Case study: Chronic, non-healing wound post radiotherapy and surgery

Management to date: 

Owner tried Manuka honey at the advice of another vet and bandaging and hydrogel and buster collar but he keeps licking through the bandages, or traumatising the wound with the buster collar edges. The wound has been like this for nearly a year. 

Specialist advice:

Radiation wounds are challenging due to death of stem cells within the wound removing healing potential. Best option is to bring new skin/tissue into the area - options are reverse saphenous flap or distant direct flap. Otherwise try to re-stimulate the granulation tissue - advise Prontosan irrigation/soaks to break down biofilm + either cyprofil collagen dressing, or try NPWT or alginate dressing to stimulate. Treat similarly to diabetic ulcer in human. If granulation tissue improves could leave to heal or try punch grafts.

Will try dressings first. If no significant improvement in one month will likely refer for reverse saphenous flap.

Outcome notes: 

13/5/18 Definitely making some progress. Doesn’t look totally healthy yet, but there is more epithelialisation and its smaller, particularly width-ways.