On the Monday morning that the little shorthair walked into our clinic my heart sank. She had spent the night at the local emergency hospital after being hit by a truck. Her owner was roading her out of the truck trying to get her in shape for the upcoming pheasant season and in a quick moment she ended up underneath the truck.

Her spirits were great and that combined with the lovable eyes of this little shorthair, in the end, were what kept her owners trying to save her. I didn't need to look at the transfer papers or x-rays to know it was bad. A quick look at her abdomen looked like she had been through a meat grinder and x-rays indicated a broken pelvis. The ER docs had spent hours trying to clean her up and they had just touched the tip of the iceberg with stabilizing this severely-injured dog.

On that first day it was very obvious she needed another surgery or she was going to lose all of the skin on her underside. This initial picture doesn't look too bad at first glance. In this image we have scrubbed and clipped the area and you can see the extensive bruising:

In this next photo, every area contained within the yellow highlights is unattached from the underlying muscle. Basically it was like she had been skinned but with the skin still on the body. So while at first glance it just looked like bruising, the actual deeper problems were potentialy life-threatening. In addition, as the swelling had come down I found large amounts of gravel and dirt that had been embedded deep into the tissue and was not able to be removed at the emergency hospital; I've outlined those areas in black. In the black circled areas the debris was deep down within the fat and muscle layers. I was going to have to try to further clean the wounds and try to reattach as much of the skin as possible with the hopes of returning blood supply to the quickly dying skin, while at the same time try to avoid cutting off other blood supplies with my stitches and staples:

Two days later we were back in surgery, as a lot of the area had changed as the tissues began to lose their blood supply and slough off. My initial worries of tissues dying off and infections were realized, and we once again had to clean up the dead stuff with hopes of reattaching the living tissue. With cases like this your hope is to maximize the healing process with the least disruption of the blood supply. When the skin us unattached from the dog this can be a difficult proposition:

Here is a close-up of the worst area:

At this point we were starting to get some good reattachment of the skin; however we were still encountereing an incredible amount of drainage, which was creating some scalding issues, and there still was a fair amount of dead space or areas that were unattached and filled with air. I tacked down as much of the skin as possible, but in some areas there was just too much tension when we attempted to suture. This led to some creative bandaging of our patient:

During these initial days her condition was a constant roller coaster of ups and downs. We would spend two days of making head way with the healing process, only to walk in on the third to find things looking worse again, which led us back in surgery to clean up the area. Finally after multiple surgeries and innumerable bandage changes we sent the little girl home with instructions we were going to need to recheck her in order to perform a skin graft down the road. She was healing nicely but had lost a tremendous amount of skin over her central abdomen.

When they returned in three weeks I was floored at the amount of healing that had taken place. This huge area of tissue damage and necrosis had healed down to an incredibly small area. Things were improving so nicely that it was looking like a skin graft may not even be needed:

At this point we decided there was no reason for us to interfere with a good thing and had them continue with home management. It was looking like the skin graft was off the table; however, I was still concerned we'd need one more surgery to bring all of the tissue together and to relieve some of the tension in the area with all of the scar tissue.

Another two weeks past before I saw her back. I was amazed when we rolled her over to take a look:

The little dog who we were worried about having to put to sleep early in the process was walking with very little discomfort from her pelvic fracture and the skin on her abdomen had healed completely and was starting to regrow her hair. The biggest issue she was facing going forward was the amount of tension that was present from the shrinking and tightening of the skin in the area. With a course of controlled exercise and physical therapy our hopes were a return to normal function.

Prior to posting this case I called and spoke to the owner who was happy to report she was back to "going 100 mph" and was having a very succesful pheasant season.

Two points that I'd like to emphasize with this case. One, these dogs have an incredible ability to heal if we stick with them and give them correct care, and two always be aware of the danger of certain situations. Many dogs are roaded this way every single day; however, one quick move or lapse in concentration and disaster can strike.