A few months ago I talked about pressure sores and how we are dealing with Leroy’s sore. In that post I discussed what a pressure sore was so today I thought we would talk about the stages of a pressure sore and the healing process.
According to Web MD there can be 4 stages of a pressure sore:
Stage 1: Sores are not open wounds. The skin has no break and tears but may be painful. The skin is red and warm to touch and the sore can feel softer or firmer than the area around it.
Stage 2: The skin breaks open, wears away, or an ulcer forms. This can be tender and painful. The sore can go deeper into the skin. It can look like a scrape, blister, or small crater in the skin. In this stage the sore can look like a blister filled with clear fluid. Some skin may be damaged beyond repair or die at this stage.
Stage 3: At this stage the sore expands and goes into the tissue beneath the skin and forms a small crater. Fat may show at this stage but not muscle, tendon, or bone.
Stage 4: The pressure sore is really deep and into the muscle and bone which causes extensive damage and may cause damage to tendons and joints.
In stages 3 and 4 there may be no pain due to the extensive damage that has been done to the tissue but blood sepsis and bone infections may occur.
As far as I can tell, even though these are pressure sore stages for a human, it is almost the same as the pressure sores that Leroy is dealing with. I could not find any sources that listed the stages of a pressure sore on a dog.
A few months ago Leroy would be a stage 3.
Right now his left rear pressure sore is a stage 1 and right rear pressure sore is a 1 1/2.
It seemed like an extremely long road to get that stage but with the help of the Assisi Loop we got there quicker than we probably should have.
Since pressure sores are considered wounds they can undergo various stages of healing.
Here are the 4 stages of wound healing according to The Merck Manual. Pet Health Edition.
Inflammation is the first stage of wound healing. It can be divided into 2 phases. First, blood vessels constrict to control bleeding. Then, within minutes, blood vessels dilate. This causes swelling.
Debridement is the second stage of wound healing. This is removal of foreign material from the wound. It happens naturally on a cellular level. Certain white blood cells attack bacteria and other debris in the wound. The same term is used for the cleaning process used by doctors and veterinarians.
Repair is the third stage of wound healing. In a healthy wound, cells begin to grow and rebuild missing and damaged tissues. Small blood vessels develop to deliver a blood supply to the wound. Skin cells then migrate, and scabs form within hours of the initial wound. These skin, or epithelial, cells can cover a properly closed surgical incision within 48 hours. In an open wound, the creation of granulation tissue takes longer.
Maturation is the final stage of wound healing. During this period, the newly laid collagen fibers reorganize. This process allows wound strength to increase slowly over a long period (up to 2 years). Most wounds remain 15% to 20% weaker than the original tissue.
Of course other factors need to be taken into consideration when dealing with wound healing such as the current health status, such as malnutrition which can slow down the healing process, medications and care.
Pressure wounds can be extremely difficult to treat and are best prevented. If pressure wounds are mild or caught early, cleaning and bandaging may be enough to prevent further damage. More severe wounds require surgery.
Here’s Leroy’s right rear pressure sore progression:
It’s obvious that Leroy’s pressure sore was an open wound and in a crucial stage. Our goal was to try and stop the pressure sore from progressing and try to get it to heal as fast and safely as possible.
We’ve been treating Leroy’s pressure sores ever since he came home from the hospital in late September. His left sore we were able to be treated by just wrapping and using Triple Antibiotic ointment. His right sore proved to be a lot more difficult because it’s on the leg that he lays on the most so we enlisted the help of the Assisi Loop back in November and added in a lot of soft surfaces for Leroy to lay on..
We started using the Loop 4 times a day along with the bandage and Triple Antibiotic. By the end of December we began to see improvement and with the wet weather we dropped the bandage because it was too hard to keep it dry. By January we were using the Loop twice a day and the wound healing really began to speed up which I contribute to the Loop and the fact that Leroy’s over all body was beginning to heal. In about 4 months time we almost have a closed wound. That’s pretty good since a lot of information suggests that pressure sores that are in the 3 and 4 stages can take months to years to heal.
You can read more about how the Assisi Loop speeds up healing in our last post here.
The set backs that we had were Leroy licking at the wound, which he reopened once it was almost completely healed over one night, and the fact that he is still on a small dose of steroids which slows down the healing process. The fact that we are in the dead of winter and the wound is continuously being exposed to a lot of moisture doesn’t help much either.
I think, and I could be wrong, that if we were in the middle of summer we would have a completely closed wound.
So what’s my opinion of the Assisi Loop? I’m a big fan. I think it’s great that I’ve been able to treat Leroy’s pressure sore from home. This could of been a wound that might of needed surgical intervention or it could of made him lame. I’m also happy to be able to provide feedback in this area because there isn’t a lot of studies on treating wounds with targeted pulsed electromagnetic therapy. I’m happy to see more vets talking about it like Dr. Patrick Mahaney and Vetgirl, who is having a webinar where Dr. Michelle Trappler, DACVS, will discuss the stages of wound healing and effective technologies available for various stages of healing.
I hope that more veterinarians will look into this type of treatments for their patients in the near future.
Disclosure-I was sent an Assisi Loop from Assisi Animal Health (with a prescription from Leroy’s vet) at no charge in return for my honest review of this product. All opinions expressed in this post are mine and mine only.