Swanson Elizabeth A, Freeman Lynetta J, Seleem Mohamed N, Snyder Paul W
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.
J Am Vet Med Assoc. 2014 Mar 15;244(6):699-707. doi: 10.2460/javma.244.6.699.
A 4-year-old spayed female Mastiff was evaluated for treatment of chronic nonhealing pressure wounds over both elbow regions resulting from attempts at hypertrophic callus excision.
The wound bed granulation tissue was mottled red and yellow with hyperemic, rolled epithelial edges. The right wound communicated with a large fluid pocket along the thoracic wall. The dog had an inflammatory leukogram with a left shift.
The wounds were debrided, and tissue specimens were collected for histologic evaluation, microbial culture, and bacterial identification by means of molecular diagnostic techniques. The left wound was closed immediately. Calcium alginate rope with silver was packed into the right wound. Vacuum-assisted closure was applied for 6 days. Debridement was repeated, and a thoracodorsal axial pattern flap was used to cover the wound. Systemic treatment with antimicrobials was initiated, and pressure over the elbow regions was relieved. Bacterial biofilms were identified histologically in tissue specimens from both wounds. Staphylococcus intermedius, Staphylococcus epidermidis, and Streptococcus canis were cultured and identified by 16S rRNA fragment sequencing. Pyrosequencing identified multiple bacterial species and no fungal organisms. Both wounds healed successfully.
Biofilms are implicated in infected orthopedic implants in veterinary patients; however, this is the first report of a bacterial biofilm in chronic wounds in a dog. In human wound care, extensive debridement is performed to disrupt the biofilm; a multimodal treatment approach is recommended to delay reformation and help clear the infection. In this case, biofilm reformation was prevented by systemic treatment with antimicrobials, by reducing local pressure on the wounds, and by wound closure.
一只4岁已绝育的雌性獒犬因肘部区域慢性不愈合压疮接受评估，这些压疮是由于肥厚性胼胝切除尝试导致的。
伤口床的肉芽组织呈斑驳的红色和黄色，上皮边缘充血、内卷。右侧伤口与胸壁处的一个大液腔相通。该犬炎症性白细胞计数伴有核左移。
对伤口进行清创，采集组织样本进行组织学评估、微生物培养，并通过分子诊断技术进行细菌鉴定。左侧伤口立即缝合。将含银的海藻酸钙绳填入右侧伤口。应用负压封闭引流6天。重复清创，并使用胸背轴型皮瓣覆盖伤口。开始全身性抗菌治疗，并减轻肘部区域的压力。在两个伤口的组织样本中均通过组织学鉴定出细菌生物膜。培养出中间葡萄球菌、表皮葡萄球菌和犬链球菌，并通过16S rRNA片段测序进行鉴定。焦磷酸测序鉴定出多种细菌物种，未发现真菌。两个伤口均成功愈合。
生物膜与兽医患者的感染性骨科植入物有关；然而，这是犬慢性伤口中细菌生物膜的首次报道。在人类伤口护理中，进行广泛清创以破坏生物膜；建议采用多模式治疗方法以延迟生物膜的重新形成并帮助清除感染。在本病例中，通过全身性抗菌治疗、减轻伤口局部压力和伤口缝合防止了生物膜的重新形成。
