A 1-year-old neutered male domestic shorthair cat was examined by the surgical service at our veterinary medical teaching hospital because of a 6-month history of recurrent swelling and draining wounds of the distal aspect of the left forelimb. The cat had been acquired as a stray, and the condition was evident at the time the cat was acquired.
The cat was initially evaluated by a referring veterinarian because of a swollen left forelimb with a small wound with purulent material along the medial aspect of the distal third of the radius. Orbifloxacin (2.2 mg/kg [1 mg/lb], PO, q 24 h) was prescribed for 3 weeks. Six weeks later, the limb was less swollen and the wound along the medial aspect was healing, but a draining tract was evident along the lateral aspect of the limb. Surgical exploration of the swelling was suggested, but the owners elected to continue conservative treatment. Clavamox (12.9 mg/kg [5.9 mg/lb], PO, q 12 h) was prescribed for 4 weeks. Swelling and purulent drainage were still evident during reevaluation 2 weeks later. Examination of radiographs obtained during the reevaluation revealed osteolysis in the distal aspect of the left radius and ulna.
Samples were collected from the draining tract for culture and susceptibility testing, which yielded Staphyloccocus aureus that was resistant to amoxicillin. Clindamycin (10 mg/kg [4.5 mg/lb], PO, q 12 h) was prescribed for 6 weeks. Five weeks later, swelling of the limb had decreased and no drainage was evident, but examination of repeat radiographs revealed no progression of the bony lesions. Referral was recommended because of the recurrent nature of the draining tract when antimicrobials were discontinued and the lack of improvement of the bony lesions.
Four weeks later, the cat was examined at our veterinary medical teaching hospital. During our initial examination, the cat was alert and had normal mentation. A soft fluctuant swelling was evident along the cranial aspect of the distal third of the left radius, but there was no evidence of a fistulous tract. There was no evidence of discomfort during palpation of the limb, and the cat was not lame. A CBC and serum biochemical analysis did not reveal abnormal findings. Craniocaudal and lateromedial radiographic views of the left forelimb revealed a circumferential pattern of osteolysis affecting primarily the lateral and caudal cortex of the ulna and the medial cortex of the radius with minimal periosteal reaction. A circular opacity was evident within the soft tissues and surrounding the radius and ulna circumferentially; this was suggestive of a circular, circumferential foreign body (Figure 1). No progression of bony lysis was visible, compared with results of radiographs obtained by the referring veterinarian 9 and 4 weeks before our initial examination.
Surgical exploration for removal of a suspected foreign body, debridement, and collection of samples for microbial culture was recommended. The cat was anesthetized with isoflurane, and the left forelimb was clipped and prepared for aseptic surgery. Clipping revealed a circumferential scar at the center of the soft tissue swelling along the distal aspect of the radius and ulna (Figure 2).
A craniomedial skin incision was made along the distal third of the left radius. A subcutaneous pocket of purulent material surrounded by thick fibrous tissue was identified. A foreign body (a tight elastic band) was found within the center of the purulent material. The band was severed to ease tension and allow removal (Figure 3). Tissue samples were collected from the fibrous tract and submitted for aerobic and anaerobic culture and susceptibility testing. Cefazolin (22 mg/kg [10 mg/lb], IV) was administered after tissue samples were collected. The surgical site was debrided and lavaged with warm sterile saline (0.9% NaCl) solution. The purulent material appeared to be contained within the thick fibrous tissue capsule that had formed around the elastic band, and the radius and ulna were not visible or palpable. In an effort to prevent further contamination, the surgeon decided not to explore deeper layers of tissues.
To allow postoperative drainage of this infected cavity, a small closed-suction drain system was constructed by removing the syringe adapter of a 19-gauge butterfly catheter. The tubing was fenestrated and placed circumferentially along the entire fibrous tract; the tubing exited the skin through a separate stab incision. The needle end of the butterfly catheter was attached to a 2-mL vacuum serum tube to create a small closed-suction drain system. The subcutaneous tissue layer was closed over the drain by use of an interrupted pattern and a continuous pattern of 3-0 and 4-0 monofilament glycomer 631,a respectively. The skin was closed in a cruciate pattern by use of 4-0 monofilament polypropylene.b A soft padded bandage was placed on the limb to hold and protect the drain and serum tube. Hydromorphone (0.05 mg/kg [0.023 mg/lb], SC) was administered as required after surgery. No fluid was aspirated from the closed-suction drain, and because the cat did not tolerate the bandage or wearing of an Elizabethan collar, the bandage and the drain were removed a few hours after surgery.
The day after surgery, the cat used the limb well with no visible lameness. Minimal swelling of the surgical site was still evident. The cat was discharged to the owners with instructions for administration of meloxicamc (0.1 mg/kg [0.045 mg/lb], PO, q 24 h for 3 days) and clindamycin (10.3 mg/kg [4.7 mg/lb], PO, q 12 h for 7 days) pending results of culture and susceptibility testing. Aerobic bacterial culture yielded S aureus; no anaerobes were isolated. Clindamycin was prescribed for an additional 3 weeks.
Radiographic reexamination was recommended 4 to 6 weeks after surgery to assess progression of the bony lesions and determine whether antimicrobial treatment should be continued. However, the cat was not returned to our veterinary teaching hospital for reevaluation. Telephone communications with the referring veterinarian and owners 1.5 years after foreign body removal revealed that the cat had received a 4-week course of antimicrobials after surgery and recovered uneventfully without recurrence of a draining tract.
Biosyn, Auto Suture Division of Tyco, Pointe Claire, QC, Canada.
Surgipro, Auto Suture Division of Tyco, Pointe Claire, QC, Canada.
Metacam, Boehringer Ingelheim (Canada) Ltd, Burlington, ON, Canada.
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