The Wound Whisperer
When is a dog NOT man's best friend?

This 34-year-old patient is a Type 1 diabetic status post kidney and pancreas transplant on immunosuppressive medications who now has a neuropathic foot ulcer. That’s dog hair all over the dressing. When I showed her the hair, she argued I shouldn’t worry because the dog hair was not actually INSIDE the wound. (I am actually getting pretty good at identifying dog breeds based on the dog hair in the wound. It’s odd that patients always respond by telling me how sweet their dog is – as if that makes the hair in the wound OK, but I digress).

Here is the wound which probes to bone.

I got the patient to agree to a Total Contact Cast, since it’s clearly necessary to protect this wound from her sweet dogs. She healed beautifully with a TCC as you can see.

What I thought was interesting are the results of the bacterial DNA assay by MicrogenDx. I’ve been getting these DNA assays of wounds for years and included them in my wound care EHR notes, but I am still figuring out how to best use them. This one is interesting. I got my microbiology degree from Google since I have not heard of most of these bacteria:

  • Porphyromonas cangingivalis is a bacteria found in the periodontal pockets of dogs.
  • Haemophilus parainfluenzae can be part of the normal flora of the mouth but brain abscess, liver abscess, osteomyelitis, pneumonia, peritonitis, septic arthritis, and bacteremia have been reported to be caused by it.
  • H kunzii is primarily recovered from infected wounds, particularly diabetic foot ulcers with cellulitis.
  • Anaerococcus lactolyticus is a human pathogen found in chronic wounds that is involved in polymicrobial infections.
  • Peptoniphilus harei is part of the normal vaginal and gut microbiota but can be part of polymicrobial infections of diabetic skin and soft tissue, bone, joint, and surgical site infections.
  • Anaerococcus hydrogenalis is isolated from human feces and vaginal discharge.

Ich. Maybe it’s the dog that needs to worry.