C09977828 / invoice 10000

Reason: Chewed Out Sutures YesterdayAppointment Notes: Overdue remindersHISTORY:Charlie presented for a recheck of a surgical wound on his back leg. The owner reports that Charlie has been chewing at the stitches, despite wearing a cone. The wound was described as fleshy but not purulent. The owner believes the chewing was initiated by itchiness associated with the healing process. Last night, the owner wrapped the leg in gauze to prevent further self-trauma. Charlie appeared more sensitive on the leg during his walk this morning. The cone is causing some distress and difficulty, particularly when getting in and out of the car, and has been ineffective in preventing him from accessing the wound. Vomiting, diarrhoea, coughing and sneezing were not mentioned. Appetite, drinking, defecation and urination were not mentioned.The owner also noted a smelly rash on the neck, which has occurred previously during warmer weather.Current meds: noneVaccination: Not mentionedParasite Prevention: Not mentionedPre-existing conditions: History of seasonal skin infections.Access to toxins eg. Rodenticide: noneEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): hydration clinically adequateCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint pain. Examination of the surgical site on the back leg revealed wound dehiscence with evidence of necrosis and scar tissue formation, requiring revision surgery.Gastrointestinal:- Oral: normal, no mouth pain, dental score (1-4): There is a depot of food debris present in the lower left arcade.- Abdominal: no detectable pain on abdominal palpation- Rectal: not performedUrinary: NSFReproductive: NSFIntegument/Ears: A malodorous, moist dermatitis is present on the neck.Lymph Nodes: NSFEyes: NSFDemeanour/Behaviour: Bright, alert, and responsive.PROBLEM LIST:- Surgical wound dehiscence with necrosis on back leg- Malodorous moist dermatitis on neck- Dental debris in lower left arcadeDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:- Surgical wound breakdown- Superficial pyoderma/Malassezia dermatitis of the neck- Periapical abscess- Benign hyperplastic lesion (fibroadnexal hamartoma/collagenous nevus) - Histopathology results receivedTREATMENT:Antibiotics prescribed.The wound was cleaned, and honey was applied to the exposed tissue. A multi-layer bandage was applied.ASSESSMENT:The surgical wound on the back leg has broken down and will require debridement of necrotic and scar tissue, followed by resuturing.The histopathology from the original mass excision was reviewed. The mass was identified as a benign hyperplastic lesion (fibroadnexal hamartoma/collagenous nevus). The report noted complete excision with clear margins. However, the presence of scattered spindle cells was noted, which have the potential for malignant transformation if left. Given the location on the tarsal region, wide excision would be difficult if recurrence occurred. The complete excision is considered surgically curative, and recurrence is not anticipated.The skin on the neck has a suspected bacterial and/or yeast infection, consistent with previous episodes.The debris in the mouth will be addressed during the upcoming anaesthetic procedure.PLAN:Charlie is to be started on a course of oral antibiotics for 2 weeks.The owner is to bathe the neck area with Malaseb shampoo every 3/7 for 2/52. The shampoo should be left on for 10 minutes before rinsing.The bandage on the leg must be kept dry. Booties made from fluid bags were provided to be used during walks. If the bandage becomes wet, it must be replaced.A recheck appointment for a bandage change is scheduled for Friday, 06/03/2026.Charlie is scheduled for surgery on Thursday, 12/03/2026 at 9:00 AM for wound revision and dental assessment/treatment. Food is to be withheld from 8:00 PM the night before the procedure. Water can be available.CLIENT COMMUNICATION:Discussed the need for revision surgery to repair the dehisced wound, including removal of necrotic tissue. Explained the histopathology results, confirming the benign nature of the removed mass but noting the potential for future issues if it had not been removed. Advised that the excision was curative. Provided instructions for managing the skin infection on the neck with medicated shampoo and for keeping the leg bandage clean and dry. Instructions for pre-anaesthetic fasting were provided. The owner will book a bandage change for Friday and the surgical procedure for the following Thursday.    Vital Signs    Weight: 42;