Urgent advise needed! Nose tear, stitches opened

Discussion in 'Health & Wellness' started by malkotigarche, Dec 12, 2017.

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  1. Dec 12, 2017 #1

    malkotigarche

    malkotigarche

    malkotigarche

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    Hi all,
    First time posting here, but there seems to be a great wealth of knowledge here, so I'm hoping to get some useful feedback please.

    First off, we live on a small island in the UK, so there aren't many rabbit-savvy vets available.

    My bonded female, Strawberry, was attacked by our newest house rabbit addition Robin. We took her to the vet and she ended up getting three sets of stitches about 1.5 weeks ago. The worst damage was done to her nose. Basically half of it was torn and they had to sew it down with stitches.

    We went for a checkup last week and the nose wasn't healing very well and there was a little necrosis, so she immediately went in for a new set of stitches after removing the little bit of dead tissue. We went in for another checkup this morning. This afternoon her stitches opened up again.

    Now, when we spoke to the vet, he said that the second time around the stitches would hopefully heal the nose, and that they couldn't likely carry out the same type of stitching for a third time, as the amount of tissue is very small and there's not much room to tie down the nose flap to cartilidge.

    This afternoon, after trying to gently apply some iodine to the tip of the nose, the stitches opened. I'm not sure what we should do. The tissue underneath the skin is exposed, a small triangle's worth. I'm afraid to go back to the vet as I'm not sure what other options there are for her re: stitching it closed shut.
    She doesn't seem to be in any pain (I know rabbits don't show pain) and is eating normally. I just don't know if it's ok for that tissue to be exposed, or what we can do to help it heal at home, without more trauma to the area.
     
  2. Dec 12, 2017 #2

    JBun

    JBun

    JBun

    Jenny - Health & Wellness Mod Staff Member Administrator Moderator

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    I think only your vet would be able to tell you if they could no longer stitch it closed. Maybe phone them to ask your options at this point. If there isn't enough skin there to stitch it again, it might be that you will just need to let it heal as it is. If so, using a rabbit safe antibiotic ointment can help in the skin healing and preventing infection setting in. Your vet should have a suggestion of what kind you can use. The trick though, is keeping your bun distracted long enough that it doesn't immediately get groomed off. Bringing your bun into a new room to explore right after applying it, or applying it right before feeding time, might provide enough distraction.

    One other option too, is your vet could always consult with one of the rabbit specialists in your country, or if your vet is a member of the RWAF, I believe they can consult with the RWAF rabbit specialist, Richard Saunders, without having a consult fee. And maybe the specialist might have some ideas for what to do with the difficulty in stitching this area closed. I don't know if this will make any difference or not, but it might be a specialist more accustomed to working with rabbits, could have some experience that might prove helpful.
     
  3. Dec 12, 2017 #3

    Aki

    Aki

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    Couldn't they glue it? A lot of vets use that to avoid stitches nowadays (mainly because you don't have the risk of the rabbit eating the thread when it's on a place where they can reach). Maybe there wasn't enough flesh to do it... I think you should discuss it with your vet before doing anything and I don't know if it can help but I know people who healed that kind of wound and open abcesses by putting honey on them. Manuka honey is supposedly the best, but I've heard from people who used regular honey - my vet, which is one of the best rabbit specialist in France, recommended that treatment for a lot of flesh wounds that couldn't be surgically closed, including pododermatitis. Use caution, but if there is no other option available I don't think it can hurt - it's a good antiseptic, it promotes the growth of new tissues, the rabbit can safely swallow some... the main problem is that it's sticky and it gets everywhere ^^'. The thing is to make sure your rabbit isn't pawing at the wound, which might explain the sutures failing. if he is, you might have to find a solution (from a cone, even if most people don't recommend it for rabbits, to a nice makeshift dress to empede the rabbit's movements).

    I don't know if I missed it, but isn't your bunny taking any antibiotics? Most vets would give them for a few days as a precaution after that kind of wound.
     
  4. Dec 13, 2017 #4

    malkotigarche

    malkotigarche

    malkotigarche

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    Thanks for the information. I'll remember about the RAWF for future instances.
    Fortunately the vets seem quite competent and willing to help with Strawberry's injury. I went for a checkup yesterday morning, prior to the stitches opening, and the consulting vet mentioned that she was afraid they may have explored even putting her to sleep! Over a flesh wound? That's crazy.

    The second time around, they put in more stitches and they were smaller. As they were much closer to the edge of the wound, it sounds like the skin couldn't hold these stiches, plus there was some pus building underneath the skin.

    I just spoke to the overnight vet this morning, and this time around (third time), they put in larger sutures and are no longer attempting the completely close the wound as they had to remove a little more tissue.

    We will pick Strawberry and her partner up this afternoon after we've decided on a cohesive after care plan with the vets. It may be that they flush the wounded area every day or every other day, or we get some kind of wound care spray to help prevent infection. She is on Baytril, which is an antibiotic, but it's very difficult to administer. I've been putting it on her paw so she can lick it off, as I don't want to "wrestle" with her, and when we did the "burrito" bunny in a towel, she kept squirming and burying her face (nose) in the towel, thus agitating the wound.

    We'll gather a list of questions for the vet and will definitely ask for other ideas on administering her antibiotic.

    We thought about iodine or honey, but she did clean the iodine right off yesterday (prior to the vet visit). I really like the idea of giving her a new space to explore, with obviously no obstacles to nose boop, to distract her from grooming, or alternatively giving her some food to distract her.

    Thank you again and I will update this thread after we speak with the vet this afternoon.
     
  5. Dec 13, 2017 #5

    Aki

    Aki

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    I hope it does the trick! About giving the antibiotic, / Baytril I always found that the burrito thing was more trouble than help. My opinion is that trying to find tricks to give meds is complicated and often result in meds not being entirely taken / not being taken all at once... The most straightforward approach is the best - it's quick which makes it easier for you and less traumatizing for the rabbit. You have to sit on the floor with the rabbit on your lap, her side completely against your belly and your left arm (if you're right handed ^^) maintaining her while your left hand holds her head still and lift her upper lip a bit. Then, with your right hand you put the syringe at the commissure of her lips (behind the teeth) and just administer the meds. She'll swallow and that will be the end of it. You have to learn how to do it - once you've got the hang of it it takes a few seconds and it's easy (believe my, I've had a rabbit with vertigo who couldn't stand having his paws be not on the ground and Aki hates being handled so I've had difficult patients too - luckily Tybalt freezes when he's scared which makes everything easier ^^) because it probably won't be the last time you'll need to give her something.
     
  6. Dec 13, 2017 #6

    malkotigarche

    malkotigarche

    malkotigarche

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    I thought I posted a reply, but I don't think it saved.

    Every bunny is back from the vet and happy.

    Is the following a common occurrence? She got stitches one again, but this time larger and fewer. Before they administered the sutures, they had to trim away some dead tissue that was at the edges of the wound. This is the second time they've trimmed away tissue! Is it really necessary?

    Strawberry has baytril and metacam. We'll try giving her some in critical care from a dish or spoon tomorrow.

    I can administer meds with a fussy bunny on the floor by lifting up their upper lip and putting the syringe in the gap of their teeth. It's just with her, her nose is so fragile that I don't want to bump it too much.

    We'll also put a little bit of iodine onto the wound, just to be safe. We have a follow up appt this Friday morning, and probably early next week, with close monitoring between visits.

    Oh and it will be interesting keeping her from bumping it and from harming it during normal grooming. She's in the bathroom which doesn't have many things to bump against. Also her partner wants to help, and we cannot easily separate them because he gets really stressed without her. If we put up a divider, it cannot be mesh or anything she can grab onto with her teeth, so any type of fencing stuff is out. She just needs to really be in a bubble for a couple weeks ;)

    Wish us luck! I'll try to provide an update on her progress soon.
     
  7. Dec 16, 2017 #7

    RavenousDragon

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    Often times with infected wounds, more and more tissue needs to be trimmed. Necrotic tissue (even a little bit) will prevent the edges from coming back together. The heterophils in rabbit pus creates necrotic tissue (like our neutrophils do). It sounds extreme, but cutting down some tissue was probably the right decision (unfortunately). Sometimes a little bit of (microscopic) dead tissue is left behind when they cut it off too, and that can become more evident after the wound has had some time.

    Iodine can be a little harsh on wounds (and even cause some of the necrosis requiring tissue to be cut off!). Sometimes, it's right for the wound (very wet, pus filled wounds), but often something less drying is better. Is that what the veterinarian recommended or something you are choosing to do on your own? Flushing is a GREAT idea, but sometimes just sterile saline works best.
     
  8. Dec 16, 2017 #8

    Thumperina

    Thumperina

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    I am wondering if manuka honey (with high factor number) could be an option if the nose is left to heal on its own? It has antimicrobal qualities and healing, too.

    After trying all different methods of giving meds, I can tell what works for us (given that the medicine tastes OK). My bunny prefers no pressure or violence on my side, she just licks the medicine off the tip of the syringe, all I have to do is hold syringe so that the tip touches her lips and squeeze out medicine slowly
    the last time we were taking baytril, it was in a crushed tablets form (mixed with flavored base) she didnt mind taking it at all

    Good luck to Strawberry!
     

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