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Date:   01 September, 2011  

Focus:
 Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
The Jack Russell had a "hole" after spay
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Sunset Hong Kong Island. Toa Payoh VetsI was in Hong Kong on this bright sunshine Sunday August 21, 2011 when I received a phone call from an owner who said that his dog still had a "hole" some 10 days after spaying by Vet 1. "I thought all vets will not discharge a dog when she has a hole," he said from Singapore.

As I was not in Singapore, I told him that I would check the dog out. In the meantime, I asked Dr Vanessa to examine the dog and get the infected surgical wound re-stitched. It was not her case as she did not spay the dog. I had to make sure that I communicate with the owner and that she would do so as the owner was very upset. Crisis do happen in any business and how they are handled will mean a big difference to the reputation of a company. 

I made a phone call to my friend Khin Khin to ensure that she had contacted the owner on my behalf and to ask him to bring the dog to Toa Payoh Vets for treatment. It was a Sunday and I felt that it was not Dr Vanessa's job to phone the owner and therefore I phoned Khin Khin. She did that. When the dog was re-stitched by Dr Vanessa, I asked Khin Khin to phone the owner to let him know too.

Post-operation wound infections do occur to every vet. It is important that the vet check the dog carefully and not discharge the dog if the spay wound is infected.

On Wednesday, Aug 24, 2011, I was back to work at Toa Payoh Vets. The dog was OK. Dr Vanessa's stitches were holding the skin incision cleanly. No inflammation. I phoned the owner to update him. He was quite happy that everything was OK.

Much unhappiness and complaints and litigation can be avoided with good updated communications. This dog was not spayed by me but I could be called up as a witness in cases of litigation in which only the lawyer makes the money. It can be quite time-consuming in answering to complaints from authorities and lawyers even if I am not involved. I will still have to write reports about this complaint. So, I normally handled such post-op complications of other vets with as much care as if they were my complications. A happy owner will seldom bad-mouth a practice, sue or complain.

The important thing is to keep spaying simple. No fanciful subcuticular sutures. But each young vet has his or her own ideas. In this case, subcuticular sutures could have had hindered healing of the skin incision or introduced infection. I don't know as I did not see the "hole" but I had asked Dr Vanessa to take some pictures. As every vet will encounter post-op complications and infections, it is best to keep skin suturing simple. I use horizontal mattress as they are hold better than appositional sutures and may be more difficult for the dog or cat to lick them off. In any case, over 20 years of use of this horizontal mattress stitching pattern absorbable PDS or equivalent sutures in several hundreds of operations had led to around 1 or 2 stitch breakdown. Each vet will have his or her own stitching style and pattern. They all work in closing the skin wound.  

post-spay complications do occur and must be handled well. toapayohvets, singaporeI note that Dr Vanessa has her own appositional stitching as she has her own success with them. Both type of stitching pattern will work. Some dogs just can't stand the stitching or they could be allergic to them. Not all dogs but a small percentage and subcuticular sutures would be very intensely itchy.

Even with e-collars. The spayed dog could just rub her tummy directly onto the floor, the mat and get the wound opened up. Hence the complaint of the "hole" when the dog was sent home after a few days at the vet.

It is best to do a mutual check with the owner before sending home the dog after spay and record the inspection. However, I don't do it and I doubt many vets do that too. It is common sense not to send a spay dog with a "hole" home though.

P.S. I saw the image of the "hole" after spay. The dog had licked away all stitches leaving a big gap. Infections under-run the skin and therefore the skin edges did not close. There was no subcuticular stitches. Debridement, cleaning of the wound and re-stitching of the skin and antibiotics and pain-killers resolve the owner's problem. 
 

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