A six-month-old Doberman Pinscher with sever laceration in the mucosa of the lip and nose, and a part of nostrils, as well as the shoulder area was referred to the Veterinary Hospital of Shahid Bahonar University of Kerman. According to the owner’s statement, the animal was injured due to a clash with barbed wire, 24 hours before admission.
On physical examination of oral cavity, there was a sharp tear began in the mucosa and submucosa of the right side of the upper lip, adjacent to the upper canine teeth, and continued craniorostrally and involved the right nostril in full thickness (Fig.1).
The animal showed anorexia, depression, and sialorrhea. There was also a deep laceration over the right shoulder, involving skin and subcutaneous tissue, and part of the musculature.
Treatment and Outcome
The dog initially sedated by 0.05 mg/kg of Acepromazine 1%, IM. Anesthesia was induced using 15 mg/kg of Ketamine 10% (Alfasan co, Neatherland) plus 0.2 mg/kg of diazepam (Chemidarou, Iran) through angiocatheter.4 Since endotracheal intubation interfered with surgical site, the surgery continued via total intravenous anesthesia (TIVA). The wound was lavaged with copious amount of normal saline and remnants of necrotic tissues and foreign bodies removed. Muzzle and nostrils were also surgically prepared. Wound repair was begun from the oral side by suturing the submucosa and mucosa in separate layers with simple interrupted pattern of absorbable suture material (Vicryl 3/0). In order to have uniform tension to the wound edges, all the sutures in the submucosal layer were preplaced and tied at the end (Fig.2). Finally the muzzle and nostril was repaired using simple interrupted pattern of non-absorbable suture material (nylon 3/0) (Fig.3). Shoulder laceration was managed as second intention wound healing.1 Finally, two weeks after the surgery and healing time is right for the stitches removed (Fig.4).
Following the surgery, dexamethasone (0.5 mg/kg IM), tramadol (3 mg/kg IV) and ceftriaxone (40 mg/kg IV for 4 day) were administered. The owner was advised to feed the soft food to the animal for seven days and wash the oral cavity with normal saline following each meal.3
Lacerations of the mouth, lips and muzzle in the dogs happen in a variety of conditions such as fight, clash to obstacles and chewing the sharp foreign bodies. Although the lacerations of oral cavity heal fast, good alignment of the wound edges is mandatory to avoid undue scar formation which induce a foreign body sensation in the mouth.2 Preplacing the sutures deep in the submucosa avoids undue tension on the wound edges during chewing and obliterates the dead space, which results in favorable wound healing with minimal scar formation.