Dog eating toes

[PADPM]

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You've heard it on the news, now it's happened in our practice. I received a call from our new associate yesterday, that one of the patients that one of my partners treats at the wound care center was in the emergency room.

The ER called to let us know that the patient was being admitted since his dog ate two of his toes.😱

I told our new associate that if it had to go to the O.R., I'd come in to give him a hand, but he called me back to let me know that one of my partners decided to take the case since it was his patient at the wound care center, and since he lives close to the hospital, and we'd have a decent trip.

Regardless, at least I had something interesting to talk about on New Years Eve. I was thinking of waiting until his dog "recycled" the toes to see if we could perform a reattachment.

 

[347932]

Ewwww. Just ewwwww...

Had a patient in externship way back when in San Antonio. A rat ate his hallux off while he was sleeping at home. Gross...

 

[Ferocity]

How? These patients have peripheral neuropathy?

 

[PADPM]

Yes, This isn't the first time it has occurred. It's usually a diabetic patient with significant neuropathy who has a wound or wounds. There is often drainage and the patient falls asleep with his/her foot exposed in bed, on a recliner, etc. The friendly family dog comes over and starts licking the crud off the wounds and WHAM, the dog decides to munch on some funky toes. The patient often doesn't even realize what happened until he/she sees some blood or notices the stumps. To those who haven't treated diabetics with significant neuropathy, it's mind boggling, for those who have treated this condition, it's not REALLY that surprising.

Most who have been in practice long enough, especially in colder climates, have had patients come into the office, remove the socks and found a toe in the sock.

 

[dyk343]

Story link for those who have not read about these cases


"Jerry had had all these margaritas so I decided to let him sleep it off" lol

 

[PADPM]

Our case was slightly different. The dog certainly didn't save his life and our patient wasn't in a drunken stupor. Regardless, these cases are what makes going to work interesting.

 

[flyhi]

I was thinking of waiting until his dog "recycled" the toes to see if we could perform a reattachment.

Besides the entire story at first making me 😱, I now can not stop giggling. Especially about a patient removing a sock and 😱, no toe on end of foot Oh my.

So, the part about waiting and following pooch around with an ice cooler for expelled piggies....probably would take 24-48 hours (if it wasn't a 'big' toe...pun intended..that caused a foreign object blockage).... is this too long for a reattachment?

And, what about the environment said toes were in during that time? Is is possible that feces and other fun stuff in the colon could get inside the 'chewed' end of the tissue, procreate internally, and make it almost impossible to ensure a situation that did not result in a nasty infection?

 

[PADPM]

Besides the entire story at first making me 😱, I now can not stop giggling. Especially about a patient removing a sock and 😱, no toe on end of foot Oh my.

So, the part about waiting and following pooch around with an ice cooler for expelled piggies....probably would take 24-48 hours (if it wasn't a 'big' toe...pun intended..that caused a foreign object blockage).... is this too long for a reattachment?

And, what about the environment said toes were in during that time? Is is possible that feces and other fun stuff in the colon could get inside the 'chewed' end of the tissue, procreate internally, and make it almost impossible to ensure a situation that did not result in a nasty infection?

I was only kidding about reattaching the toes after they were "recycled". I'm sure that the digestive enzymes, etc., would do a little damage. I doubt that any toe, digit, etc., has ever been reattached after an animal has gobbled it up. Additionally, it wasn't exactly a "clean" cut. So, the bottom line is that those toes are history.

The worst part was that the patient is on Coumadin and as a result he bled, and bled, and bled.......

 

[Ferocity]

I was only kidding about reattaching the toes after they were "recycled". I'm sure that the digestive enzymes, etc., would do a little damage. I doubt that any toe, digit, etc., has ever been reattached after an animal has gobbled it up. Additionally, it wasn't exactly a "clean" cut. So, the bottom line is that those toes are history.

The worst part was that the patient is on Coumadin and as a result he bled, and bled, and bled.......

What happens to patients that need immediate emergency surgery (invasive) that are on blood thinners? Particularly for pod surgery - does the tourniquet make the bleeding more controllable or is surgery simply out of the question for these patients?

 

[347932]

What happens to patients that need immediate emergency surgery (invasive) that are on blood thinners? Particularly for pod surgery - does the tourniquet make the bleeding more controllable or is surgery simply out of the question for these patients?

You generally don't use a tourniquet for this type of surgery. You want the patient to bleed out the bugs if you can. Then you control the bleeding with pressure or topical or foam thrombin. A compressive post op dressing is the order of the day once you get things under control in the OR.

 

[PADPM]

Agreed. Many of these patients are already vascular compromised, and tourniquets are not utilized. The use of gelfoam and topical thrombin and multi-layered compressive dressings are usually the key to addressing this problem.

 

[flyhi]

I was only kidding about reattaching the toes after they were "recycled". I'm sure that the digestive enzymes, etc., would do a little damage. I doubt that any toe, digit, etc., has ever been reattached after an animal has gobbled it up. Additionally, it wasn't exactly a "clean" cut. So, the bottom line is that those toes are history.

The worst part was that the patient is on Coumadin and as a result he bled, and bled, and bled.......

But, of course 😳

I don't know the 'rules' about reattachment, but it piqued my interest. I knew time was of the essence, for when I was a very young child, I was in Muhammad Ali's hotel room before a fight when something bizarre occurred. One of his entourage was sitting in one of those wooden director's chairs. It collapsed and next thing we knew, there was a finger lying on the floor.😱 All I remember was the EMTs bringing an ice cooler in the room for the finger, and off everyone went to the hospital. I recall hearing them talking about whether they thought it could be reattached. Would have love to known the outcome.

Worst part was, he was a world reknowned concert pianist. Go figure.

What is the 'time limit' on a cleanly severed toe, assuming a patient that is in good health, for the best chance at a successful reattachment?

 

[skiz knot]

But, of course 😳

I don't know the 'rules' about reattachment, but it piqued my interest.

What is the 'time limit' on a cleanly severed toe, assuming a patient that is in good health, for the best chance at a successful reattachment?

Who is replanting toes? That is generally not performed unless in a child, or a partial amputation of a non-mangled, non-crushed digit.

The general consensus for limb replantation is a maximum of 6 hours warm ischemia time although there is debate whether that should be shorter or longer. With fingers some push the limit to a much longer warm ischemia time (12-24 hrs), and there are reports of "successful" replant with cold ischemia time >>48 hours. Since digits do not contain significant amounts of skeletal muscle, there is much less risk of systemic acidosis/rhabdomyolysis and reperfusion injury.

 

[PADPM]

Exactly. I am not personally aware of any attempted toe re-attachments in an adult, though I'm sure it's been attempted. As per skiz knot's post, drastic efforts will always be used on a child, as long as the potential benefits don't outweigh the potential risks of the actual procedure.