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Tuesday, November 23, 2010

Pain In The Neck

Back in September I saw a dog for a swelling on the neck.  Apparently the dog had fallen while running back in the Spring, and had landed on a sharp rock.  Since then she .had a bloody swelling on the left side of her neck where she hit the rock.  A previous veterinarian had thought this was a hematoma (blood swelling or clot under the skin) and various treatments hadn't helped.  So she came to me for a second opinion.

I noticed that there was a slight draining tract and some inflamed tissue that was potentially preventing it from closing.  Whatever the cause, we needed to do surgery to try and resolve the issue.  The owner agreed to the procedure, and a couple of weeks later one of my associates performed the surgery. Now keep in mind that this was about four months after the original injury and the problem was still there.

During the surgery my associate found several small slivers of wood in the wound.  She removed them and explored the area, not finding any more pieces.  The site was closed, leaving an area for excessive fluid to drain.  A couple of weeks later I looked at the incision and removed the sutures.  At that time everything looked like it was healing well.  The scab came shortly thereafter and the owner was satisfied.

Then over the last week a spot reappeared in the same location and started to ooze fluid like before.  I looked at it yesterday and felt firm swelling under the skin very similar to the first visit.  There could have been something left behind, though I know my associate is skilled and thorough.  It was also possible that there was some dead tissue that was trapped under the skin.  Whatever the cause, I knew we had to do a second surgery, and likely be more aggressive this time. 

Today I did that surgery and removed the entire tissue around the draining tract. I wanted to make sure we didn't leave anything behind, and so excised the entire area.  It was a bit tricky since I was right next to the trachea and pretty close to the region of the jugular vein.  Even so, I was able to carefully dissect down and around the area and remove the inflamed tissue.  The closure was routine and the dog recovered normally. Afterward I cut open the tissue and found another piece of wood.  This one must have been deep enough that it wasn't easily noticed on the first surgery and wend hidden until it created another tract.  This time, though, because of how much tissue I removed I'm confident that everything will be fine and we won't see another return of this problem.

The whole thing seems like a pretty crazy and freak accident.  Apparently when the dog fell and hit her neck several splinters of wood punctured the skin and were driven deep.  Because the wood wasn't obvious or sticking out, there wasn't an immediate reason to go in surgically.  So these pieces caused a reaction in the body that resulted in a draining tract, and it took six months before the final piece was removed.

Not sure that there's a great lesson here, but I thought it was an interesting case.

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