C10000760 / invoice 10000

Reason: Gaping Hole From Stitches RemovedAppointment Notes: saw you last night, stitches removed but now has gaping hole where stitches were - LKLaboratory: DIAGNOSISHaired skin (left stifle): Soft tissue sarcoma, grade 1 (low grade)COMMENT/SThe mass is a soft tissue sarcoma, assessed as a grade 1 (low grade)tumour on the basis of moderate differentiation, low mitotic count,and absence of necrosis. Excision appears complete in the planesexamined, with a narrowest margin of approximately 1 mm. Continue tomonitor for any recurrence.Histological margin status is considered the main prognostic factorfor local recurrence, with clean margins predicting non-recurrence.Soft tissue sarcomas (STS) develop from mesenchymal cells of softtissues. They are common in the skin and subcutis of the dog. Despitebeing phenotypically diverse and having a variable histogenesis, STSsare considered as a group due to similar microscopic features andclinical behaviour. Prognosis can be predicted by tumour grade and thecompleteness of surgical margins. Complete margins (distance betweensurgically created tissue edge and neoplastic cells is at least 3-5mm)predict non-recurrence. Most grade 1 STSs with "close" margins(distance between surgically created tissue edge and neoplastic cellsis less than 3mm thickness, or surgical margins do not contain normaltissue outside the pseudo-capsule) will not recur, but the likelihoodof recurrence increases with grade. The frequency of metastasis hasnot been accurately estimated, but it is believed to be rare for grade1 STSs and most likely to occur with grade 3 STSs. However,metastasis does not necessarily equate with poor survival. A highmitotic count (MC) is prognostic for reduced survival time. For a MC<9per 2.37 mm2, the MST is 1444 days, for MC 10-19 it is 532 days, andfor MC>19 it is 236 days.History:  had sarcoma removed from L medial stifle but wound has dehisced.Plan: resuture.Treatment:  domitor 1.4 mls IV, alfaxan 1.5 mls  IV, intubate , iso maint.Clean, flush/irrigate  and debride mid part of wound.Closure PDS 3/0 cont, skin prolene 3/0 SI.Leave sutures for 3 weeks.  Continue cephalexin 1000mg  0.75 bid    Vital Signs