Incision filling with fluid {Any veterinarians here?}

[supercorndogs]

My dogs had tumor removed from his shoulder a few weeks back. It was 14oz and required big cut. The drain came out a couple weeks ago, the stitches came out last week, at which time the vet poked it with a big needle and drained it. It refilled over the weekend, and I took him in and they lanced it, and cut a little bit back open so it could drain then packed it. I pulled the packing yesterday morning as instructed. By the afternoon, I could feel the fluid in it again, and I squeezed it until probably a tablespoon squirted out. I wrapped it, but its on his front quarter directly above his leg. So its hard to get pressure the direction I want, without squeezing the wound the other way, an creating air space to fill with fluid. I squeezed half a teaspoon this morning, after removing the wrap to give him a break from it. I stayed home from work to squeeze it every thirty minutes to hour, and hope it will dry out some and stick down and start to heal.

I was wondering if benadryl would reduce the fluid filling the wound. Or if anyone has any suggestions or helpful hints.

 

[UKDslayer]

You are describing a "seroma" (providing fluid is "serosanguineos" = clear to blood tinged). Very common after many surgeries (not docs faults). Here's the deal - you were probably instructed in pulling out the packing too soon. I have lots of experience here - but on humans (I can't imagine much different in this case). When you have a closed "empty" space, you need to gradually remove the packing (iodoform tape gauze is perfect for this - it comes in 1/2" long and my favorite 1/4"), a little every two to three days while the granulation (scar) tissue forms from the wall of that empty space gradually forms to close that space. It might need to be repacked with this in mind, especially if the amount doesn't decrease every day. If its repacked,the gauze gradually pulled out a little at a time (If you tell me the size of the "pocket" I can give you an idea of how much/how often to pull the gauze - usually a little every 2 or 3 days). Probably a shot of antibiotics or if your dog is good taking pills is a not a bad idea, or at least have ready on hand in case any that fluid turns with cloudiness or purulence (pus) starts to because eventually these do often get infected. With a half of teaspoon of fluid (2/2.5 cc?) then it might not need repacking, but again it depends on size. If it still has a sizable "air pocket", may need repacking. (so more info please..)

No Benadryl won't help the fluid, but giving it 30-45 minutes before manipulate this spot might make your dog more comfortable.

Edit: I should add, especially if this is a large surgery for the size of your animal which is sounds like, if that pocket gets infected all the internal sutures can dissolve too quickly and the whole thing can dehisce (all sutures fail and the whole wound pops open)...which would be horrible...because at that point you can't just sew it back together and have to let that huge wound heal in. Make sure you wash your hands before handling, and a good idea to wear new gloves (even if not sterile) with handling. If you can cover the opening, better.

 

[Alphatreedog]

Fish Amoxicillin . You can get it online . Open capsule and sprinkle over half a slice of peanut butter on bread . Check online for weight dosage .
Used it on my Lab for occasional ear infections and a paw infection once .
She made it to 16 years old .
Good luck .

 

[supercorndogs]

You are describing a "seroma" (providing fluid is "serosanguineos" = clear to blood tinged). Very common after many surgeries (not docs faults). Here's the deal - you were probably instructed in pulling out the packing too soon. I have lots of experience here - but on humans (I can't imagine much different in this case). When you have a closed "empty" space, you need to gradually remove the packing (iodoform tape gauze is perfect for this - it comes in 1/2" long and my favorite 1/4"), a little every two to three days while the granulation (scar) tissue forms from the wall of that empty space gradually forms to close that space. It might need to be repacked with this in mind, especially if the amount doesn't decrease every day. If its repacked,the gauze gradually pulled out a little at a time (If you tell me the size of the "pocket" I can give you an idea of how much/how often to pull the gauze - usually a little every 2 or 3 days). Probably a shot of antibiotics or if your dog is good taking pills is a not a bad idea, or at least have ready on hand in case any that fluid turns with cloudiness or purulence (pus) starts to because eventually these do often get infected. With a half of teaspoon of fluid (2/2.5 cc?) then it might not need repacking, but again it depends on size. If it still has a sizable "air pocket", may need repacking. (so more info please..)

No Benadryl won't help the fluid, but giving it 30-45 minutes before manipulate this spot might make your dog more comfortable.

Edit: I should add, especially if this is a large surgery for the size of your animal which is sounds like, if that pocket gets infected all the internal sutures can dissolve too quickly and the whole thing can dehisce (all sutures fail and the whole wound pops open)...which would be horrible...because at that point you can't just sew it back together and have to let that huge wound heal in. Make sure you wash your hands before handling, and a good idea to wear new gloves (even if not sterile) with handling. If you can cover the opening, better.

Probably partially my fault, we could have left the drain in longer, the vet also said he though maybe he should have left it little more open around the bottom of the drain.

Drain was in for 5 days, the stitches came out 5 days later. I think today is 21 days post surgery. This morning I haven't got much of anything out and it seems to be sticking down. I have been holding pressure on the incision above the new incision 1/2" long probably, for maybe 15 minutes at time, working any fluid toward the hole and out. I try to stay away from the open cut.

I called the vet a minute ago and he advised to keep doing what I am doing. I haven't really gotten any fluid out since 7:30, maybe enough to make a drip. The skin seems to be sticking down. The vet said the fluid has been clear all along, and he didn't think antibiotics were necessary.

Hopefully this can be pulled off with out another vet trip and repacking. He has hated going to vet since he was 4 and had his ears rinsed for ear mites. Its funny its the only time I have ever seen this vet say, "that dog is making a little nervous." Poke him, cut him, give him shots, drain his wound, mess with his cut, fine......Rinse his ears, AH HELL NO.

I am not sure how the big the cavity is, the tumor was probably 3-4" circle. The packing i pulled yesterday morning was about 4" long.

 

[UKDslayer]

Just keep a close eye on the color and consistency of the drainage and whether you can appreciate a large empty space under the wound (with minimal handling - you are correct not to squeeze, you can apply a little pressure directly down to drain and get an idea). If its "stuck" down, don't try to manipulate it too much, but if there is an obvious space, that might be trouble - it will fill again. Little drainage that you described prior ok. Can always text vet pics/videos too. Worthwhile to invest in sterile gauze of you don't have it, but trust the vet.
Edit: I'm not surprised he didn't want to give antibiotics, if the fluid is clear no need UNLESS it changes. Human docs have to practice "prophylactic medicine" to due high malpractice. Sounds like you have a responsive vet that will act quickly if the drainage changes, but its ON you to notify them if it does.

 

[NoDopes]

would squirting a little distilled water in to flush it out when changing the bandage help? I know this was the proceedure for somebody with a similar gaping hole while healing.

 

[Supersubes]

We just went through something similar with our dog. This is the site of a tracheotomy. It blew up like this this right after we removed the stitches. It was drained once and almost immediately returned. Doc then added this drain, which was left in for 10-12 days. Worked like a charm. Daily I would disenfect the area, thread the drain back and forth a bit which would release fluid, then re-disinfect.


Nickname “Ballchinian”

 

[UKDslayer]

Thats technically not a "drain" (a drain is actually tubing with a lumen), this is the iodoform gauze tape in rope form packing I mentioned. But same result. Slightly different if you were told to thread drain back and forth, that had to be uncomfortable to your dog. Light direct straight downward pressure I would think would be better...but again in human realm. It worked, so what do I know...
Edit: excellent wound edge apposition. All vets do surgery, but you can tell when your animal had a surgical" vet expert like here.

 

[UKDslayer]

would squirting a little distilled water in to flush it out when changing the bandage help? I know this was the proceedure for somebody with a similar gaping hole while healing.

The problem is being careful the water remains sterile as quirted, but yes it could basically act as lubrication.I would pack so that the tape so it was in the middle off the space, not off near an edge of tissue, so their is little drag agains the wound "wall"/tissue to cause discomfort.

 

[supercorndogs]

Just keep a close eye on the color and consistency of the drainage and whether you can appreciate a large empty space under the wound (with minimal handling - you are correct not to squeeze, you can apply a little pressure directly down to drain and get an idea). If its "stuck" down, don't try to manipulate it too much, but if there is an obvious space, that might be trouble - it will fill again. Little drainage that you described prior ok. Can always text vet pics/videos too. Worthwhile to invest in sterile gauze of you don't have it, but trust the vet.
Edit: I'm not surprised he didn't want to give antibiotics, if the fluid is clear no need UNLESS it changes. Human docs have to practice "prophylactic medicine" to due high malpractice. Sounds like you have a responsive vet that will act quickly if the drainage changes, but its ON you to notify them if it does.

We have antibiotics on hand. The vet is an old cowboy and probably one of my favorite people in the world. He is never hard to get a hold of, or i can have my mom call his daughter.

Squeeze was a bad word. I am applying pressure downwards, trying to move everything as little as possible and trying to keep him laying down, and not moving around a lot. It seems to be getting better. What I am getting now is more the consistency of honey instead of water, and I can see the skin is sticking down underneath where it wasn't. I will maintain course at least through tomorrow.

Thank you. I appreciate you taking the time.

The drain and incision was stressful because it was right where he could really scratch it with his back foot.

He is 99% inside right now, trying too keep everything clean. Terrible picture. I left my GI joe phone case on.

 

[supercorndogs]

Its in about the worst possible place.

A little cream cheese, sliced cheese, or Velveta works great for my dogs taking pills.

 

[UKDslayer]

What I am getting now is more the consistency of honey instead of water, and I can see the skin is sticking down underneath where it wasn't.

The increase in thickness like honey is good too (thats shows coagulation proteins and wound factors the tissue is secreting) as long as clear! All in the right direction. That is a huge incision! Wound opening looks good - its all about the drainage from here.
Most vets, especially more "rural" vets, are pretty good people. I persuaded my old vet to buy a GAP (he did). Glad to help.

 

[supercorndogs]

Rodeo was always my vet's thing. He would show up with his rickety ass old pickup and trailer, and clean everyones clock at calf roping when I was little. They are horse people, and everything revolves around that. Might be able to get him interested in a Colt SAA.

We took a step backwards when the drain hole closed for sure then. Shortly after pulling the drain, he was squirting out some clear yellowish honey constancy stuff, same stuff now but way more of it before. Once it closed, that stuff built up and turned like water. I want to say what came out last night and this morning was fairly thick too, just more of it. I could hear the air space in there earlier too, and can't now.

 

[supercorndogs]

It didn't stick. I sure thought we had it whipped but the low spot started to show some fluid on Saturday night. IT didn't fill nearly as much this time as last time. Maybe a table spoon this time, vs like 1/2 cup last time we cut it open.

I took him today, and we cut it back open. I talked to the vet about what @UKDslayer mentioned, and thats what we did. He is on amoxicillin now, and has a packing made to pull about an inch per day over the week.

Cavity is about 1" wide by 4"-5" long. There is a fair cavity under there, it was such a big tumor, but luckily most of the tumor was growing out instead of in. Hopefully it will be whipped in four or five more days.

 

[Supersubes]

Thats technically not a "drain" (a drain is actually tubing with a lumen), this is the iodoform gauze tape in rope form packing I mentioned. But same result. Slightly different if you were told to thread drain back and forth, that had to be uncomfortable to your dog. Light direct straight downward pressure I would think would be better...but again in human realm. It worked, so what do I know...
Edit: excellent wound edge apposition. All vets do surgery, but you can tell when your animal had a surgical" vet expert like here.

It worked well. Dog didn't seem to care at all when it was manipulated. Vet is a well regarded guy who is the owner of a large practice. Thanks for the info.

 

[LeftyJason]

This thread is part of why I like the Hide so much. There's people from all sorts of walks of life that are willing to share info.

Hope your dog continues to improve.

 

[supercorndogs]

It worked well. Dog didn't seem to care at all when it was manipulated. Vet is a well regarded guy who is the owner of a large practice. Thanks for the info.

My dog in particular doesn't care either. Unless you want to rinse his ears for mites or do drugs, he is cool. He will bite someone who is on herion or pills like right now. He growls at them from inside the car when we drive by. Had a friend hooked on pills who came by my house to see my brother once. My dog stood about a foot away staring at him the entire time, then when he turned to walk out the door, the dog latched right onto his ass. Literally.

Friend is clean now, i am proud of him, i have known others that didn't make it.

I was laughing with them agin today. They are alway amazed how easy to treat he is. I lift him up on the table, one arm under his neck and one under his belly, and he stands there still as a statue while they work on him. Today they said, a lot times we have to put the dogs under to do this.

 

[UKDslayer]

I know there are at least three vets who are "regular" members - can y'all chime in here?

 

[animaldoc]

It sounds like you are doing everything you can. I would have followed the same treatment path. Seromas are very common after removing large growths or other surgeries with large incisions. It was a large growth, which requires large borders to ensure complete removal, this creates a lot of dead space the body does not like, so it fills it with serum. The incision is also over a mobile area of the body, which will slow the healing as well. It is just going to take time. The only other thing I can think to try is a Jackson-Pratt drain system. Good luck.

 

[supercorndogs]

It sounds like you are doing everything you can. I would have followed the same treatment path. Seromas are very common after removing large growths or other surgeries with large incisions. It was a large growth, which requires large borders to ensure complete removal, this creates a lot of dead space the body does not like, so it fills it with serum. The incision is also over a mobile area of the body, which will slow the healing as well. It is just going to take time. The only other thing I can think to try is a Jackson-Pratt drain system. Good luck.

I have been PM'ing with @UKDslayer. It is repacked, the cavity is about 1"x4" its little narrower at the top and wider at the bottom, about like a medium to small pear. The cavity feels like a 3-4" piece of seton runs from the incision at the bottom, about 3-4" to the top of the old incision. The plan right now is to wait until Friday or Saturday {4-5 days} to start removing the seton, giving it some time for the tissue to granulize. It went in on Monday at 11:00AM. Then the plan is to pull about an inch every 2-3 days after that. How does that sound to you? I think the only thing UKDslayer wasn't completely sure of was the healing rate of dogs vs humans. At 3mm of growth healing per day {on humans}, i assume that is per-side so I doubled it, it should heal about 30mm in 5 days. This is all right up his alley except he works on humans, and it sounded like he would like to hear another vets opinion.

I know a small town vet can't have removed too many tumors this big from dogs. He didn't seem totally sure on the best course of action at the point we are. I think his plan was to have me pull seton at 24 hours again, before i talked to him about what UKDslayer mentioned. The one inch per-day was just my laymen explanation of what I was told by UKDslayer.

The drain was in for 5 days at the beginning. stitches removed at 10 days, surgery was 25 days ago. Main thing I am worried about is getting him healed up right. i don't want to be cutting him open again and again.

Thank you for taking the time to reply.