Recurrent Septic TPLO Failure Resolved with Simini Intraoperative Lavage and Jumbo Plate Revision
Fwon Veterinary Clinic · Left Stifle · Third Surgery with Simini Protocol
Case Summary
A 4-year-old English Mastiff underwent left TPLO surgery. Three weeks later, implant failure required a second operation to place a second plate. Bacteriology at that revision confirmed co-infection with Pseudomonas aeruginosa and Staphylococcus pseudintermedius — both resistant to beta-lactam antibiotics.
Despite targeted antibiotic therapy, wound dehiscence occurred 15 days later and was managed conservatively. One month on, the wound remained unhealed and radiographs showed no bone healing, indicating persistent infection.
A third surgery was performed: both previous plates were removed, a new jumbo TPLO plate was inserted, and Simini Protect Lavage was applied directly to the plate before closure. Skin healing was uncomplicated, bone fusion was confirmed at two months, and no further septic episodes were observed. The implant was removed six months later.
Clinical Presentation and First Revision
Implant Failure and Confirmed Multiresistant Co-infection
The patient presented for left TPLO. Three weeks post-operatively, implant failure was identified and a second surgery was performed to place an additional plate. Intraoperative bacteriology at this revision confirmed active infection with two resistant organisms.
Causative Organisms — Beta-Lactam Resistant
Culture confirmed co-infection with Pseudomonas aeruginosa and Staphylococcus pseudintermedius, both resistant to beta-lactam antibiotics. This combination presents a significant management challenge: Pseudomonas is a recognised biofilm-forming organism with intrinsic resistance mechanisms, and co-infection limits antibiotic options substantially.
Image 1 — Bacteriology report confirming co-infection with Pseudomonas aeruginosa and Staphylococcus pseudintermedius, both resistant to beta-lactam antibiotics.
Post-Operative Course After Second Surgery
Wound Dehiscence and Failed Healing Despite Antibiotic Therapy
Following the second surgery, targeted antibiotic therapy was initiated based on the culture results. However, 15 days later the wound dehisced and required conservative wound management. One month after the second revision, the wound remained unhealed and radiographic assessment showed no evidence of bone healing at the TPLO site — indicating persistent infection despite antibiotic coverage.
Image 2 — Wound dehiscence at 15 days post second surgery. Managed conservatively. Antibiotic therapy ongoing.
Image 3 — Wound appearance at 1 month. No healing progress.
Image 4 — Radiograph showing absence of bone healing at the TPLO site.
Image 5 — Additional radiographic view confirming non-union and persistent septic context.
Third Surgery — With Simini
Jumbo TPLO Plate Revision and Simini Lavage
Given the failed healing and persistent infection, a third surgery was indicated. Both previous plates were removed, the bone was reassessed, and a new jumbo TPLO plate was inserted. Simini Protect Lavage was applied directly to the plate before wound closure.
| Step | Description |
|---|---|
| 01 | Both previously placed TPLO plates removed |
| 02 | Wound bed debrided. Bone fragments assessed |
| 03 | New jumbo TPLO plate inserted for enhanced fixation stability |
| 04 | SiminiSimini Protect Lavage applied directly to the plate before wound closure |
| 05 | Layered wound closure performed |
Image 6 — Intraoperative view at third surgery. New jumbo TPLO plate in situ. Simini Protect Lavage applied directly to the plate surface before closure.
In this case, Simini Protect Lavage was applied directly to the implant surface at the time of revision surgery in an established septic context with two resistant organisms. Simini reduces bacteria, biofilms, and resistant bacteria at the surgical site. The prior two revisions without Simini had not resolved the infection; the third revision with Simini was followed by uncomplicated skin healing and confirmed bone fusion at two months.
Outcomes and Follow-Up
Uncomplicated Healing, Bone Fusion at 2 Months, Implant Removal at 6 Months
Following the third surgery with Simini lavage, skin healing was uncomplicated. Bone fusion was achieved two months post-operatively with no clinical signs of infection. The implant was removed six months after the final surgery without complication.
Bone Fusion Confirmed
Uncomplicated skin healing. Bone fusion radiographically confirmed at 2 months. No septic episodes.
Implant Removal
Implant removed at 6 months without complication. No infection signs at that procedure.
Image 7 — Follow-up radiograph confirming bone fusion at 2 months after third surgery.
Image 8 — Radiograph following implant removal at 6 months. No signs of residual infection or bone pathology.
This case represents single-surgeon clinical experience. Simini was used alongside antibiotic therapy at the third revision. The relative contribution of each cannot be separated from clinical data alone.
Clinical Timeline
Post-Operative Course
Primary Left TPLO
Initial TPLO surgery performed.
Implant Failure — Second Surgery
Implant failure 3 weeks post-op. Second surgery to place additional plate. Bacteriology confirmed Pseudomonas aeruginosa and Staphylococcus pseudintermedius — both beta-lactam resistant. Targeted antibiotic therapy initiated.
Wound Dehiscence
15 days after second surgery. Managed conservatively. Antibiotic therapy continued.
No Wound Healing, No Bone Healing
1 month after second surgery. Wound unhealed. Radiographs show no bone healing. Third surgery scheduled.
Third Revision — Jumbo Plate with Simini Lavage
Both previous plates removed. New jumbo TPLO plate inserted. Simini Protect Lavage applied directly to plate before closure.
Bone Fusion Confirmed
Uncomplicated skin healing. Bone fusion radiographically confirmed at 2 months. No septic episodes.
Implant Removal Without Complication
Implant removed at 6 months post third surgery. No infection signs. Case resolved.