Expert: Dr. Louis N. Gotthelf - 10/6/2010

Question
Hello,

I noticed my 2 year old kitty had a dime-size hole in his
armpit area last Thursday. He wasn't complaining, limping or
anything and I'm not sure when/how he got it since he plays
outside most mornings. Anyway, I rushed him to the vet who
said that he certainly needed stitches. Next day I brought
him home. Following morning I noticed that the wound was
opened around the 2 stitches. One opening was between the
stitches and one was under the bottom stitch. So we went
back to the vet who looked kitty over and said it looked
like infection had crept out out of the wound, causing the
openings and that things didn't look like they needed
additional intervention, just watch for big infection, edema
etc.

I took the kitty out of his cone on Saturday night because
he had pretty much stopped eating and wasn't sleeping very
well. I stuck him in a baby onesie so that he couldn't
access the stitches. It's seemed to be working great - he
can't get near the stitches and he immediately started
eating again. I peeked at the wound yesterday and it seemed
okay, but I didn't examine it very well. This evening I took
off the onesie to get him a clean one (the other has ooze
and light blood in the armpit area) and examined the wound.
It's just as big of a hole now as when I initially took him
in on Thursday! The stitches are still there but they are
pulled across the hole so basically appear to be doing
nothing. There isn't active infection (pus etc) and he had
antibiotic shot, pain killer etc so I'm not immediately
worried, but I don't understand what's happening. We'll call
the vet when he opens tomorrow but I'm afraid of being told
that it's fine.

Is it fine? Or is it a shoddy stitch job? If we're told the
wound CAN heal like this (which I find doubtful, since the
wound hasn't shrunk at all since Thursday) then why were we
told we had to get him stitches in the first place? Is it
possible to do multiple layers of stitches in the armpit and
maybe it's just the top layer that's opened? It doesn't look
like that's what's going on but I'm dumb in that area. Also,
was the onesie a bad idea? It doesn't seem like it would rub
the wound anymore than the other side of his arm would but I
can put the cone back on him if the onesie is a bad idea.
Any advice, thoughts you can offer would be really greatly
appreciated.

Thanks a lot,
Megan

Answer
It is very difficult to suture the armpit and to get the stitched to hold because of all of the skin movement in that area.  I normally use a suture pattern called a Ford Interlocking pattern which will allow for movement of the wound edges without the edges coming apart.

Without stitches all wounds eventually heal with scar tissue forming.  The fact that the stitches did not hold may also be resulting from the edges of the wound becoming devitalized by lack of blood supply.  That may be from the initial wound or from infection.