Case study: wound from dog attack

Management to date: 

He has had three general anaesthetics so far to surgically debride the wounds. Between the surgeries the wounds have been flushed with saline and dressed with Manuka honey. He is currently on noroclav and meloxicam. 

Specialist advice 1st presentation: 

Given the location on the trunk, the best way to deal with this would be to continue to manage the wound open for a little longer until all of the necrotic/infected tissue has been adequately debrided and a healthy granulation bed has formed, then to close the wound surgically. There should be plenty of skin available (or that you can make available) on the trunk and this option will be much faster than second intention healing with a more cosmetic result.

Continue for now with relatively frequent dressing changes: every 2–3 days depending on how much exudate the wound is producing. Honey or Prontosan gel would both be appropriate as a primary layer with a foam dressing as the second layer to absorb exudate and keep the wound moist, but not wet. At each dressing change, under sedation, use a scalpel to debride the yellow unhealthy tissue from the wound back to bleeding tissue. Once all of the necrotic tissue has gone and it looks healthy, either undermine the edges and close primarily (if sufficient skin), or perform a simple advancement flap from caudally or an H-advancement flap from caudal and cranial to close this. A penrose drain could be placed at time of closure in case of ongoing infection and that would also be a good time to take a swab for c & s if you are able.