“I was horrified. It was the worst burn case I’d ever seen,” recalls Steve Adair, MS, DVM, Dipl. ACVS.
Pattycake, a 5-year-old horse, had suffered third-degree burns from a barn fire over 60 percent of her body.
“When Pattycake was referred to us three weeks after the fire,” says Dr. Adair, associate professor of equine surgery at the University of Tennessee, “she didn’t have any skin on the side of the neck, from her withers to her tail, and from mid-rib cage all the way over to the other side mid-rib cage—pretty much the entire dorsum of the body. She couldn’t live the way she was.”
Owned by an elderly couple, Pattycake was initially treated at home for a week before admittance to a nearby veterinary clinic for more intensive daily symptomatic treatment.
As news spread about the injuries suffered by Pattycake and her less severely burned stable mate, the University of the South Equestrian Center (USEC) offered to care for the other horse and to transport Pattycake to the University of Tennessee for skin-loss treatment. USEC students held fundraisers to defray veterinary costs.
The severity of Pattycake’s burns prompted Adair to employ unusual therapies: Adjunctive to traditional debridement and skin grafts, he added hyperbaric oxygen therapy.
“High oxygen tension in the granulation tissue produces good vessel growth,” he explains. “It also improves growth of any remaining dermis.”
After a two weeks of thrice-weekly hyperbaric sessions, eraser-size alums of skin started growing in areas where Pattycake didn’t have full thickness burns, reducing to about 40 percent the area needing grafts. Adair covered the granulating beds with biological dressings—allografts and amnion—to decrease the amount of serum exuding out.
By early October, Pattycake was ready for her first grafts.
“Because you need low oxygen tension in the grafts, we took the grafts one day, put Pattycake in the hyperbaric chamber the next morning, and applied the grafts as soon as she came out. This increased oxygen gradient encourages vessels to grow into the graft.”
Regular hyperbaric sessions resumed five days later.
Of the six grafts placed, one was lost and the other five had a 40 to 70 percent take. Adair hopes that two or three more grafting sessions will achieve the needed 70 percent dermis coverage of the wound.
“After that, dermis usually fills in the spaces,” he says. “I’m using a new instrument that cuts slits in the graft at a 9-to-1 ratio, which allows me to cover more surface area than the 3-to-1 ratio that I used on her first graft.”
The outlook for recovery is good, Adair says.
“Pattycake won’t have normal skin. Her hair will be sparse and grow out at different angles. She may need to have sunblock put on her and be kept away from bushes where she could scratch her back, and it’s doubtful that she could ever be ridden. But at least she’ll have functional skin.”
Adair credits the hyperbaric treatment for improving Pattycake’s chances by decreasing the number of skin grafts needed.
Additionally, this experience documents how hyperbarics can help heal burns.
“In humans and horses, HBOT has no benefit in normal wounds with normal-thickness grafts,” he notes. “However, in compromised wounds and in compromised skin grafts, HBOT benefits.”