Spur-Thighed Tortoise with Dog Bite Wounds

PATIENT DETAILS

A male 6 year old Spur Thighed (Testudo graeca) tortoise presented in July 2012. He was maintained with a good husbandry for this species (lighting/temperatures/humidity/diet).

PRESENTATION/CLINICAL SIGNS

The reason of consult was a dog attack whilst out in the garden on a sunny day.

He presented bright alert and responsive with a good body condition score (based on weight and ante brachium musculature) and a weight of 526g. His respiratory rate and depth were normal, his eyes open and pink mucous membranes in the mouth. Numerous bite wounds were noted. Multiple superficial wounds and scratches covered the plastron and carapace. The caudal right side marginal scutes were separated completely and on the left side a full thickness wound affecting the three caudal pleural and marginal scutes was also affected severely. These scutes were still attached to the soft tissues underneath. The respiratory compartment was affected on this side.

INVESTIGATION

Swabs including a sterile and culture medium were taken from the respiratory compartment under general anaesthesia. Aerobic and anaerobic cultures were performed along with sensitivity. These results were received after 6 days and showed the presence of Bacillus and Streptococcus, both resistant to ceftazidime and the latter resistant to enrofloxacin. Light numbers of Candida were also reported.

Dorsal-ventral and latero-lateral radiographs were taken to assess the respiratory compartment. Good bone mineralisation was noted on the radiographs and despite perforation in to the respiratory compartment normal pulmonary radiodensity was observed.

DIAGNOSIS

Dog bite with superficial and full thickness wounds and perforation of the respiratory compartment.

TREATMENT/PROCEDURE

A 24h period of stabilisation was performed. During this time he was given 0.02ml intramuscular (IM) Meloxicam (Metacam® 5mg/ml; Boehringer Ingelheim), Butorphanol 0.4mg/kg (Torbugesic 10mg/ml; Fort Dodge), 0.1ml IM Ceftazidime (Fortum® 100mg/ml; Glaxosmithkline), 0.2ml per os (PO) Enrofloxacin (Baytril® 2.5% oral; Bayer) and 8ml of Hartmann’s (Aquapharm 11; Animalcare Ltd). 5ml of critical care formula (CCF; Vetark) was also given orally.

General anaesthetic was induced via the dorsal tail vein using 4mg alfaxalone (Alfaxan® 10mg/ml; Vetoquinol). He was connected to a ventilator (Vetronic) using isofluorane (Isoflo®; Abbott Laboratories) and oxygen and maintained at 6 breaths per minute.  The wounds were flushed copiously using dilute iodine. The severely affected left side was flushed with care not to introduce fluid into the respiratory compartment and the scutes removed. Multiple carapacial suture anchor points were drilled along the carapace after removal of the affected scutes on the left side. 2/0 Polydioxanone 2/0 (PDS II®; Ethicon)suture material was used to anchor the soft tissue to these points. An oesophageal tube was placed also to facilitate medication and nutrient administration.

The wounds were dressed and flushed daily with Hartmann’s (Aquapharm 11; Animalcare Ltd). He was hospitalised for a further 6 days, started eating after 4 days and was then managed as an outpatient every 3 days. 10 days after discharge the wounds were dry with no sign of infection and the healing process was adequate.

Based on the culture and sensitivity he continued to receive once daily doses of Enrofloxacin and commenced 20mg/kg Metronidazole (Flagyl® 40mg/ml; Sanofi-Aventis).

OUTCOME

Once sent home he continued receiving 0.2mg.kg Meloxicam (Metacam 1.5mg/ml; Boehringer Ingelheim), Enrofloxacin (Baytril® 2.5% oral; Bayer) and Metronidazole (Flagyl® 40mg/ml; Sanofi-Aventis) on a daily basis. He was brought in for regular checks in which he received a full clinical examination which included weight. He continued eating and managed to remove his oesophageal tube 3 weeks after the surgical intervention. This was replaced under general anaesthetic. Medication continued for a further 2 weeks, during which Metacam was discontinued.