Multimodal Management of a Large Postsurgical Wound Secondary to Nodulectomy in a Dog: Application of the TIME Framework, Tie-Over Fixation, Fluorescence Biomodulation, and Electrobioregulation.

Abstract

Extensive postsurgical wounds remain a significant therapeutic challenge in small animal veterinary practice, particularly when reconstructive procedures fail and tissue viability is compromised. This report describes the successful management of a large postsurgical wound in an 8-year-old spayed mixed-breed female dog following wide-margin nodulectomy of a dorsal thoracic mass initially diagnosed cytologically as a suspected liposarcoma. Although primary closure using an H-plasty reconstructive technique was initially performed, progressive central necrosis developed at the surgical margins during the postoperative period. On postoperative Day 3 (POD 3), the wound exhibited tissue necrosis and serosanguineous exudation, necessitating management by second-intention healing. Following surgical debridement, the wound measured approximately 143 cm² and was subsequently managed using a multimodal advanced wound care protocol based on the principles of the TIME framework, combined with tie-over dressing fixation, advanced wound dressings, fluorescence biomodulation, electrobioregulation, and topical regenerative therapies. Histopathological examination of the excised tissue ultimately revealed chronic-active pyogranulomatous panniculitis with abundant fibrosis, ruling out the initial suspicion of neoplasia. Progressive wound contraction, granulation tissue formation, and epithelialization were observed throughout the treatment period, with serial measurements demonstrating a reduction from 143 cm² to complete closure over approximately 16 weeks. No evidence of local infection, recurrent tissue necrosis, wound dehiscence, or systemic complications was detected during follow-up. Complete wound healing was achieved with satisfactory functional and cosmetic outcomes, without the need for additional reconstructive surgery. This case highlights the potential clinical value of a multimodal, individualized approach to managing extensive, complicated wounds in dogs. It suggests that sequentially integrating the TIME framework, tie-over fixation, fluorescence biomodulation, and electrobioregulation may offer a useful therapeutic alternative when conventional reconstructive techniques are unsuccessful.