For dog owners who decided to have their dog undergo aural hematoma repair surgery, it may be very upsetting if their dog's ear hematoma comes back after surgery. After spending a lot of money and being told that surgery was the best way to fix the ear, preventing it from developing unsightly scarring, a recurrence of a dog's ear hematoma after surgery can be a very frustrating ordeal to deal with. What is going on? Is it a complication? Was the surgery done badly? It is natural to have many questions as to what causes a dog's ear hematoma to come back after surgery. Following is just an insight as to what may have gone wrong.
The Goal of Surgery
An ear hemotoma in dogs is the collection of blood between the dog's skin and the ear cartilage.
The goal of the ear hematoma surgery is to drain the ear and suture it in such a way that the skin will scar down to the cartilage so there is no more fluid buildup.
By tacking the inner surface to the outer surface, so that the two surfaces are smooth and flat, the crinkling, cauliflower ear is prevented and faster healing should occur.
To prevent further recurrences of the ear filling up with blood, it is therefore important for the vet to place multiple sutures. This way, the dog's ear flap is "quilted" in such a way to close up the space so no fluid can fill up again, explains veterinarian Wendy C. Brooks.
With re-establishment of the adhesions that keep the skin on either side of the ear attached to to the cartilage, there is no more dead space for fluid to build up. The sutures are typically kept for about two to three weeks so to permit proper scarring to take place.
"Although surgery is the most expensive and involved method for treating aural hematomas, it has the lowest failure rate. " ~Dr. Eric Barchas
Did you know? Sutures used to repair ear hematomas in dogs are often displayed in a "quilted" fashion and are therefore referred to as "mattress sutures."
Presence of Space to Fill
If your dog's ear is filling up again after surgery, there may be chances that his ears were not sutured properly to prevent re-occurrence. It could be your dog's ears were simply drained and no sutures were placed.
Some vets will do the draining for a couple of times, and if the swelling reoccurs, they will then do the surgery explains veterinarian Dr. Karen.
However, simply draining the ears does not address the issue of the space between cartilage and skin, therefore blood vessels keep spilling blood into it. All it takes is for the dog to shake his ear again for the ear to fill up with blood again.
Another possibility for recurrence is that the sutures weren't placed close enough to one another to prevent filling up. Often dozens of sutures are needed so that there is no more space. With the skin far from the cartilage, it's a natural response for the body to want to fill up any dead spaces with blood or fluids.
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There are also chances for a re-occurrence if the sutures aren't left for long enough. If the sutures aren't left long enough, there may be chances that not enough scar tissue has formed, explains veterinarian Dr. Jenn. If the skin wasn't given enough time to scar down to the cartilage, then the fluid will buildup once again.
"Unfortunately, unless this procedure is done, to reestablish these adhesions that hold the skin of the ear to the cartilage, this will continue to fill with fluid because the bodies response to a hole is to fill it up with fluid."~Dr. Loretta
Underlying Cause not Addressed
If your dog's underlying cause for the head shaking is not addressed, there are chances that too much head shaking following surgery may be a cause for the hematoma to recur.
The ear canal needs to be examined to check for signs of infection or inflammation and the issue needs addressed.
So if your dog has allergies, those allergies need to be addressed. If your dog has a yeast or bacterial infection of the ear, it needs treated. If your dog has ear mites, their populations need to be eradicated.
Therefore, in order to achieve resolution of the problem it's important to control and remove the underlying disorder. For instance, a dog with allergies may require a course of 1 to 2 weeks of steroids drugs to reduce the inflammation. Sedatives may be needed for dogs intent to repeatedly shake their head.
In some cases, persistent bleeding may be due to an underlying condition that affects the dog's blood ability to clot. For instance, Von Willebrand's disease is a condition affecting dogs that prevents clotting factors from being produced, explains veterinarian Dr. Scarlett. Typically, blood test that may need to be run to exclude bleeding disorders include platelet counts, ACT, PT, and PTT test.
Not a Size Fits All
As seen, there can be several reasons for a dog's ear hematoma coming back after surgery. Veterinarians all use different methods to treat aural hematomas based on several different factors.
Some vets will just drain and put the dog on steroids, some will drain and inject a bit of steroid into the ear flap before putting the dog on steroids, some others will drain and tack with sutures while some others will place a cannula so that the ear can drain daily until adhesions finally form, putting a stop to the recurrent filling up of blood.
You can basically talk to 10 vets and they will all give you a different approach to fixing it, explains veterinarian Dr. Drew.
This lack of uniform approach may therefore lead to different outcomes and different problems depending on what strategy is used. Some dogs heal with with no surgery, some recover with surgery and never get the problem again, and then in some unfortunate cases, some dogs more have one re-occurrence or more despite undergoing the ear hematoma surgery.
- Dr. Barchas: Ear Hematomas in Dogs and Cats
- Wikimedia Commons, Dog with ear hematoma, Lucyin, Creative Commons Attribution-Share Alike 3.0