Post-TPLO Suture Removal and Implant Exposure Managed with Simini Lavage
Vogue Vets and Wellness Centre · Right Stifle · Revision Debridement
Case Summary
A 4-year-old female spayed Kelpie X Border Collie underwent right TPLO on 27/3/24 for partial cruciate tear. Six days post-operatively, the client removed the e-collar and the patient chewed out her sutures, resulting in full-thickness wound opening to the level of the bone and TPLO plate.
Revision surgery was performed on 2/4/24 including wound debridement, Simini Protect Lavage for 5 minutes, high-volume saline lavage, and 4-layer closure. Despite the implant exposure, no infection developed. The TPLO plate was retained, the patient regained full function of the limb, and she remains well with no signs of infection.
Clinical Presentation
Post-TPLO Implant Exposure from Patient Self-Trauma
The patient underwent right TPLO on 27/3/24 for a partial cruciate tear confirmed on radiography. Six days post-operatively, the client removed the e-collar. The patient chewed out her sutures, and on 2/4/24 she was presented with a full-thickness wound open to the level of the bone and TPLO plate.
Full-thickness wound opening to the level of bone and implant is one of the most challenging post-TPLO complications. Direct implant exposure greatly increases the risk of biofilm formation and implant-associated infection. The clinical expectation at presentation was that implant removal would be required once bony union was confirmed at approximately 8 weeks.
Fig. 1 — Intraoperative view at revision surgery 2/4/24. Full-thickness wound open to the level of the TPLO plate following patient self-trauma. Chewed suture ends visible in wound.
Fig. 2 — Post-operative radiograph following revision closure. TPLO plate and screws in satisfactory position. No periimplant lucency at follow-up.
Revision Surgery Protocol
Debridement, Simini Lavage and Closure
The patient was admitted and taken to surgery on 2/4/24. The wound was assessed and found to be open full-thickness to the bone and TPLO plate, with chewed suture ends present. The joint capsule closure was intact and was not reopened. Wound swabs were taken for culture prior to debridement, focusing around the plate. A 4-layer closure was performed following lavage.
| Step | Description |
|---|---|
| 01 | Full-thickness wound to bone and plate assessed. Chewed suture ends identified and remaining proximal sutures removed. Joint capsule found intact and not reopened |
| 02 | Wound swabs taken for culture and sensitivity, focusing on tissue around the plate |
| 03 | Dry swab debridement performed |
| 04 | SiminiSimini Protect Lavage applied (10 ml) to the wound area for 5 minutes |
| 05 | High-volume sterile saline lavage performed (900 ml total) |
| 06 | Sharp debridement of muscle and skin edges to freshen previously sutured margins |
| 07 | 4-layer closure: muscle layer (2-0 monofilament absorbable), subcutaneous layer (2-0 monofilament absorbable), intradermal closure (2-0 monofilament absorbable), skin sutures (0 Supramid nylon, cruciate pattern) |
Simini Protect Lavage was applied for 5 minutes — an extended dwell time reflecting the severity of contamination risk with direct implant exposure. This was followed by 900 ml of high-volume saline lavage. Simini reduces bacteria, biofilms, and resistant bacteria at the wound site. Biofilm formation on implant surfaces is a well-recognised driver of persistent orthopaedic infection. The extended dwell time and high-volume saline follow-through represent the most aggressive lavage protocol seen across this case series.
Outcomes and Follow-Up
Recovery and Long-Term Result
Recovery was uneventful. Three days post-revision surgery, the patient had minimal swelling, good pain control, and the wound edges looked excellent. By day 9, inflammation was scored at 0 out of 5. The patient commenced hydrotherapy by 30/4/24. At the 8-week assessment, there was no evidence of infection and the TPLO plate was retained.
Excellent Wound Edges
Minimal swelling. Good pain control. Wound edges appearing excellent.
Inflammation 0/5
Inflammation scored 0 out of 5. Wound edges healing well. No signs of infection.
No Infection — Implant Retained
No evidence of infection. Implant removal was not required, contrary to initial expectation. Bony union confirmed.
Normal Function Restored
Patient seen regularly and remains well. Normal limb function restored with equal muscling bilaterally. No pain on examination. TPLO plate retained in situ with no signs of infection.
This case represents single-surgeon clinical experience. Culture swabs taken prior to revision showed no growth, which the treating surgeon attributed to antibiotic administration prior to swabbing.
Clinical Timeline
Post-Operative Course
Primary TPLO
Right TPLO performed for partial cruciate tear confirmed on radiography. Routine closure. E-collar applied.
Presentation with Implant Exposure
Client removed e-collar. Patient chewed out sutures. Full-thickness wound to bone and TPLO plate. Admitted for emergency revision surgery.
Revision Surgery
Wound debridement, swabs taken, Simini Protect Lavage 10 ml for 5 minutes, 900 ml saline lavage, sharp debridement of wound edges. 4-layer closure performed.
3-Day Recheck
Minimal swelling, good pain control, wound edges excellent.
9-Day Recheck
Inflammation 0 out of 5. Wound healing well. No signs of infection.
Hydrotherapy Commenced
Patient in hydrotherapy and recovering well. No complications.
8-Week Assessment
No evidence of infection. Bony union confirmed. Implant removal not required. Full function restored.