Degloving and shearing (ie, deep degloving) injuries typically occur when an animal is pushed or dragged by a moving vehicle.1-4 The distal limbs are affected more frequently than other parts of the body, with the most common site of injury being the medial tarsus/metatarsus.1,2 Various amounts of skin, subcutaneous tissue, neurovascular supply, muscle, tendon, ligament, and bone are sheared away by frictional forces. The structures that remain may be lacerated or damaged by crushing forces. In addition, debris and bacteria are embedded in the wound. Joint instability and joint capsule penetration are common, as are concurrent injuries in other parts of the body.1-3
OUTCOME
Despite their often severe appearance, the prognosis for shearing wounds is very good with proper care. In a study by Beardsley and Schrader,1 91% of dogs with healed shearing wounds were clinically normal or had only minor functional abnormalities, even dogs that sustained extensive tissue loss and orthopedic damage. In most cases, primary wound closure is not an option due to loss of soft tissue and inability to convert the contaminated wound to a clean wound during initial treatment. Owners should be advised that treatment may require multiple surgeries and prolonged open wound management.1,2
PRETREATMENT CONSIDERATIONS
Patient stabilization and immediately life-threatening injuries take priority over initial wound management. For example, patients with massive blood loss or hypovolemia often need fluid or blood product infusion to improve their cardiovascular status before sedation or anesthesia can be contemplated. To protect wounds while more urgent problems are being managed, they should be covered with a sterile bandage as soon as possible.
Wound assessment may require a local anesthetic, sedation, or general anesthesia. When possible, the patient’s neurologic status should be assessed before anesthetic agents or sedatives are administered.
What You Will Need
For All Cases
- Sterile surgical instruments and supplies (including gloves)
- Clippers
- Sterile water-soluble gel
- Surgical skin scrub
- Lavage solution in IV fluid bag with administration set and 16- to 22-gauge needle
- IV bag pressure cuff
- Analgesics
- Sedatives and/or general anesthetic
- Moisture-retentive dressings (specific dressing selected is based on the amount of wound exudate and the phase of wound healing)7
- Bandage material
For Some Cases
- Splint, cast, or external skeletal fixator
- Orthopedic implants
- Doppler ultrasound probe
- Stents (eg, suture and IV tubing, red rubber catheter, buttons)
- Stent tighteners (eg, hemoclips, split-shot fishing sinkers)
STEP-BY-STEP MANAGING DEGLOVING & SHEARING INJURIES