Case Studies In Small Animal

Cardiovascular Medicine

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Case 28

Discharge Instructions

SUMMARY: Drifter presented to the VMTH with a presumptive diagnosis of an arteriovenous fistula affecting the right proximal antebrachium. A cardiac ultrasound was performed and considered within normal limits in spite of a Grade II/VI holosystolic murmur detected at the left heart base, which was considered to be secondary to an innocent murmur due to increased blood flow. An angiogram of the lesion was performed confirming the diagnosis and surgical en bloc excision was performed without complication. Drifter's recovery was unremarkable.

Drifter was discharged with instructions for restricted activity X 3 weeks and cephalexin 500 mg PO TID X 5 days. A modified Robert Jones bandage with an aluminum spica splint was applied to minimize movement at the surgical site, which is likely to develop a seroma secondary to the dead space following excision. The bandage should be changed daily while fluid is present and then less frequently as discharge subsides. The bandage/splint should be necessary for 1-2 weeks or until the skin has adhered to underlying tissue. The prognosis is good, however, recurrence is possible.

ACTIVITY: Drifter should be restricted to a crate with short leash walks for bathroom purposes only over the next 2 weeks. Drifter should not have unsupervised access to other dogs and should not be allowed to run, jump, or climb stairs.

BANDAGE/INCISION: The incision should be evaluated daily for signs of infection including progressive redness, swelling, oozing, or separation of skin edges. The bandage should be kept clean and dry, and should be changed daily. The bandage functions to limit movement of the limb and gently compress the skin to promote adhesion of the skin to underlying muscle. The bandage should be maintained for 1-2 weeks until the skin is adhered to underlying tissue.

MEDICATION: Please give cephalexin 500 mg orally every 8 hours for 5 days. This antibiotic may cause intestinal upset such as poor appetite, vomiting, or diarrhea. If any of the above signs occur, please discontinue the medication and contact us.

E-COLLAR: The E-Collar should be worn at all times unless she is directly supervised until her sutures are removed. Please schedule a suture removal appointment with your veterinarian for 10-14 days from the time of surgery. 

PROGNOSIS: Drifter's prognosis for full recovery is excellent, however, recurrence of the A-V shunt is possible either locally or at another site. 

  

Mark D. Kittleson, D.V.M., Ph.D. All rights reserved.