Abstract

A 6-week-old female tiger (Panthera tigris) weighing 4 kg was presented to the University of Florida College of Veterinary Medicine, Zoological Medicine Department 1 week after being attacked by an adult tiger. The young tiger suffered multiple severe skin lacerations (including a degloving injury to the left hind leg) and had to have its ears and tail amputated at a local veterinarian. The lacerations were cleaned and sutured, but after 1 week the lesions were infected and dehiscing, the tiger was weak and anemic. Intravenous fluid therapy, nasogastric tube, CBC, chemistries, wound culture and systemic antibiotics were initiated. The wounds were treated with wet-to-dry bandages that were changed daily under isoflurane anesthesia.

Most wounds healed within 2 weeks, except one large defect over the left leg that could not be closed. This wound developed into an indolent “pocket” wound, condition commonly seen in felids where the wound fails to contract and epithelialize despite the presence of a healthy granulation bed.^2,4 A caudal superficial epigastric skin flap was surgically utilized to cover the defect, but did not adhere well to the granulation tissue over a period of 1 month and became severely infected despite the daily bandage changes.

At that point, 4 weeks post-surgery (6 weeks post-presentation), University of Florida Shands’ Hospital Burn Unit staff was consulted and a novel technique called the Vacuum-Assisted Closure (VAC, Kinetic Concepts Inc, San Antonio, TX, USA) was attempted on this animal. This technique is currently used in humans with burns, acute and chronic wounds as well as skin grafts and is proven to quicken healing compared to standard wet-to-dry bandages.^1,3 A silver coated dressing was placed over the wounds (Acticoat burn dressing, Westaim Biomedical) to control infection. A sterile sponge was placed on the defect, covered with transparent adhesive dressings (Steri-Drape and Tegaderm, 3M, St. Paul, MN, USA) and sealed using a protective skin barrier (Stomahesive paste, Convatec, Bristol-Squibb, Princeton, NJ, USA). The covered wound was hooked up to a suction pump via a plastic tubing that created constant subatmospheric pressure on the wound. Systemic antibiotics were stopped, and the tiger was placed under this negative pressure bandage continuously for 4 weeks.

The VAC system expedites wound healing by creating a subatmospheric pressure on the wound, increasing blood flow, creating a quicker granulation rate formation and reduced tissue. The bandages were changed every other day under general anesthesia because the animal would not let us change it awake. The infection cleared up and the flap finally adhered after 4 weeks of VAC therapy (10 weeks post-presentation). The remaining deficit was treated using wet-to-dry bandages and let to heal by secondary intention. The tiger was sent back home 4 months after presentation, weighing 24 kg. In conclusion, the technique revealed to be very effective, although high maintenance. This presentation covers the management of chronic wound in a young growing carnivore with the use of a new technique (VAC).

Acknowledgments

Thanks to all the University of Florida Wildlife ward staff and students on the rotation for the extensive management of this case, the Surgery department for their help and advice, to Dr. Mozingo and the University of Florida, Shands Hospital Burn Unit department for their help, advice and donation of equipment and material. Thanks to KCI for donating their pump to the Zoological Medicine department.

Literature Cited

1.  Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. Wounds: a compendium of clinical research and practice. 2000;12:60–67.

2.  Lascelles BD, White RA. Combined omental pedicle grafts and thoracodorsal axial pattern flaps for the reconstruction of chronic, nonhealing axillary wounds in cats. Vet Surg. 2001;30:380–385.

3.  Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Annals of plastic surgery. 1997;38:553–562.

4.  Pavletic MM. Atlas of Small Animal Reconstructive Surgery, 2nd ed. Philadelphia, PA: WB Saunders; 1999.