Post Skin Graft Infection

[Guest]

Here's the story:

A month ago, my kitten Mythie developed an infection, just around her anal area. We're still unsure as to how she got it... It could have been a bite, a scratch, a nip from one of the older cats with whom she is very fond of wrestling with... It could have been anything.

This wound, due to it's location, got infected.

Unfortunately, because she had a fairly large pouch of fat developing, when we took her to the emergency vet she was diagnosed as having a digestive tract problem... A day later, we took her from the emergency vet to our vet and by the time she got there was meowing in pain and her tummy looked very swollen.

SO they did an Xray. The xray turned up what looked like a blockage so, we were all convinced that she had swallowed something. The vet decided to wait another day or so, to see if she would pass the object as it was moving down the digestive tract. Meanwhile she was put on pain killers and laxatives.

Anyway, on Monday, three days later, while the vet was inspecting her to see if the object had moved down any further, the vet noticed that she was oozing something fairly smelly from her tummy. He picked her up and apparently the whole area of fat, that usually starts to develop between the hind legs fell away...

She had developed severs tissue necrosis. And this caused a huge open wound. So she spent the next three weeks at the vet. While he waited for the wound to close a bit and decided on wether he thought it was necessary to do a skin graft or not.

Then a couple of days ago, on wednesday he did the skin graft. What he did was he pulled the skin from the tummy fat that was starting to develop again down over the exposed area and stitched it up...

Since then one side of the wound is healing well, while the other side has gotten an infection. The vet says this is largely due to fecal content as the wound is so near the anus. Now, what i'm concerned about is that today one of the stitches burst, and there was a lot of puss etc.

So the vet released a couple more stitches in that area of the wound and inserted some gauze... to absorb the oozey stuff... they're going to change this twice a day and she's on antibiotic shots...

What gets to me is that... it doesn't seem that we are any farther off from where we started. what i mean by saying this is that, she had tissue necrosis to begin with, and after the skin graft etc, we are still dealing with infected tissue...

I worry that she has ben on anti bios for so long, and i'm also worried that as soon as she comes off it, what's to stop the infection from coming back?

I don't know... I mean there's only so much i can hound my vet before human natyre starts to take it's toll and he gets annoyed. I'm beginning to think that he should have just let the wound heal in stead of doing the skin graft.

She has been stitched up, all the way along the join between hind legs and tummy... and now she has just where the hind legs end and her genitals begin got a large wedge of gauze inserted under the skin...


Somehow, it just doesn't seem right... It doesn't seem right that she is constantly oozing serum either. I don't see how she is supposed to heal when the wound is constantly wet.

Other factors such as her being at the vet for a month... constantly being poked and prodded and uncomfortable... I don't know how much more of this she can take? She's only just a kitten still. We're planning on starting to bring her home for a few hours everyday, just so she's not SO alone, and plus it'll be easier to re-introduce the cats again.

Do you have any experience with this sort of thing? Are there any questions i should be asking the vet? Will she pull through this i sometimes wonder... What happens if the wound just refuses to heal? Can that happen? I just wish we could see the light at the end of tunnel... If you think of anything, please let me know. I'm really at my wits end about this. I feel utterly helpless...

This is a diagram of what has happened:
Red x = stitches removed to clean the infection
Black x = stitched area
Green Dot = where gauze has been inserted UNDER the skin to dry up the oozey stuff



And this is Mythie a couple of weeks before it happened...

[Traci]

Let me see if I understand correctly....the developing fat was actually an abcess developing, undetected previously by you and your vet? Was there no obvious signs of puncture wound or gash, open wound in the abdominal region until three days later?

(my guess is that there was a wound going undetected, was kitty outside before you noticed the wound near the anus?)

"Waited three weeks while he waited for the wound to close"....what treatment did he approach in those three weeks, was the wound flushed, drained daily and were injectable antibiotics given daily? Was debridement done on a daily or every-other-day basis? (removal of necrotic skin)

Was kitty on IV fluid support, incubation or any other emergency treatment during these three weeks? Did her temperature ever fall below normal or in a danger state? Was there any loss of blood or anemia?

Based ONLY on your post, it sounds like the vet took a great deal of time to treat this before considering grafting. Not knowing the antibiotic approach, other care methods given, and wound cleaning techniques, I hesitate to comment on WHY it's taking so long to heal. One thing I would be concerned with is packing the wound with gauze, this might actually introduce further bacteria. If it is still a large gaping wound and draining blood as well as pus, I can see where packing would be necessary, but if the wound is closed or closed enough only to allow small drainage, I'm not sure packing is ideal. (without seeing her and the wound, I don't want to make guesses here)

How is her attitude, appetite, urination/bowel function? Is she having additional problems with normal functions? Did your vet find the source of the original infection? (trauma, puncture from bite wound from cat or dog, bacteria in the GI, peritonitis from other sources)

I think I would get a second opinion immediately. While the vet may be doing everything he can to graft and promote healing, it may be a technique he is not accustomed to, improper antibiotic support, and nursing care during her recovery. I also worry about her developing depression in the clinical setting, depression can halt healing and prevent kitty from finding strength and reserves in order to heal. She doesn't look much older than 6 months of age, and I would worry about her ability to overcome peritonitis. Please, don't wait on this, get her to a more experienced vet ASAP.....most emergency vets are equipped and experienced to handle serious cases such as this, but it may be this vet in particular is inexperienced. See another vet promptly and/or fax kitty's records to them for review so they know what approach has been taken, what type antibiotics given, nursing and wound care applied, vitals, etc.

[Guest]

You see, at first, she was straining to go the toilet, and she threw up twice. This was the day we rushed her to the emergency vet. They began treating her for parasites. I wasn't happy with this diagnosis so I took her into our normal vet, who did the xray etc...

We just weren't comfortable with the emergency vet as they just weren't delivering the standard/quality of treatment that we are used to with our vet...

At this time, there was no way of us knowing if she had a cut. I mean in all fairness to our vet it wasn't possible to know that it was a cut... In fact, we never found out what it was that caused it to begin with.

But Mythie is not an outdoor cat. We live in an apratment so, it wasn't a fight with a stray, though it could have been a tussle with one of ourother cats that caused it.

The necrotic skin was removed and they cleaned the wound 2 times a day, and she was on antibios to stop the infection, and the first couple of days she was on IV, until she started eating again... her temperature was elevated for the first few days but it has been normal ever since. No blood loss or anaemia.

The area being packed with gauze is quite small, a little more than an inch in diameter and depth... Of course the gauze has been cleaned and an antibio cream has been used as well. she s now getting antibio shots instead of medication.

She has a HUGE appetite. She's emotionally really good considering all that she has been through... The only thing is that the last 3-4days her stool has been slightly loose, no diahrhhea just a bit loose.

I'm not sure if there's much point in getting a second opinion, primarily as our vet is the best vet in town [also the most expensive, but we don't mind as we know we're paying for the experience he has]. And i'm not just saying that... we are really confident in him, and his abilities... Also he has 4 other surgeries and the vets from the other surgeries rotate so, there has been a lot of input from different sources on her case already...

Also, we know that they are taking especial care with her as it was our vet, who found her and her brother on the road side when they were still babies with their eyes closed... and he and the vets at the surgery hand raised her... So, while i'm aware that uner normal circumstances a second opinion might be necessary, in this case i think we're pretty safe...

We are planning as i mentioned on bringing her home for a couple of hourse everday as of tomorrow... I myself have been going everyday for a couple of hours to play with her, and we've also been treating her with reiki.

I will however ask the vet about peritonitis, and ... i guess there's no harm in getting a second opinion either... the biggest problem about getting her a second opinion is finding a vet with better credentials...

If we do, i shall take her in on one of the days we bring her back from the vet...

Is there any thing we can do, alternative remedies etc to promote healing?
The reiki is helping, emotionally and with some aspects of the healing. For example the vets continue to be amazed at how well she healed in that 3 week period... One of them is actually considering learning reiki themselves!

What do you mean by peritonitis? what are the signs that she might have this? I shall ask my vet to check for it today when i go... but, what happens if she has it and how might she have gotten it?

[Guest]

Do you think it could be a re-action to being vaccinated?
Is that a possibility?

[Guest]

I just did some reading on the net about FIP... I really hope she hasn't developed this...

what signs would she have if she is developing it?

[MA]

Just would like to interject that just because he is expensive and has lots of associates, does not mean he is good. I am just drawing from my own experience in my neck of the woods. A second pair of eyes on the situation is always a good idea.It does seem like this vet stalled for awhile in treating this kitten. My heart goes out to Mythie, she has to be so uncomfortable and lonely.

[Traci]

Peritonitis is a serious infection that can invade the abdominal cavity, it requires agressive treatment, usually with penicillin-type drugs. Sometimes it is a result of GI tract bacteria, other causes are from wounds, abcesses, organ infections, trauma-induced problems. From the initial account of your situation, I'd say she was suffering from peritonitis initially, but if you feel her attitude and appetite, etc is improving, chances are, the antibiotic approach is making a difference. However, in wound cases such as this, the potential for peritonitis is always there during any point of recovery.

I did think of one thing, that being.....was she recently spayed before this incident? I understand the initial concern was the wound at the anal area, but if a spay was recently performed, I am wondering if a secondary bacterial infection occured to escalate the problem.

Vaccinations do not cause bacterial infection or peritonitis. In immune compromised situations, they may exacerbate existing conditions, or slow recovery time from a current condition. In this case, vaccinations would not be a differential.

I'm sorry, but I place no faith or stock in alternative treatments, least of all reiki. My personal opinion is that reiki is a belief system, not an evidence-based approach in medicine. I would question any vet who told you he/she was interested in learning/practicing reiki on his patients simply based on your anectdotal claims. While you are entitled to your own belief system, reiki would not have a part of your kitten's medical intervention or recovery.

As for other alternative treatment approaches, I will not recommend them. We're talking about a serious, necrotic sizeable wound here, I cannot nor will not tell you in good faith or confidence that any alternative method would heal your kitten. The correct approach is aggressive antibiotics (penicillin-type), proper and agressive nursing care and wound care, nutritional support, fluid support where necessary and probably tincture of time to promote healing. Might I suggest observing when your vet is attempting a graft or cleaning the wound, then you will see for yourself how serious this truly is. I'm not questioning your ability to understand the seriousness, I'm simply suggesting observing so that you understand the treatment and care involved.

I read your thread on MA's board, and by most accounts, it would seem that she is beginning to heal. But, the current problem with the sutures, one side of the wound continues to be infected, and continues to be risky. Again, I do not know what type antibiotics were approached, and the level of nursing care given. I have to take your posts into account to gather that information. Until the infection is clearing, and until the wound edges begin to granulate with new tissue, the potential for persistent infection is there (including peritonitis). Her eating and seemingly good attitude and responsiveness are all good signs, hopefully she will continue to improve with each day, but when you are considering bringing her home for a few hours each day, keep in mind that stress needs to be minimized at all costs. Transferring could lead to stress and that's the last thing you need to deal with right now. I understand the need for her to be in her own environment and to be able to bond with you, etc....but please keep an eagle eye on her behavior, attitude, eating habits, etc. If it gets to the point where she is agitated, depressed or stressed in the least, then discuss care in the clnicial setting only until your vet gets a handle on this.

As for the soft stools, it could be from a number of things. Infection, the type of food they are feeding her in the clinic, antibiotics, pain meds, combination of medications and stress. Your vet has medications available to help keep the colon functioning normally, and he can give her fluids where necessary to curb dehydration.

Don't be afraid to discuss these matters with your vet. You need to know how he is treating your kitten so that you understand what is involved in her care and recovery. Keep a daily log to record every day of improvement, medications given, etc and discuss them with your vet.

Hang in there and be persistent with your vet.....I'm praying and sending healing thoughts for your kitten, poor baby.....

[Traci]

If you looked up peritonitis in a search and came up with FIP, I should be clear that it is not the same thing. Peritonitis as it applies to your kitty is exactly as I described above.

Feline Infectious Peritonitis is a viral disease that targets the organs or abdominal cavity. Since your search, you've probably learned more than you want to know about FIP. In your kitten's case, it is unlikely that FIP is a concern. In your case it started with an abcess, another abcess developed, and further complications developed. FIP symptoms would be much more obvious, if your vet has seen cases of FIP, he would have ruled that out immediately simply by viewing the fluid from the abdominal cavity, tested it, and would have taken an account of her history, exposure, clinical signs and symptoms.

[Guest]

Just would like to interject that just because he is expensive and has lots of associates, does not mean he is good. I am just drawing from my own experience in my neck of the woods. A second pair of eyes on the situation is always a good idea.It does seem like this vet stalled for awhile in treating this kitten. My heart goes out to Mythie, she has to be so uncomfortable and lonely.

Yeah... I know what you mean about the expense factor. I think our level of comfort with has more to do with the fact that from what we've seen and heard about him, he really is just a good vet. And it's also they way they treat the animals. They're very very gentle and careful. We've had some experience with less, professional vets...

But i also think that at some point, we should get her a second opinion. Perhaps this week...

[Guest]

She hasn't been spayed yet.