Pressure sores

Pressure sores, also called bedsores or decubital ulcers, are localized injuries where the dog’s elbows or other bony pressure points (hips, hocks, etc.) come into contact with hard surfaces regularly. This constant pressure and friction causes the skin to callus, lose hair and sometimes crack and bleed. Pressure sores are more common older dogs, especially large or heavy breeds.

Causes of Pressure Sores

Pressure sores are almost always caused by chronic trauma to a dog’s skin and subcutaneous tissue as a result of lying on hard surfaces for prolonged periods of time. Pressure sores are common in domestic dogs, especially in large, heavy or giant-breed dogs and those that are kenneled on cement floors without soft, well-padded bedding. Long-term pressure on an area of the body where the bone and skin are thinly separated compresses the blood vessels and decreases the blood supply to the area, which in turn causes tissue damage and, ultimately, tissue death (necrosis), calluses and hygromas. The elbow is probably the most common site of pressure sores, although they also frequently occur on the hips, hocks and sides of the legs.

What dogs elbow calluses actually are 

Calluses are the thick, rough skin over a bony pressure point, just like a callus on our heel from that glorious pair of shoes that never quite fit right, but we wore anyway.

Often called pressure sores, dog elbow calluses appear as a result of your dog's body protecting the bony part that pokes out. Continual trauma caused by your dog flopping down on the aforementioned cool tile or concrete causes the skin to thicken to protect the bone. Calluses DO perform a service, but it can be lessened.

Prevention of Pressure Sores

The best way to prevent pressure sores is to provide dogs with lofty, well-padded bedding in all areas where they regularly rest. Dogs that are recumbent for medical reasons are especially at risk of developing pressure sores. They should be given very soft, thick, well-padded beds to lie on; egg crate foam, thick foam rubber, waterbeds or inflatable airbeds are all good options. Recumbent dogs should be physically turned (have their position changed) every 2 to 3 hours, to prevent concentrated pressure on their elbows, hocks, hips and other thin-skinned bony areas. Massage, hydrotherapy and other forms of physical therapy can be helpful by stimulating blood circulation to affected sites.

Treatment Options

It is imperative that dogs with pressure sores be provided with well-padded, thick, soft sleeping surfaces at all times, to prevent further trauma. This may be all that is needed to decrease the size of the pressure sores and prevent their progression. There are many commercially available dog beds, mattresses and fabric-covered foam pads that will take the pressure off of bony prominences when a dog is resting or sleeping.

 

If a pressure sore is not infected, adding soft bedding to the dog’s living environment - and observing the dog when it is lying down or resting - are probably all that is necessary to manage the condition. The site of the pressure sore should be wrapped with a padded bandage to prevent further trauma to the area as it heals. Moisturizers, aloe lotions or antibiotic ointments or gels can be applied to the affected area to soften the rough skin and provide some relief from discomfort. The area should be bandaged after these substances are applied, to reduce the risk of secondary bacterial infections developing in the moist environment.

If pressure sores become infected, the veterinarian will need to inspect the site more carefully. He probably will take a sample of the oozing exudates on a cotton swab and submit it to a diagnostic laboratory for culture and sensitivity, to identify the precise microorganisms that are responsible for the infection. Long-term antibiotic treatment, both orally and topically, is usually recommended to treat infected pressure sores. A typical course of oral antibiotic treatment is 4 to 6 weeks, at a minimum.

Dogs with hygromas – fluid-filled sacs over areas of pressure, also called bursas – may be treated by draining and flushing the lesion. If caught early, this can be accomplished by needle aspiration, which basically involves inserting a needle into the hygroma and extracting its fluid contents into an attached syringe by pulling on the plunger. The fluid inside hygromas usually is clear or yellowish-to-red. The aspiration site should be well-padded and bandaged after this procedure. However, unless the underlying cause of the hygroma is resolved, most of them will return after being drained by a veterinarian.

Surgical excision (removal) of calluses or hygromas is usually not recommended. Laser therapy may be helpful for small pressure sores, although this treatment is not yet widely available. Pressure sores with extensive ulceration may require surgical skin grafts. Some authorities report that slathering the sores with raw honey or wound-healing creams may accelerate healing.

All pressure sores should be cleaned daily with an antiseptic solution, which the attending veterinarian can recommend. This often is a chlorhexidine solution.

Special Notes

Our large, heavy or giant-breed dogs are much more prone to elbow calluses. The giant breeds that are heavily coated usually do not have as many elbow callus issues as their shorter coated cousins, as their coat softens the blow of the elbow against the ground. That is why your Newfoundland is not as likely to develop elbow calluses as his shoer coated cousin the Mastiff.

In warmer areas hard surfaces are usually cooler for big dogs, creating a dilemma. Your dog is hot and just wants to spread across the cool concrete of the patio and catch a breeze. He doesn't care about his elbow calluses, he just wants to cool his belly.

The elbow is the most common site of calluses for dogs, although they also occur on the hips, hocks and along the sides of the legs.

Dogs of all sizes that are kept on hard surfaces may also develop calluses. We see many dogs that come into rescue with callused elbows, hocks etc. from living on hard surfaces. This does not mean dogs with elbow calluses were mistreated, at all! 

Frustrating!!

Dog elbow calluses are one of those maddening problems we face as dog owners. Not only are dog elbow calluses ugly to look at, sometimes the callus can ulcerate and get infected or crack and bleed. 

You spent big bucks for a thick, cushy orthopedic dog bed and your dog looked at it, then flopped down on the tile in the kitchen. Everything you've tried has been a waste of time and money.

Prognosis

Unfortunately, because of their location on areas where bone and skin are in close proximity and where constant friction is present, pressure sores can be difficult to treat. Most calluses can be controlled by consistently providing appropriate lofty bedding, although it can take a long time for calluses to go away once they have developed, despite well-padded bedding. Fluid-filled hygromas often require more invasive techniques, such as surgical drains, to resolve them.

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