winter 2014 | · winter 2014 | . in this issue: new state-of-the-art . veterinary hospital update:...

WINTER 2014 | www.wear-referrals.co.uk

IN THIS ISSUE:

NEW STATE-OF-THE-ART VETERINARY HOSPITAL UPDATE:

CASE REPORT:DEGLOVING INJURY IN A DSH CAT

T: 01388 602 707 | F: 01388 605 660 | www.wear-referrals.co.uk

INTRODUCTION:Welcome to our Christmas Newsletter. 2014 has been an eventful year for Wear Referrals as our workload had increased dramatically, work started on our new hospital and we have been recruiting intensely for our current referral practice and in anticipation of our move into our new hospital.

PERSONNEL:Orthopaedic & Soft Tissue Surgeon:Alasdair Frost BVM&S Cert SAS MRCVS has started working for Wear Referrals in October 2014. He graduated in 2003 and worked in mixed practice in Lanchester and in Haddington for three years during which he developed an interest in small animal surgery. In October 2007 Alasdair started an internship at Fitzpatrick Referrals during which he was involved in writing scientific journals, radiography, supervising anaesthesia and pain management and assisting in advanced orthopaedic and neurological surgeries.

Alasdair worked at Peace Avenue Veterinary Clinic (PAVC) in Hong Kong for two years where he worked towards his Certificate in Small Animal Surgery which he obtained in September 2011. In September 2012 he founded Hong Kong Referrals, a mobile surgical service for veterinary practices in Hong Kong. During this time he developed a particular interest in TTA in miniature patients and corrective osteotomies for growth deformities.

Practice manager:Stacy Burleigh RVN is our new Practice Manager. She qualified as a veterinary nurse in 1990 while working for Peoples Dispensary for Sick Animals. After qualifying Stacy worked in first opinion practice as both head nurse and later as practice manager. Most recently she worked for Guide Dogs for the Blind Association overseeing the health and welfare of guide dog stock in the North of England. In her current position Stacy is responsible for the day to day running of the clinic. Over the next few months Stacy will work alongside the team to ensure a smooth transition to the new state of the art Veterinary Referral and Emergency Hospital in 2015.

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NEW FAX FOR CLINICAL HISTORIES:

We now have a new fax number which is: 0844 335 1831

Your fax will be transformed into a PDF document which is then automatically attached to an email. This means

that no paper is printed on our fax machine which helps to further reduce our carbon foot print. Please note that

the new email address for clinical histories and radiographs is: [email protected]. Please try

to email clinical histories where possible.

Work on the new Referral and OOH hospital at junction 60 of the A1 is

progressing well. We are currently on schedule to be in by the 16th of March.

The OOH service will start that same day. Work on phase 2 of the hospital has

now started. Phase 2 was planned in three to four years’ time but we decided

to build phase 2 now due to the rapidly increasing workload. Phase 2 will

accommodate an extra theatre, an extra dog ward with only large walk-in

kennels and a hydrotherapy suite with two water treadmills. The hydrotherapy

suite will be in addition to the physiotherapy suite (in phase 1). This will enable

us to provide a complete one-stop rehabilitation service for our clients. Phase 2

is expected to be finished by the middle of May.

Green Credentials:

As you can see from the pictures, the green sedum roof is now on as are the

solar panels. The hospital will be heating by a biomass boilers which use wood

chips as their fuel. The building is highly insulated and it has a high-tech climate

control and heat recovery system. All these features will give the new hospital

significant green credentials with low carbon emissions.

OOH & EMERGENCY SERVICE:

In additional to the referral service we will be opening a dedicated Out-Of-Hours and Emergency service for both

the local veterinary practices and practices further afield.

The emergency service will be open 24/7 and it will be supported by the referral

team. Please speak to Gerard te Lintelo if you are interested in using this service which will be free of charge for

the participating practices.


UPDATE:NEW STATE-OF-THE-ART VETERINARY HOSPITAL

DECEMBER 2014 GREEN ROOF AND SOLAR PANELS AR ON

NOVEMBER 2014DECEMBER 2014 PHASE 2 HAS STARTED

CPD MEETINGS:These are the details for our next two CPD meetings. Our aim is to organise monthly meetings once we have moved into our new hospital. There will be a special lecture room in the new hospital. Tuesday the 20th January 2015, 8 pm | Subject: Front leg lameness in young dogs | Speaker: Alasdair Ossian Frost BVM&S, Cert SAS, MRCVSTuesday the 3rd March 2015, 8 pm | Subject: Wound closure techniques: Tips for closing difficult wounds | Speaker: Jonathan C. Bell BVM&S CertSAS DipECVS MRCVSVenue: Hardwick Hall Hotel, Sedgefield, Co. Durham, TS21 2EH | Please note: Food and drinks are available from 7:30pm.


CASE REPORT:CASE REPORT: DEGLOVING INJURY IN A DSH

Delgloving injuries in small animals usually arise following road traffic accidents and are the result of the animal being dragged along a hard surface. These shearing injuries are characterised by extensive skin loss and often damage to the underlying joints, particularly those of the distal limb. Although these injuries look extremely unpleasant and daunting to manage, almost all of these limbs can be salvaged with appropriate wound management techniques, provided the neurovascular supply to the distal limb is intact.

Maisie is a 6-year-old female domestic short-haired cat who presented with an extensive degloving injury to the antebrachium and caudolateral carpus (figure 1). There was loss of the ligamentous support to the caudolateral carpus, and radiographs showed a fracture of the distal ulnar styloid process. The neurovascular supply to the distal limb was, however, intact, and this limb was readily salvageable.

Figure 1: Photo of degloving injuryThis wound was managed with a moisture-retentive dressing of manuca honey and allevyn. These dressings retain a level of moisture at the wound surface which allows autolytic debridement of devitalised tissues and which promotes granulation tissue formation. Additional support was provided to the carpus in the form of a Robert-Jones dressing to allow Maisie to use the injured leg. These dressings are comfortable and do not need to be changed as frequently as conventional wet-to-dry dressings. Within 10 days, healthy granulation tissue was present and the wound edges were starting to epithelialise (figure 2).

Figure 2: Photo of granulating woundFour weeks after the initial injury the wound had contracted to leave a 5mm strip of exuberant granulation tissue. The gain in skin elasticity over the four weeks allowed excision of the granulation tissue, delayed primary closure and uneventful healing. The carpal joint, however, remained unstable, and Maisie’s limb function was poor. Two weeks after closure of the wound a pancarpal arthrodesis was performed (figure 3).

Discussion.While degloving injuries such as this appear extensive on first presentation, almost all of these limbs are salvageable. As a general rule, wounds with skin loss of 180° or less are amenable to second-intention healing, a method of wound closure which is often overlooked. The concurrent orthopaedic injuries are of secondary concern at the initial presentation, and provided that external support is provided, the patient can continue to use the injured limb until there is a more favourable soft-tissue environment. Some shear injuries to the carpus and hock will adequately stabilise with external support. This was not the case with Maisie and it was necessary to perform a pancarpal arthrodesis. Pancarpal arthrodesis in this case is expected to restore near normal thoracic limb function.

Figure 1

Figure 2

Figure 3

winter 2014 | · winter 2014 | . in this issue: new state-of-the-art . veterinary hospital update:...

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