Very Very Sad Happy Tail (Poor Results After Surgery)

[Guest Amis_Ma]

Sending love and light to Trump on his surgery today.

[charbess]

Sammie the Yorkie says, a short tail is better than no tail! Bess the GH says to get well fast (and to forget whatever Yorkies say.)

[kudzu]

Sending good thoughts! Hope all goes well today.

[teri_d]

former happy tail girl, ronee, sends her hope that trump's surgery is as successful as hers was!!

[Neighsayer]

Any news? Hope all is well!

[Guest ebscearce]

Trump had another surgery today. His vet consulted with another practice before proceeding; he had 3 vertebrae taken off, extra sutures put in and put in under or below the incision (I didn't take very good notes on this).

 

He's wearing an e-collar; we're hoping to keep him out of the muzzle if possible, but the e-collar may stress him out.

 

His tail is bandaged until Monday, when we have our follow-up. He's only allowed out on a leash and is taking tramidol 3xday.

 

If I knew how to upload a picture, I would- he's such a sweet boy! I really hope this heals soon!

[kudzu]

I really hope this heals soon!

We hope so, too!

[SarahsBlackPack]

My male Fast had happy tail as well. Dispite the vet saying it was healing, it wasn't so I forced the vet's office to amputate it. It was only then did his tail actually heal. When ended up having to keep his muzzle with a poop guard on him for 2 weeks since he ripped the stitches out after 2 days and 3 diffrent cones!

[Guest ebscearce]

Trump has been in an e-collar and muzzle with a guard since Friday. I took him for a follow-up yesterday, and his tail had necrotic spots and was very swollen; yesterday was the first time he really showed that he was in pain. The vet says that she learned from another practitioner that he's so thin (racing weight, minus three pounds from this ordeal) that his body is diverting the blood away from the injury. We are going to treat it as an open wound, as she expects that the necrotic tissue will come off and leave sores. He's on a new course of antibiotics, increased tramidol, benadryl and rimadyl.

Poor pup! How long does this have to continue?!

[kudzu]

Wow! Poor thing. Would have thought going up three vertebrae would be enough. Guess there's a reason so many end up with repeat surgery & finally just taking the whole thing off. Suppose we just got lucky with my girl. Sorry you all are going through this.

 

Many people swear by manuka honey for rapid healing. Have you discussed laser therapy? I believe part of the healing benefit is through increased blood flow. I do have some experience with that & it can/does indeed help a great deal.

[Guest ebscearce]

Trump's skin is healing, but it's not healing around the vertebrae. He has a surgery scheduled for Friday, to remove some of the bone (maybe all of it?) without making a significant incision, so that the skin can heal over the bone.

 

WHAT A NIGHTMARE!

[o_rooly]

Poor Trump, and you! I hope this all resolves soon. When it rains, it pours

[a_daerr]

Oh my goodness! So sorry you are dealing with this. One thing you need to be VERY careful about is how tight you wrap the bandages. I made that mistake, and almost overnight, Truman's tail became infected and necrotic. I've had vet techs also do the same thing. Even though it's tempting to wrap it tightly (to make it stay on), err on the side of looser.

[Guest ebscearce]

Thank you! His bandage is being changed every other day at the vet; his tail looked great on Monday, the best it's been yet- but the skin wasn't covering the bone, so that's a bit of a problem.

We've used elasticon to keep the bandages on- I'll make sure I let the vet know as this process continues.

[Guest Amis_Ma]

Sending lots of love and light to Trump; what a warrior!

[quarrystepper]

I'm sorry I didn't see this post until now. I'm not a frequent GT contributor, but if you look at my posting history you'll see that I first came here to talk about Brooks's tail injury and subsequent surgeries.

 

Brooks had a similar incident as username: kudzu. Freak storm door accident after being walked by my mom, only three months after we adopted him. In this case, he lost about 2.5 inches guillotine style in the initial trauma, then another two vertebrae (which had been crushed) in the first surgery.

 

We live in a rural place and unfortunately our local vet (good people, but not greyhound savvy) didn't have a good plan for healing his tail. They tried the v-cut incision and wrapped extra skin around the bone, but what you described re: a plastic syringe and toilet paper roll sounds eerily similar to the initial post-op treatment suggestions we were given. We were also instructed NOT to remove and change his dressing, which seems like a no-brainer bad idea now but at the time seemed reasonable. The wrap was on for two weeks, and was apparently too tight, so when we finally took it off the very top of the tail was pink (healing) but most was necrotic and the bone was exposed.

 

The vets were determined to help us by this point, so we stayed with them and scheduled a second surgery which was either going to be another 2-3 vertebrae or a full docking. We felt like the best decision for Brooks and his chance to heal was the dock, so that happened. It, too, did not heal well or quickly. We watched it like a hawk, had some setbacks, became rewrapping pros, and eventfully after four long months the skin was finally pink all the way to the end of his tail. The fur even grew back everywhere but the tip. Brooks wore the e-collar that entire time. Ten months later, it has never opened up, but when we finally saw a greyhound pro vet (our adoption group's preferred doc) she was very disappointed that it had come to that decision, and pointed out that the layer of skin covering the tip is VERY thin, so we might run the risk of a problem down the road.

 

Anyway, I have a couple suggestions. We used Granulex spray to help promote healing and removal of exude. If I had known about manuka honey we might have tried that too. My stepmom is a wound care nurse (for humans) and sent me a bunch of vials of a topical called OnSite that also worked well at promoting healthy, pink skin where there had been gray, unhealthy, furless skin or dying, blackened tissue. Sounds like you've got a great thing going with the daily rewraps from the vet. Wish you the best and hope it heals quickly from this point on!

[JJNg]

For the OP and any others who've experience problems with tails healing after surgery... What seemed to be the problem that interfered with healing? Did the incision open up? Did sores develop somewhere other than the incision? Did the tissue at the tip of the tail become necrotic and die? Did the dog get a chance to lick/chew it?

 

Maybe I've been lucky, and I haven't done a lot of these, but all the partial tail amputations (just removing 1-2 vertebrae above the injury to healthy tissue) I've done have healed with no problems. <knock on wood> Thinking back, I can remember 3 greyhounds, a pitbull, a malti-poo, and a cat, that I've done this surgery on. I make sure there is adequate skin to close over the bone without any tension and carefully suture the skin so that the ends are well aligned. For the larger dogs, I use a syringe case to protect the end of the tail. The syringe case is held onto the tail using adhesive tape and Elasticon, relying on the stickiness of the tape and hair between layers of tape to hold it on, so that there is very little bandage pressure on the tail to interfere with circulation. All have healed within the usual 10-14 days for suture removal.

 

Sending good thoughts that Trump heals quickly after this last surgery!

[a_daerr]

Jen, to answer your questions, this was our experience. After surgery, Truman's tail was fine. But before then, our major battle was making sure the dressings were tight enough to stay on, but not so tight as to prevent normal blood flow. Truman's tail became infected and necrotic overnight after one particularly botched bandage change. Then, the other issue of course was him whacking his tail into things and opening the wound back up. But for his surgery, they cauterized the tail, which made healing so much easier. Absolutely no issues then.

Edited August 31, 2013 by a_daerr

[Guest ebscearce]

Trump's skin is very sensitive, and though it's healing, it's not healing together (due to lack of blood flow in the tissue- the dog has not been able to get to it- he's muzzled with a guard and in an e-collar, or sleeping under my feet!). Post-second surgery, we treated the site like an open wound, letting it heal and then trying debridement. The skin and tissue began to heal, but not around the vertebrae. The vet has taken out a vertebrae without cutting the skin; she said the tissue looked great and very healthy, and was tissue that was starting to granulate (am I saying that right?). There are a few sutures holding the skin together, and we're in for a follow-up on Monday. He's on heavy sedation until then; we're hoping that this will keep him from messing with the tail and will keep him from getting anxious; when he gets nervous, his heart rate goes up and he bleeds.

 

Poor pup.

Thank you all, too, for your support. I really appreciate it!

[quarrystepper]

Brooks's happy tail returned pretty quickly after his first surgery, guess it started feeling better after a few days on pain meds, and with the plastic syringe over the too-tight wrap it was a constant whapping sound on walls, etc. We tried the backwards kids' t-shirt and the loose tie-the-tail-to-one-leg trick to no avail. The bone was totally exposed when we finally returned to the vet two weeks after surgery and they unwrapped it.

 

After the second surgery (docking it) the setbacks occurred the one or two times he got around the e-collar, ripped through the wrapping and licked off the scab. When that happened, there was always some good new skin higher up the tail that wasn't quite stable yet and would come off too. Looked like a chicken neck. It was so upsetting and frustrating to watch the slow progression. We weren't always patient with the process toward the end, and a couple of times, we thought he could be trusted (while we were home) to stay off it... but of course, we were wrong then, too.

 

The lessons learned were definitely the need for daily rewrapping and constant monitoring, and no exceptions on the 24/7 e-collar. I think the Granulex and OnSite helped but they only helped offset an otherwise shoddy job of providing enough skin over the tip of the tail for a more natural and speedy recovery.

[JJNg]

Any surgery and wound healing has the potential for complications, and I know that tails are tricky. It just doesn't seem like it should be as problematic as some here have experienced. I'm sure there are some dogs that just don't heal well, regardless of what is done. But the things that we can control to improve the chance of successful healing are 1) surgical technique, 2) bandaging technique, and 3) preventing self trauma.

 

I really wonder if bandaging is one of the big reasons that these often don't heal well. Blood flow to the tip of the tail is limited, and even slight pressure may be enough to compromise it enough to interfere with healing. IMO, tail bandages should never rely on 'tightness' to stay on. As I mentioned in my previous post, I use adhesive tape (bandage tape and Elasticon) and rely on the tape's stickiness to keep it on the tail.

 

If the dog is a strong and frequent wagger, securing the tail to the dog's back leg, in addition to the regular bandage/syringe case, can also help. I hate doing this, though, as you do have to be careful to make it comfortable and monitor for sores on the leg.

 

When wrapping 'happy tail' I almost never go around the tail with tape. I use 2 wide pieces of Elasticon and sandwich the tail between them, with the sticky side of the tape facing each other. Then at the top of the tape, I pull out a few good tufts of hair (hopefully the dog has enough hair on their tail to do this), then tape over the hair, so that there is hair between layers of tape. If anyone wants more details on how I do this, I can try to explain better, or try to get some pics the next time I have to do this (or use one of my dogs to demo).

 

Surgical technique is probably not something most owners feel comfortable discussing with their vet, but I'll just throw this out there in case anyone finds it helpful. I believe that tails usually need to heal by primary closure, not by granulation. Wounds on other parts of the body are more forgiving because there's more skin and less tension.

 

When there's a missing area of skin, the majority of it heals by contraction of the surrounding tissue that closes around the defect - that's why you get scarring and the skin around a large wound feels 'tighter'. The body really isn't able to effectively produce new skin to heal a wound. So if you have a granulation bed at the end of the tail, there is very limited surrounding skin and tissue to contract down and close the 'hole', and most healing will result in fragile scar tissue and not normal skin.

 

Here's a diagram of the surgical technique I use to do an amputation of the tip of the tail. I leave extra skin and soft tissue beyond the end of the last remaining vertebrae in the form of a flap above and a flap below. The rounded flaps allow for a nice, even closure, and also makes it easier to remove the vertebrae above the surgery site. If it's not obvious, the blue line is the incision, the green X's are the sutures.

 

 

Unfortunately, I don't have any post-op pics of the sutured tail end, but here are some pre-op and post healing photos of one of my fosters. He had cut his tail wagging it against the frame of a sliding glass door of his previous foster home, and they had been managing it as an open wound for a couple weeks when I got him.

 

Here's the tip of his tail the day I got him.

 

Immediately pre-op, after it was clipped and cleaned up. Healthy granulation bed, but not enough skin to contract down over the defect. The white near the end is the tip of the last vertebrae.

 

 

Here's the end of the tail that was removed.

 

And the healed end of the tail at suture removal 12 days later.

 

I kept a syringe case on it for an additional week to make sure the tissue was healed and strong. The day after surgery, I realized that when he wagged his tail, it would still bleed a little and he'd fling blood all over the walls. Fixed that by tucking a small piece of gauze into the syringe case around the tail tip and put a piece of tape over the end of of the syringe case to hold the gauze in place. Only had to do that for a few days.

 

Here's the handsome boy attached to the tail.

[Guest ebscearce]

JJNg, you're only 2.5 hours away from me! Do you do weekend surgery? I'd drive down next week if you do (and I'm not kidding! Really not kidding!)

 

Your diagram was excellent- I think this is what the vet did this time. She said she didn't cut the skin, took a bone out and the ligatures from around the bone, then put in loose sutures to pull the skin together.

 

I'm really glad that I had a glass of wine in my system when I saw the pictures you posted- gross and awesome!

 

I hope that Trump looks that good when he's done with this. (Seriously, do you do weekend consults?)

[JJNg]

I see appointments on Saturday, but we're only open in the morning so don't do surgery. Hopefully your boy heals well from this surgery and he won't need another procedure.

[quarrystepper]

Wow, that's an impressive heal. Wish we had had your expertise in our case, JJNg. Brooks's tail doesnt even look that good now, and it is ostensibly healed after docking and 10 months of stability. The most noticeable difference between those photos and Brooks after his first surgery is how much the contours of Brooks's vertebra were apparent during the healing process. In your pre-op photos, the skin appears almost completely flat over the remaining vertebrae. In Brooks's case, it never looked that smooth, but instead was much more bumpy toward the last inch or so. To this day, we can almost see the white bony end of his stump through the skin, and unlike your post-op photo, his fur never grew back over the tip.

 

During the docking surgery, our vet also added a "padding layer" of grafted skin at the tip (something I had read about on GT and suggested in my desperation for a good outcome). I honestly still wonder if that was a bad idea. Especially considering he actually took my advice, and I'm far from a DVM!

 

Ebscearce, how is Trump doing personality-wise? We noticed quite a change in Brooks during his recovery. Luckily his mood did eventually improve once he was stable (but that was weeks after the e-collar came off). Hope Trump is managing okay.

[quarrystepper]

After reading your post more thoroughly, JJNg, I have to say that our vet was STRIVING for a primary closure rather than a granulation approach. He insisted that the goal was to remove the last vertebra and leave plenty of skin with which to overlap the tip, just as your diagram depicts. That said, Brooks's tail POST-OP looked a lot like your pre-op photo dated 8/6/2011. That's basically the amount of red, inflamed, exposed skin that was left to heal AFTER his tail was docked. It was at least two inches of furless, compromised tissue that we were left with after his final surgery. As I have said, it took four months to heal, literally one millimeter at a time. Your final photo dated only 17 days later is making me feel like we got a pretty bad deal, or we were just incredibly unlucky.