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Featured Patient:
Princess a 4 month old, female, spayed, mix breed dog presented to the emergency service for suspicion of smoke inhalation after being trapped in a burning building on 2/1/2008. She was treated with oxygen therapy, IV fluids, pain medication, and antibiotics. Upon admission she had superficial burns at the base of her tail and on her back over her pelvis. She was discharged on 2/4/2008; her smoke inhalation injury was clinically resolved and the burns appeared to be mild and healing. On 2/11/08 she returned to emergency service for her first recheck. At this time there was a large fluid- filled pocket on her back (see image 1). It was determined that she should be transferred to the surgery service where drains were placed and a bandage was applied to the affected area. She was initially managed at home but hospitalization became necessary on 2/15/08 (see image 2). At this time an in-depth discussion took place between the owners and the surgeons regarding Princess’ guarded prognosis due to the extent of her burns. It was agreed upon to perform multiple bandage changes for the next 2-3 months, surgical procedures to remove dying tissue, and surgical procedures as needed to close the burn wound. Princess’ care over the next few weeks required she be placed in our intensive care unit. Her treatment plan was very complex consisting of IV fluids, IV pain medication, and an esophageal feeding tube. IV antibiotics to treat infections and daily anesthesia to debride her burn wound and change her bandage. The burned tissue declared itself fully on 2/18/08 (see image 3). By 2/26/08 the bandage changes were decreased to every other day and Princess was discharged from the hospital. She could now be treated as an outpatient until the burn wound was ready for surgical closure. On 3/17/08 the wound bed was ready for primary closure (see image 4) and surgery was performed without complications. She was discharged 3/18/08, requiring only a few postoperative bandage changes. Princess was re-evaluated on 4/11/08 and there are 2 small areas on her back that she is licking but the majority of her wound is healed. We expect her to be completely healed within 30 days. (see image 5) Currently, Princess is a very happy, healthy puppy who just received her second set of vaccinations. We estimated that Princess’ burn covered 25 % of her body. In human medicine 50% survival is expected in patients with burns that involve 70 to 80 % of the body surface area. The hospital stay is usually long as is physical rehabilitation. The cost even considering insurance is tremendous. Giving the high complication rate and suffering involved patients with burns consisting of 50 % or more of the total body surface area, euthanasia should be strongly considered. Burn wounds affect all aspects of the body including the cardiovascular, circulatory, renal, hepatic, immune, and gastrointestinal systems. One of the most difficult aspects in the management of a patient with extensive burn wounds is the necessity for daily and sometimes hourly evaluation of their physical status and adjustments in their treatment plans. Michael Aronsohn, DACVS David Spranklin, DACVS Brian Daubs, surgery resident
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