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Patient Signalment: 5-Year-Old Male Neutered Shih Tzu

Diagnosis: Degloving Injury of Left Tarsometarsal Region, Resulting in Skin Sloughing and Mixed Bacterial Infection 

History & Diagnosis: The dog was presented on 3/3/25 immediately following vehicular trauma to his left hind leg. Remarkably, no bony injuries were identified. However, the skin had been avulsed from the underlying tissue, extending from just proximal to the hock down to the toes. After several days of conservative management — including a drain, bandaging, oral antibiotics, and pain medication — all of the affected skin sloughed. A culture was obtained at the time of debridement on 3/10/25.

Implantation
March 12, 2025: A pouch flap was created on the left body wall, and the left hind leg was inserted into the flap and sutured in place, along with a fenestrated drain and a 10 mL Vetlen Pouch. The drain was removed on 3/15/25. Antibiotic treatment administered through the pouch. The client was very grateful to discontinue oral antibiotics once the switch to vancomycin was made, as administering oral medications to the patient had been challenging.

Drug and Concentration used in the Vetlen Pouch: Initially ceftiofur sodium, 50 mgdose, qs to 9 mL total volume with 0.9% NaCl (3/12/25 through 3/21/25). Cultureresults revealed multi-drug resistant Enterococcus faecium along with Streptococcus canis and Staphylococcus schleiferi, so the doctor switched tovancomycin hydrochloride, 30mg dose, qs to 6ml total volume with 0.9% NaCl(3/22/25 through 4/1/25).

Explantation
April 2, 2025: The flap of skin was excised from the donor site and was closed over the left distal limb. The Vetlen Pouch was removed, discarded, and the body wall wound was closed routinely. Parts of the flap became necrotic and sloughed; however, the majority has survived with only small areas of open granulating wounds currently remaining. As of today's bandage change, healing is progressing well, and the client is delighted with the result.

Diagnosis and Procedure: Degenerative arthritis of the fetlock joint, pain leading to overloading the other foot. Fetlock arthrodesis was performed.

Treatment:
Amikacin 250 mg/ml
Daily dose administered: 6 ml
Days of treatment: 5 days

Conclusion: Vetlen Pouch worked well. The surgeon liked the ability to instill the antibiotics onto the plate for 5-days post-op. The mare has done well and is back home.