Medical and Surgical Management of a Large Thermal Burn in a Dog

Background: Thermal wounds are relatively uncommon in veterinary practice and most of them are the result of accidental burns. Patients with severe burns are among the most challenging cases presented to veterinarians, because severe burn injury leads to significant hemodynamic instability, massive fluid shifts, and hypovolemia requiring prompt and aggressive therapy. Because severe burn injury in small animals has been poorly described in the veterinary literature, this case study describes the presentation, complications, medical and surgical treatment of a female dog with an accidental severe burn wound caused by a thermal mattress during an elective surgery. Case: A 6-month-old 9.6 kg female crossbred was referred with 20% total body surface area burned by a thermal mattress during an ovariohysterectomy procedure two days before. The dog presented a severe burn and systemic complications as anemia, leukocytosis, total protein at the lower limit and hyperlactatemia, which were managed with intensive medical care, including administration of crystalloid fluids, colloids, antibiotics, analgesics and enteral nutrition. The large wound was treated with debridement and the use of different kind of dressing to obtain a healthy granulation tissue. As a large portion of the trunk was lost, it was not possible to use axial pattern flaps, so skin-stretching devices and multiple surgical procedures were used until complete wound healing occurred, which took almost six months. Discussion: Burns in small animals are presented in a wide clinical range, from mild to large and deep burns, and carry a serious to grave prognosis. Deep burn injuries that encompass more than 20-30% of the body are classified as severe burn injury, and patients with severe burns are among the most challenging cases presented to veterinarians, and usually they require emergency supportive therapy. It was estimated that the patient in this case had 20% of her total body body surface burned, and according to the depth of tissue destruction, burn was classified as a full-thickness burn. Most burns seen by veterinarians do not involve more than 20% of the body surface area, and as a result, major metabolic derangements, including fluid and electrolyte imbalances, red blood cell destruction, and increased susceptibility to systemic infection, are not likely to be noted. The severity and complexity of the burn demands a thorough knowledge of burn pathology and the highest level of medical and surgical care to ensure a positive outcome. The hypermetabolic state induced by severe burn injury predisposes patients to systemic inflammatory response syndrome, sepsis and multiple organ dysfunction syndrome, as observed in the present report. Full-thickness burns result in complete destruction of all cutaneous structures making surgical intervention necessary to perform excision of necrotic tissue and posterior reconstructive surgery. The skin-stretching device used in the case reported here was useful to help closing many parts of the wound, however, the wound over the dorsal lumbosacral region was less amenable to lateral undermining and advancement, because of the less mobile lateral thigh skin and lacks a panniculus muscle layer. The case described in this report represented a significant management challenge and an expensive treatment because of the several systemic problems and extensive loosening of dorsal trunk skin. Although warming systems are effective in maintaining normothermia in surgical patients, they pose burning hazards to patients, so veterinarians should pay more attention to the probability of burns during surgery.