Abstract
A 35-year-old female Beluga whale (Delphinapterus leucas) was diagnosed with a full thickness skin laceration of unknown etiology. The laceration was located 5–6 cm cranial to the genital slit and extended 20 cm along the left ventral midline. The cranial aspect of the laceration contained a loose flap of tissue that extended laterally 5–6 cm resulting in an 8–10 cm deep wound that exposed deep subcutaneous and mammary gland tissue. The unique skin anatomy of cetaceans provides challenges to laceration repair and wound closure.1,2 Initially the wound was lavaged, packed with KaltostatTM (ConvaTec, Greensboro, NC, USA) and CoronaTM ointment (Summit Industries, Marietta, GA, USA) and primary closure was performed with 1-0 PDS II (Ethicon, Somerville, NJ, USA) skin sutures, leaving the cranial extent open to facilitate drainage. However, the edges of the laceration necrosed and the wound progressed, separating along fascial planes and the deep margin of the left mammary gland. A secondary closure was attempted with more aggressive manual debridement of necrotic tissue using scalpel blades followed by skin edge apposition using five 18 Fr Foley catheters as stents. Foley catheters were placed across the wound defect by undermining the skin using blunt dissection and hemostats. The catheters were held in place on one end by inflating the balloons with water, ligated to preserve inflation, and on the other with IV fluid line clips that could be repositioned to reduce tension.3,4 The catheters remained intact 8 days after secondary closure but follow-up inspection of the wound revealed no granulation tissue and continued necrosis of muscle and connective tissue. The location of the wound near the ventral fulcrum of the peduncle may have been impeding healing by allowing entry of water during normal movement. Local muscle necrosis and loss of tissue continued unabated and the wound appeared to be nearing the parietal peritoneal layer. Tertiary closure was performed, approximately 34 days following original injury, using a waterjet hydrosurgical system to remove necrotic tissue.5 Amikacin impregnated polymethyl methacrylate beads were placed within the wound and the wound was closed by replacing the Foley catheter stents and adding four horizontal mattress sutures with 2-0 nylon using 18 Fr red rubber catheter sections as stents on either edge of the wound.
Waterjet hydrosurgical systems use a high-pressure jet of sterile saline parallel to the wound that spares healthy tissue and removes necrotic tissues.6 Loss of viable tissue is lessened with this debridement method and bacterial loads are also reduced compared with conventional methods.7,8 This system is especially useful for deeper, three-dimensional wounds and is used in human medicine for the treatment of wounds, burns and skin ulcers.9,10 Following the tertiary wound closure, the wound healed uneventfully. All stents were removed two weeks later and edges of the wound were completely healed 48 days after the procedure. A successful outcome was achieved by making use of novel veterinary wound therapies such as a waterjet hydrosurgical system and Foley catheters as stents. These techniques can be applied to other difficult wound closures in non-domestic species.
Acknowledgements
The authors wish to thank Drs. Jimmy Johnson and Katelyn Thomas and Bernadette Maciol, Jennifer Jones and Amanda Janson from John G. Shedd Aquarium, Drs. Mitch Robbins and Adam Mordecai and Jeanette Potter from Veterinary Specialty Center and Dr. Michael Pavletic from Angell Animal Medical Center for their assistance with this case.
* Presenting author
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