One of the more interesting surgeries I saw while on the Chief Medicine service was an exploratory wound debridement. Our patient was a 2-year-old Lab mix, an adorable bundle of energy despite a melon-sized mass extending from his inner thigh and inguinal region to his underbelly. The mass had appeared 5 days ago when the owner noticed a golfball-sized lump that grew to the size of a baseball within a day. Bloodwork showed signs of infection and drastic blood loss, and an ultrasound of the mass showed evidence of a huge organized blood clot. The Lab received 2 blood transfusions and antibiotics in-hospital, and when it became clear that the abcessed hematoma (infected blood clot) wouldn’t resolve on its own, the dog was referred to our specialized teaching hospital.
The melon-sized mass looked even more dramatic when the Lab was positioned on his back under anesthesia. After the surgery technicians clipped and rough-prepped his thigh and belly, the senior surgery resident felt the mass again and decided on her surgical approach. Since we didn’t know if the mass was cancerous or caused by an embedded foreign object, we hardly knew what to expect.
It was difficult to incise the thick, fibrous capsule of the mass, and all of us jumped when a gout of old brown blood spurted several inches into the air. My stomach rolled when the surgeon started removing handfuls of clotted blood, but soon the surgeon turned her attention to exploring the extent of the wound and the health of the surrounding tissue. After removing a fair amount of unviable tissue, the surgeon found some small wood splinters and a 3-cm extension of the wound heading deep into the groin in the exact location of the femoral artery and vein, with some residual active bleeding. It seemed most likely that our friend ran into a stick that lacerated his femoral vessels.
The surgeon finished removing all traces of dead tissue, placed a drain to prevent any blood or oozing fluids from continuing to accumulate, then sutured everything up. The crazy Lab ended up staying another 2 days before being sent home with the drain still in place due to financial limitations. The owner was instructed to empty the drain and quantify how much fluid was produced every 4 hours. Once the amount of fluid being drained dwindled, the Lab’s primary vet could remove the drain. It was a surprising case from start to finish, but the best part was the fact that the Lab mix recovered well!