SOME OF OUR PATIENTS: “Lily"
Lily, a very pretty blue-eyed white cat, was getting to an
age where she wanted to explore her neighbourhood and meet new
friends. Unfortunately she hadn't yet learned about motor cars
and although unlike most cats of her colouring who are deaf
her hearing is perfect, it didn't prevent her having an altercation
with one. Her owners found her in a really sorry state; both
front legs had obviously been run over by the car and were very
badly damaged. She was also bleeding from one nostril so there
were worries she had suffered a severe head injury, although
she was conscious and responsive. She was immediately taken
to the emergency vet for treatment and assessment of the damage.
The nose bleed stopped quite quickly and there seemed to be
no other injuries to any other part of her body than her front
legs but both were bleeding profusely and it was obvious that
she had lost quite a lot of skin from them.
She was treated for shock and when the vet was happy she wasn't
in any danger, given a general anaesthetic to check the damage.
Miraculously, there was no damage to the bones in either leg,
but there were horrendous soft tissue injuries. The left fore
had the lesser of the damage, with mainly the lower part of
the leg being struck. However, she had lost a lot of skin around
her toes and "wrist" area and there was quite a lot of contamination
from the road. The wounds were thoroughly cleaned up and a few
loose sutures were put in to keep the edges close together to
start the healing process. It's not a good idea to try and get
all the edges perfectly together in a case like this; firstly,
a lot of skin was missing so there naturally would be gaps and
secondly, no matter how carefully you clean and even with immediate
antibiotic cover, there is always a high risk of trapping infection
under the sutures, leading to them bursting open a few days
later. By loosely apposing the skin edges, you are encouraging
healing but allowing any infection to drain away.
right leg was another matter. There was severe skin damage along
the full length of this leg, from the elbow to her toes. Not
only had the skin been ripped away but there was evidence that
the leg had been crushed, with the possibility of the blood
vessels being permanently damaged. If the blood supply to an
area has been affected, then problems such as necrosis (tissue
death) and gangrene are a real threat, leading to amputation.
From her "wrist" down, about 80% of the skin had been ripped
away, exposing the bones, although there was a narrow strip
of skin left down the back of this area. Above the "wrist" was
just as bad; again all the skin from the front of the leg right
up to the elbow was missing but at least there was a wider strip
at the back. Worryingly, the remaining portion of skin was quite
bruised and discoloured. Both legs were very carefully and thoroughly
cleaned, the left had some sutures put in and dressed but there
was too much missing skin from the right one so this had to
be dressed only.
Lily was given antibiotics and painkillers and hospitalised
overnight on an intravenous drip to counteract shock and replace
some of the fluids she had lost due to the accident. The next
morning she was obviously very stiff & sore but managing a purr
when spoken to, and even a little food! There a was a little
bit of discharge on both bandages but she was quite comfortable
and trying to get around on 3 legs so she was booked into theatre
for another anaesthetic and reassess her injuries. When the
dressings were removed, the left leg was looking very good.
The sutures were still in place and everything was looking nice
and pink and healthy. Even at this early stage, there was some
evidence of healing and so the leg was left undressed to encourage
the new skin to grow.
The right leg however, was a bit more serious. One good sign
was that the leg started to bleed as the bandage was removed,
showing that the blood vessels hadn't been damaged in the accident.
The upper part of the leg, although very gory looking, was not
looking too bad (or as good as a leg can look without much skin
left!!) but worryingly, the paw was swollen. However, it felt
nice and warm, a sign that the blood supply is good and so a
special dressing was applied to help promote quick healing.
It was decided that the best course of action would be to have
Lily in for the day every 4 days to sedate her and redress the
right leg - it would be too painful just yet to do them without
any form of anaesthetic.
the next dressing change, the left leg was looking very good
but on the right leg there was a large patch of black skin,
meaning that there had been a problem with the blood supply
to it and it had died. There was nothing we could do at this
stage; it would just have to be left to eventually come away
from the leg and be replaced with new skin. This was the pattern
for the next few dressing changes - more of the skin was dying
off but there was evidence of new skin starting to grow. After
a couple of weeks, there was a slight hiccup when things looked
like they had taken a step backwards. One of the tendons in
the lower part of her leg had become exposed and it also looked
like there was going to be an excess of granulating tissue,
so it was necessary to actually trim away some of the new flesh.
In fact, this had to be done a couple of times - it seemed that
Lily was trying to heal a bit too well!
Once all the dead areas had sloughed off, the healing started
with a vengeance and every time the dressing was changed (twice
a week), the part left to heal over got smaller and smaller.
Finally, 2 months after the accident, the leg was completely
covered with skin and could be left without a dressing, much
to everyone's relief! Because it had been covered up for so
long with a thick padded dressing and the tendons had been scarred
in the accident, rather than immediately start using the leg
normally again, Lily waved it around in the air somewhat. The
muscles had atrophied slightly with the lack of use, but within
a few days, it was looking and behaving like a normal leg again,
and now exposed to the air again, the fur started to grow.
At her last check up, Lily was once a gain the proud owner
of 2 hairy front-legs! Addendum: shortly after her last visit
to attend to her leg, Lily was noted to be somewhat "fruity".
We're now awaiting a litter of little Lilies- we hope they don't
take after their mum in all respects!
Above: a note of thanks from Lily's family. It's things
like this which make our jobs as vets and nurses all worthwhile.