If your three-legged dog develops an elbow pressure sore, don't panic. A Tripawd hygroma is not uncommon in canine amputees.

Sheldon's Elbow Hygroma (Pressure Sore) Story

When sweet angel Sheldon the Tripawd Pyrenees developed a "hygroma," pressure sore, it led his pack on an unexpected hygroma healing journey lasting several weeks.

Now we have a minor complication.  Because he’s been putting more weight on his remaining elbow, last week he developed a nasty pressure sore that he obsessively licked and chewed at to the point it split open.  It was odd as there was very little bleeding, only what i would call a small hole where i could even see his elbow bone!

We got it in time as there was no real signs of an infection developing.  My vet was able to arrange the clinic to have it surgically cleaned, debrided, and sutured up yesterday and he’s now resting to start healing up.  They also took a culture to see if any bad bugs were in there.

@shellybelly, "Sheldon's post amputation updates"

Learn About Tripawd Hygroma Treatment and Complications

Thankfully, giant breed Tripawd Sheldon was being treated by Dr. Tiffany Stockman, DVM, Small Animal Surgery Resident at Cummings School of Veterinary Medicine at Tufts University. Sheldon's Tripawd hygroma situation lasted many weeks, and his people chronicled everything in their Tripawd Discussion Forums post. We learned so much, and later, Dr. Stockman generously shared even more behind-the-scenes details of Sheldon's Tripawd hygroma healing journey.

Are elbow hygromas on 3-legged dogs common? Do Tripawd cats ever get them?

Elbow hygromas are fluid-filled non-painful swellings that develop from repeated trauma to the area. Thankfully this is a condition that is not common and often times goes undiagnosed or untreated as it doesn’t bother the patient directly. The patient usually come in for another issue and is diagnosed at that time. I’ve not treated a cat for a Hygromas nor have I heard of them developing this condition but never say never. Cats just do not seem prone to developing them.

Are there certain breeds or body types more susceptible to Tripawd hygroma problems? How does weight factor into risk?

Large breeds in general are more susceptible and increased weight plays a large factor as it is more trauma to the elbow.

Are front leg Tripawd hygromas more common than on the rear limbs? 

Yes, the elbow is the most problematic area as it has minimal soft tissue protection over the boney prominence. Hygromas can form anywhere though that doesn’t have a lot of soft tissue protection such as the outside of the ankle joint (hock) or the point of the hip in thin/ under-conditioned dogs.

Why are dog hygromas so hard to heal? 

Hygromas in general don’t need additional treatment beyond increasing availability of soft surfaces. Hygromas that develop into wounds/ulcerations are the problem area. The reason they are so difficult to heal is that it is difficult to eliminate the trauma to that area so the wound cannot rest and recover.

Aside from the usual healing tips we've learned, such as: setting down no-slip rugs, having multiple beds around the home, etc. ... Is there anything else we can do to prevent amputee pressure sores from forming? 

Unfortunately it is very difficult to prevent them beyond providing as many soft surfaces (particularly memory foam beds) as possible. There are commercially available padded braces that can help but these also can carry a problem of their own by causing skin irritation from the brace rubbing or moist dermatitis forming under the brace if the skin isn’t allowed to breathe.

Does apparel like Dog Leggs help prevent elbow pressure sores? Is there a better device/therapy you recommend?

Dog leggs can help in some circumstances. The concern with Dog leggs is the half sleeve version can cause irritation at the bottom of the brace. The full sleeve of Dog Leggs makes it difficult for three legged friends to rise from laying down. I tend to recommend OrthoPet braces as they provide a cushion against the skin but a hard outer portion of the brace that takes pressure off the skin itself.

Learn more about leg braces for Tripawds

When Sheldon came in with his hygroma, how bad was it compared to most that you see? Did you know right away that it would be a long road to recovery?

Unfortunately, Sheldon had one of the more severe cases of hyogroma I’ve treated. He had a large full thickness skin defect that spanned the entirety of the elbow joint and a drug-resistant infection. Wounds in general take a long time but hygromas have the added difficulty of trying to figure out how to best bandage the limb and take pressure off the affected area. Hyogromas are notoriously hard to get to heal and have a high recurrence rate.

Was Sheldon's treatment standard for a severe Tripawd hygroma? Please describe how you approached the issue.

Yes, Sheldon has the standard approach. Once they become open wounds we need to treat them as such. Open wound treatment consists of regular (daily) wound management and bandage changes until we see healthy granulation tissue form.

Granulation tissue indicates the tissue is on the right path of healing. Once we see granulation tissue we can typically try to close wounds primarily or allow them to continue healing by second intention (on their own). We tried closing Sheldon’s wound once it achieved a good granulation bed but due to the size of his wound and the constant trauma to the area the closure kept failing. We then elected after two attempts to close the wound to allow it to heal by second intention.

What is the alginate dressing that was used for Sheldon's pressure sore? Is it widely available? Are there other wound care options like this?

Alginate dressing is a type of dressing I save for very exudative wounds (wounds that produce a lot of discharge). It is seaweed based and has high absorptive properties. It isn’t commonly carried or used unfortunately. I’m not aware of another, more widely available product that could be comparable to alginate dressing.

Do you have any thoughts/experience using manuka honey as a topical?

I love using medical grade Manuka honey on wounds. It has wonderful healing properties such as aiding in the initial inflammatory phase, antimicrobial activity and assisting with the debridement stage of wound healing. Manuka honey only benefits in the early stages of wound management and doesn’t carry much benefit after granulation tissue has formed.

Tell us more about the splint Sheldon had to wear. Have you used them before in these cases?

I ended up having to modify a spica splint for Sheldon. Spica splints are typically used for elbow luxation or cases where the elbow joint needs to be completely immobilized. They extend from the paw to curve over the shoulder blades/back. I had to modify it in Sheldon’s case to stop above the carpus (wrist) to allow him to be able to move the wrist to assist with standing. He was not able to stand easily on his own with a standard spica splint.

This is a good example of a spica splint. I modified Sheldon’s to stop just before the carpus/wrist joint.

What was the healing time you predicted? What actually happened with his case?

Whenever I have a wound, no matter the severity, I prep owners that it can be a long healing time as wounds can be unpredictable. Wounds can look good one bandage change and then "declare" itself or worsen by the next bandage change at no fault of anyone. Particularly sores that develop due to Hygromas.

I had warned Sheldon’s owner that due to the extent of his wound and the location of it that it would be a long treatment, months in fact. I also warn owners that it can sometimes be a frustrating process as well and it is important to remember to be patient throughout the process.

Sheldon was going on three months of wound management and making good progress in his healing. I would have predicted another month of treatment at least for him though. Unfortunately in Sheldon’s care, his cancer started to affect his quality of life more than the wound.

It is also important to know that these wounds tend to develop infections and that they have an increased infection of being a resistant bacteria.

What is the risk of a Tripawd hygroma returning after it's been treated like this? Will we always need to be on guard with 3-legged pets? 

Patients who had hygromas form typically will always have them but they are not painful in themselves. If provided with appropriate bedding, etc. then a hygroma can shrink in size.

The real problem comes when hygromas develop into wounds. It is vital to know that hygromas should never be attempted to be surgically removed. They are not painful and do not affect our patient’s quality of life unless they become infected or become a wound like Sheldon. Even then we tend to treat them conservatively and avoid surgery.

Sheldon's Legacy Lives On

This information is dedicated to Angel Sheldon and his people who worked so hard to help him live a great life on three. He got his wings far too soon, and we miss him dearly. Sheldon's legacy always lives on in the Tripawds Nation.

Sadly he was starting to lose strength in his back legs and he was progressively getting more winded when trying to work.   We think the cancer may have spread to his lungs and did not want to put him through any more discomfort.  We had to let him go on May 25.

His elbow healing was progressing nicely but without his back leg strength or lung capacity, we decided to let him go while he was still relatively pain-free, rather then have him suffer any further complications.

As pet parents we would rather let them go a month too early, than a day too late.

Rob & Michelle, aka @shellybelly

Learn more about elbow hygroma problems in three-legged dogs