (subcutaneous sutures). Finally, sutures are placed on the exterior to also help bring the edges of the skin together (skin sutures). The skin sutures are the only layer visible in a normal healing incision.
While the animal is recovering at home, pay close attention to the incision. In addition to infections and swelling, sutures may become loose or the pet may chew at them. Immediate and appropriate care for any incisional complications will help hasten recovery and prevent additional, more severe postoperative complications.
Swelling at the site of the incision
Discharge or bleeding from the incision
Sutures falling out or missing
Any tissue protruding from incision
Licking, chewing, or scratching at the sutures is the most common problem associated with sutures and incisions. Incisions can be itchy, irritating or simply annoying. A common response is for the animal to lick or chew at the affected area. Unfortunately, if licking/chewing is allowed to continue, the sutures may be pulled out or infection can develop. As soon as you notice your pet licking at the incision, call your veterinarian.
You may be able to stop your pet from licking when you are nearby but when you are not present, the pet can lick and chew without restraint. A common recommendation is to either cover the wound with a bandage or to use an E- Collar, or Elizabethan collar, which is a flexible plastic lampshade type devise that attaches to your pets collar. The device allows the pet to eat and drink but does not allow him access to parts of his body below the collar.
You might try covering abdominal and chest/body wall incisions with a t-shirt – let your pet's head and front legs go through the head and armholes of the shirt. This covers the wound and allow the pet to be comfortable. Special care must be taken, however, to keep your pet from eating the shirt or bandage, which can cause an intestinal obstruction.
Swelling of the incision is another common complication associated with incisions. Some mild swelling is expected, because, as the body begins to heal the incision, fluid and cells accumulate. However, in some situations, the swelling is excessive. This can indicate the beginning of infection or tissue reaction to the suture material, or it can result when the underlying layer of sutures becomes untied. When the deeper suture layers no longer support the incision, this can lead to herniation of tissues underneath the incision. Any excessive or worrisome swelling should prompt an examination by your veterinarian.
In cases of swelling caused by excessive fluid (often called a seroma), the fluid is sometimes drained. Skin infections are often treated with antibiotics and local wound care (cleaning and bandaging). Wound infection that extends deeper into the tissues often requires surgery in addition to the antibiotic. Wound dehiscence (when the wound opening causes tissues to protrude) is treated surgically by re-closing tissues (also see below) and is an emergency.
For the first few days following surgery, there may be a small amount of clear or slightly blood tinged fluid. This may show up if a dry paper towel or tissue is applied to the incision. However, you should not see fluid dripping from the incision. After the first few days, no discharge should be present at all and any discharge should be reported to your veterinarian. Blood is never a normal discharge, at any time. If you notice any bleeding, try to place a temporary bandage on the incision. Some incisions are in areas not easily bandaged; in that case, apply pressure to the incision and contact your veterinarian immediately. Any drainage that is cloudy or foul smelling may indicate an infection and should be seen by your veterinarian
Missing skin sutures are not a problem if there is no redness, swelling or discharge. If the edges of the skin are still connected, replacing the missing suture is not typically done. If the edges of the skin are no longer together, the suture may need to be replaced to prevent infection or additional sutures from coming out.
Tissue Protruding from Incision
This is potentially the most serious complication associated with incisions. The purpose of sutures is to keep underlying tissues in place and keep the skin edges together to allow for rapid healing. When sutures break down, the underlying tissues have the potential to protrude through the incision and be exposed to the exterior (called wound dehiscence). This can lead to serious infections, which may be fatal. If any tissue is found protruding from the incision, immediately cover the incision with a clean towel and contact your veterinarian or veterinary emergency facility. Emergency treatment is crucial.
Frequent and careful monitoring of any surgical incision is extremely important. Any abnormality should be evaluated and treated as soon as possible. With proper care, most incisions heal without any complications.