Search Results (162)

Background: Chronic lower limb wounds, such as diabetic and vascular ulcers, affect up to 2% of the global population, imposing high healthcare costs and a significant risk of amputation. Although nursing care and traditional treatments are fundamental, single-use portable Negative Pressure Wound Therapy PICO 7 system, has emerged as a cost-effective alternative. The objective of this study was to evaluate the effectiveness of PICO 7, compared to the usual treatment in chronic lower limb wounds or their dehiscence in amputations. Methodology: A randomized, controlled, open-label clinical trial was conducted at the Hospital Universitario de Toledo (2024–2026). The final analyzed sample consisted of 31 patients (Intervention Group, IG: 14; Control Group, CG: 17). Both groups followed the dynamic TIME strategy to standardize wound bed preparation. Primary variables included healing rate, healing time, wound area reduction, clinical safety (infections and adverse effects), pain levels, health-related quality of life, and physical activity. Statistical analysis was performed using SPSS v.28. Results: The IG showed a higher mean percentage reduction in wound size, although the between-group difference did not reach statistical significance. No infections were recorded in the IG. Regarding quality of life and physical activity, the CG showed a significant post-intervention decline, whereas the IG remained stable. A significant negative correlation was found between final wound size and hours of sleep, suggesting that wound reduction facilitates better rest. Conclusions: The PICO 7 system appears to be a safe and feasible alternative to conventional wound care. Favorable trends in wound area reduction should be interpreted cautiously given the lack of statistically significant between-group differences. Full article

Introduction: While global burden is underappreciated, traumatic wounds account for 23 million annual emergency department visits in the United States, accounting for trillions in medical costs and work and quality of life loss. We hypothesized that the use of intact fish skin grafts (IFSGs) would result in faster time to obtain a graftable wound bed compared to a synthetic matrix (SM). Methods: This retrospective analysis of patients with full-thickness acute traumatic wound was conducted on a matched sample of patients receiving IFSG versus SM. We hypothesized that there would be at least a 10-day difference between the two treatments. Two surgeons reviewed electronic charts for primary outcomes. Incomplete charts were excluded. For sensitivity analysis, both simple linear regression and generalized linear mixed models were utilized to adjust the primary outcome to potential confounders. Results: Data were reviewed for 80 patients. The final cohort included 38 patients [IFSG (n = 12) and SM (n = 26)]. Demographics were not different between groups. The mean age was 42.4 ± 20.7 years, with 62.2% being male and equal proportions having burns treated vs. another traumatic wound. The most common site was the lower extremity. All IFSG patients had negative pressure wound therapy (NPWT) placed at the time of implantation vs. 50% of SM (p = 0.001). The SM group had a larger TBSA (p < 0.001) and wound size (p = 0.001). Differences were subsequently used to adjust primary outcomes via regression. Patients with IFSG had faster time to a graftable wound bed compared to SM (mean ± SD: 13.9 ± 5.3 vs. 29.1 ± 10.3, p < 0.001). Neither wound size, burn severity, presence of infection, nor use of NPWT significantly altered the inference. Conclusions: In this paired sample, the use of IFSG as a dermal template for full-thickness traumatic injuries was associated with faster time to obtain a graftable wound bed compared to an SM. However, regression analysis alone is not enough to conclude that the same difference would exist in a prospectively controlled experiment, which should be performed. Full article

Postoperative complications following colorectal surgery—including anastomotic leak (AL), surgical site infection (SSI), perioperative haemorrhage and colovesical fistula—represent major causes of patient morbidity and mortality, prolonged hospitalisation, and healthcare expenditure. This review summarises contemporary evidence across two key domains of complication management—prevention and diagnosis—applied to four major complications (AL, SSI, perioperative haemorrhage, and colovesical fistula), drawn from a comprehensive literature review of recent randomised controlled trials, systematic reviews, meta-analyses, and prospective cohort studies. Preventive strategies discussed include optimisation of surgical techniques (minimally invasive and robotic approaches, indocyanine green perfusion assessment, self-expanding metal stent bridge-to-surgery, and negative pressure wound therapy), modification of patient factors where possible (obesity, anaemia, malnutrition, and immunosuppression), and system-level interventions including Enhanced Recovery After Surgery (ERAS) protocols, perioperative beta-blockade, prehabilitation, and structured quality improvement bundles. Diagnostic strategies have evolved to incorporate biomarker surveillance (CRP and procalcitonin), drain fluid pH analysis, CT imaging (including angiography), endoscopy, and novel digital health tools including wearable monitoring and mobile health applications. Reducing the risk of postoperative complications should involve a multidisciplinary, protocolised approach combining intraoperative technique optimisation with structured perioperative care bundles and close post-discharge surveillance, and centralisation to specialist colorectal surgical units. Full article

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity and lower extremity amputation. Numerous advanced wound therapies with various mechanisms of action have been developed to improve healing outcomes; however, the comparative certainty of evidence supporting these interventions remains unclear. This study evaluates randomized controlled trials (RCTs) of DFU therapies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Methods: A narrative synthesis of RCTs published between January 2016-January 2026 evaluating therapies for DFUs was performed. For studies that reported 12–week healing outcomes, risk of bias was assessed using the Cochrane Risk of Bias 2 tool and certainty of evidence for each therapy subgroup was evaluated using the GRADE framework. Results: A total of 143 RCTs were included with 45 RCTs undergoing GRADE assessment. The proportion of studies demonstrating statistically significant improvements in 12-week healing rates relative to controls varied and was not reflected in the GRADE assessment. Moderate-certainty evidence was assigned to the hyperbaric oxygen therapy subgroup. Low-certainty evidence was assigned to silver dressings, biosynthetic scaffolds, stem cell therapy, and negative pressure wound therapy. Very low-certainty evidence was assigned to topical oxygen, synthetic structural scaffolds, moisture-retaining dressings, local antimicrobial delivery, placental-derived skin substitutes, platelet-rich plasma, acellular dermal matrices, allografts/xenografts, and off-loading devices. No therapy subgroup was assigned high-certainty evidence. Conclusions: The certainty of evidence supporting DFU therapies varies substantially across intervention categories. These findings highlight the need for larger, methodologically rigorous comparative trials to clarify the effectiveness of DFU therapies and guide evidence-based wound care. Full article

Background: Acute compartment syndrome is a surgical emergency that is most often associated with trauma. Rarely, however, it can develop without major trauma in patients receiving anticoagulation therapy. Methods: A 53-year-old woman receiving warfarin therapy presented with progressive swelling and pain in the left forearm after physical therapy. Computed tomography angiography showed preserved arterial flow. On clinical examination, pain and paralysis were present, whereas pallor and paresthesia were absent. Direct compartment pressure measurements demonstrated markedly elevated pressures in the dorsal and deep volar compartments, measuring 88 mmHg and 110 mmHg, respectively. Emergency fasciotomy was performed approximately 9 h after symptom onset. Results: Intraoperative findings showed hematoma formation and partial muscle necrosis in the deep volar compartment. After surgery, persistent bleeding required repeated hemostatic interventions and blood-product transfusion. Negative-pressure wound therapy was applied, and delayed primary closure was subsequently performed. Anticoagulation therapy was temporarily discontinued and later resumed. The patient recovered without further bleeding, wound complications, or functional impairment and was discharged in stable condition. No complications, including hematoma recurrence or infection, were observed during 6 months of follow-up. Conclusions: This case highlights a temporal association between physical therapy and acute forearm compartment syndrome in a patient receiving anticoagulation therapy. It also emphasizes that preserved peripheral pulses and intact arterial flow do not exclude the diagnosis. Early recognition and prompt surgical intervention remain essential to prevent irreversible tissue damage and optimize outcomes. Full article

Background/Objectives: Chronic diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) remain a major source of morbidity, healthcare utilization, and limb loss, despite adherence to established standards of care protocols and the widespread availability of advanced wound technologies. Many advanced modalities only target isolated aspects of wound healing and fail to address the complex, interdependent pathophysiology of chronic wounds, particularly tissue hypoxia, edema, impaired microcirculation, and persistent inflammation. Cyclical Pressurized Topical Wound Oxygen (TWO₂) therapy is a home-based, multimodal intervention that combines humidified topical oxygen delivery with cyclical non-contact compression to address these core drivers simultaneously. Methods: This review synthesizes mechanistic rationale and evidence from randomized controlled trials, long-term venous ulcer studies, and real-world comparative effectiveness analyses. Emphasis is placed on the large cohort study by Yellin et al., which directly compared TWO₂ with other advanced modalities including negative pressure wound therapy (NPWT), skin substitutes, and growth factor therapies. Results: Across these studies, TWO₂ therapy is consistently associated with improved healing durability, reduced recurrence, and substantial reductions in hospitalization and amputation rates compared with both standard care and advanced wound therapies. Conclusions: The convergence of randomized and real-world evidence supports TWO₂ therapy as a clinically meaningful and mechanism-driven adjunctive treatment option for patients with chronic, high-risk lower-extremity wounds. Full article

Background: Enterocutaneous fistulas (ECFs) and enteroatmospheric fistulas (EAFs) are rare but highly morbid complications that most commonly arise after abdominal surgery. Outcomes have improved with advances in multidisciplinary care and with increasing research on how to best manage them; however, they remain associated with significant morbidity, high mortality, and prolonged hospitalization. Optimal timing of definitive repair is unknown, with many high-volume centers waiting 6–12 months, though emerging data suggest that earlier intervention may be feasible in carefully selected patients. Given their complexity and variability in management, a comprehensive review of current evidence is needed. Methods: A narrative review of the literature was conducted with emphasis on the classification, pathophysiology, and multidisciplinary management of ECFs and EAFs. Relevant studies addressing fluid and sepsis control, nutritional optimization, wound care, pharmacologic therapies, and interventional strategies were reviewed. Results: The management of ECFs requires a staged approach focused on fluid resuscitation, sepsis control, wound management, and nutritional optimization. Spontaneous closure can occur, and is most commonly within the first two months. Nutritional optimization through enteral and/or parenteral nutrition or fistuloclysis plays a vital role in improving outcomes. Therapies such as negative pressure wound therapy, biologics, and pharmacologic agents may support spontaneous closure and fistula control. In non-healing fistulas, surgical repair remains necessary, with optimal time for surgery at least 6–12 months from fistula development. Conclusions: ECFs and EAFs remain complex surgical challenges. Outcomes have improved due to advances in nutritional support and wound management, and the emergence of minimally invasive techniques. Standardization of treatment protocols and further research into novel therapy may further enhance outcomes and limit variability in management. Full article

Background/Objectives: Behçet’s disease is a chronic relapsing multisystem inflammatory disorder characterized by recurrent mucocutaneous ulceration, vasculitis, and exaggerated inflammatory responses to minor trauma. These features may adversely affect wound healing after major head and neck oncologic reconstruction. This case report describes repeated wound breakdown after oral cavity reconstruction in a patient with Behçet’s disease and advanced floor-of-mouth squamous cell carcinoma. Methods: A 51-year-old woman with Behçet’s disease and T4N2bM0 squamous cell carcinoma involving the floor of the mouth and tongue underwent tumor resection followed by reconstruction of the oral cavity defect using a right anterolateral thigh perforator free flap. Subsequent surgical procedures included debridement of necrotic tissue, negative-pressure wound therapy, split-thickness skin grafting of the thigh donor site, and salvage tumor resection with pectoralis major myocutaneous flap reconstruction after tumor recurrence. Results: After the initial anterolateral thigh free flap reconstruction, flap perfusion was satisfactory in the immediate postoperative period; however, delayed marginal necrosis developed from the distal tongue-side flap margin, whereas the floor-of-mouth portion remained relatively stable. The right thigh donor site also developed progressive suture-line necrosis and wound dehiscence, requiring operative debridement, negative-pressure wound therapy, and split-thickness skin grafting. Although skin grafting achieved eventual donor-site coverage, partial graft necrosis and delayed secondary healing occurred. Persistent fistula and wound instability delayed postoperative radiotherapy, and recurrent floor-of-mouth squamous cell carcinoma subsequently developed approximately 6 months after the initial surgery. After salvage resection and pectoralis major myocutaneous flap reconstruction, the flap appeared viable at inset, but marginal ecchymosis, partial necrosis, and wound dehiscence again developed, requiring additional debridement, quilting sutures, and negative-pressure wound therapy. The wound gradually stabilized with staged wound management. Conclusions: This case illustrates a multifactorial pattern of repeated marginal wound breakdown after technically successful flap reconstruction in a patient with Behçet’s disease. Behçet-related pathergy-like inflammation, vasculitis, and microcirculatory dysfunction may represent possible contributing mechanisms, but they were not directly proven in this patient. In oral cavity reconstruction, such wound instability may delay adjuvant therapy and adversely affect oncologic outcomes. Careful perioperative planning, close multidisciplinary coordination, meticulous tension-free closure, early recognition of wound compromise, and readiness for staged wound management are essential in patients with Behçet’s disease undergoing major head and neck oncologic reconstruction. Full article

Chronic wounds present a significant challenge to healthcare systems globally, affecting approximately 1% of the population and severely impacting their quality of life. Biofilm development occurs in approximately 90% of chronic wounds, contributing to an increased prevalence of polymicrobial infections. Currently, there is a large quantity of antimicrobial topical treatments, dressings, and advanced therapies. However, many of them are hindered by the complex biofilm environment, antibiotic resistance, and/or host tissue toxicity. Furthermore, conventional treatments such as debridement, systemic/local antibiotics, and negative-pressure therapy are often ineffective at eradicating biofilms and fostering optimal healing conditions. Nanomedicine approaches have shown promising potential to address the limitations of current treatments. In this review, we discuss the pathophysiology of chronic wounds, the role of biofilms, microenvironmental changes, current treatments and their limitations, and nanocomposite-based strategies to eradicate biofilms and resolve chronic wounds. Full article

Background: Post-sternotomy mediastinitis remains a devastating complication of cardiac surgery. Although most cases are bacterial, fungal mediastinitis due to Candida albicans is rare, aggressive, and particularly difficult to treat because of biofilm formation, prosthetic involvement, and limited penetration of systemic antifungal agents into infected tissues. Taurolidine is a taurine-derived antimicrobial compound with broad antibacterial, antifungal, and anti-biofilm properties that has shown promising results in catheter-related infection prevention and cardiac implantable electronic device surgery. Case summary: We report, to our knowledge, the first intramediastinal use of taurolidine for Candida albicans mediastinitis after biological Bentall surgery. Following urgent resternotomy and extensive debridement, 200 mL of taurolidine solution was instilled into the mediastinum for 60 min, then aspirated. Postoperatively, taurolidine irrigation via mediastinal drainage was combined with negative-pressure wound therapy and systemic antifungal treatment. Results: Rapid microbiological sterilization was achieved, inflammatory markers normalized, and follow-up computed tomography demonstrated complete resolution of mediastinal infection. Delayed sternal closure was then performed successfully without recurrence at 6-month follow up. Conclusion: To our knowledge, this represents the first reported use of intramediastinal taurolidine irrigation for fungal mediastinitis following cardiac surgery. Intramediastinal taurolidine irrigation may represent a promising adjunctive strategy for mediastinitis after cardiac surgery in high-risk patients. Further clinical evaluation is warranted. Full article

Background and Objectives: Extensive burns are devastating injuries, especially in children, associating high risk of morbidity and mortality in the absence of immediate and appropriate treatment. Negative-pressure wound therapy (NPWT) has emerged as a versatile tool for the local treatment of burn wounds. This study aims to present our approach in using NPWT for extensive burns in children, emphasizing the indications and outcomes of these very challenging cases, and proposing an algorithm for NPWT use for extensive burn patients, even in low-resource settings. Materials and Methods: We retrospectively analyzed pediatric burn patients admitted between January 2020 and December 2024, selecting the cases with at least 20% TBSA burn and the application of NPWT during treatment, recording indications and parameters of use, treatment period, and results. Results: We identified 12 patients with a burn surface ranging from 20% to 80% TBSA, caused by high-voltage electrical current (6 cases), flame (4 cases), and scalds (2 cases). NWPT was used for 3–25% TBSA for obtaining granulation tissue in very deep burn wounds with bone and tendon exposure, for reducing edema and enhancing spontaneous re-epithelialization in intermediate circumferential burns, and for preparing the wound bed for re-grafting after local infection and graft failure. There were no complications related with the NPWT use and no fatalities. Conclusions: NPWT represents a reliable option for several clinical situations in local burn treatment, for temporary closure of burn areas, graft fixation, burn wound preparation, local infection control, or enhancing re-epithelialization. The proposed algorithm offers a comprehensive overview of indications of NPWT for burn local management and may guide clinical decisions, easing the identification of the best situation and moment to use the device. Our study contributes to the body of knowledge that enforces the evidence of the safe and effective use of NPWT for burn management in the pediatric population. Full article

Background and Objectives: Diabetes mellitus (DM) is a major global health concern, with diabetes-related foot disease (DFD) representing one of its most severe complications, often resulting in chronic infection, osteomyelitis, and limb amputation. Conventional therapies frequently fail in refractory cases, necessitating novel adjunctive strategies. Ozone therapy (OT) possesses antimicrobial, immunomodulatory, and oxygen-enhancing properties, while negative pressure wound therapy (NPWT) facilitates granulation, exudate removal, and tissue perfusion. This study explored the combined efficacy of OT and NPWT in advanced DFD. Materials and Methods: An exploratory, retrospective, observational cohort study was conducted at a specialized wound care center in Gdańsk, Poland, between 2019 and 2022. The study included 30 patients (n = 30) with refractory DFD involving both soft tissue and bone infection who had not responded to previous conventional treatment. The analyzed treatment approach consisted of surgical debridement, application of topical ozonated preparations, and (NPWT) with instillation of ozonated saline administered over a six-week period. Clinical outcomes included wound healing assessed using the Wagner classification and wound volume reduction, pain intensity measured using the Numeric Rating Scale (NRS), inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]), and microbiological characteristics of wound cultures. Statistical analyses were performed using the Wilcoxon signed-rank test and the chi-square test, and regression modeling was applied to identify potential predictors of therapeutic response. Statistical significance was defined as p < 0.05. Results: By week six, 100% of ulcers improved to Wagner stage ≤1, with 26.7% achieving stage 0. Median wound volume decreased from 5.5 cm³ to 0 cm³ (p < 0.001). Pain scores declined from 7.2 ± 0.96 points to 0.2 ± 0.5 points (p < 0.001). CRP and PCT levels decreased significantly (p < 0.001), and microbiological clearance was observed in all cases. Higher body mass index (BMI) was associated with poorer pain reduction. Conclusions: The combination of standard wound care with OT and NPWT was associated with clinically relevant improvements in wound healing, infection control, systemic inflammation, and pain reduction in patients with refractory DFD. Although limited by a non-controlled design and small cohort size, these findings support further randomized controlled trials to define the role of this combined approach in integrated diabetic foot care. Full article

Background/Objectives: Chronic wounds are a major source of morbidity in patients with paraplegia, often resulting in repeated treatment, prolonged hospitalization, and reduced quality of life. Reconstruction becomes particularly challenging when a wound arises in a scarred trunk region and is further complicated by deep infection, osteomyelitis, or enteric fistula. We describe the staged management of a complex left flank wound in a paraplegic patient, initially reconstructed with a quadrilateral pinwheel flap and later requiring multidisciplinary salvage for recurrence associated with rib osteomyelitis and a colocutaneous fistula. Methods: A paraplegic man in his 50s presented with a chronic left flank wound after repeated full-thickness skin graft failure and persistent Pseudomonas aeruginosa infection. After wide debridement, the approximately 7 × 7 cm defect was reconstructed with a quadrilateral pinwheel flap composed of four Limberg-style rhomboid fasciocutaneous flaps positioned at the 12, 3, 6, and 9 o’clock orientations, elevated at the level of the deep fascia, and transposed into the central defect, with adjunctive negative-pressure wound therapy (NPWT). Approximately 1 year later, recurrence with rib osteomyelitis required rib resection. During NPWT, feculent drainage led to the diagnosis of a colocutaneous fistula. Subsequent multidisciplinary treatment included fistula tract resection, colonic repair with omental patching, transposition of vascularized omentum into the chest wall cavity to obliterate dead space, continued NPWT, and delayed primary closure. Results: Initial local flap reconstruction achieved wound coverage, and immediate postoperative clinical assessment, including pinprick and refill testing, confirmed satisfactory flap perfusion; however, delayed recurrence developed in association with rib osteomyelitis. After definitive fistula surgery, dead-space management with vascularized omentum, wound conditioning with staged NPWT, and delayed primary closure, the wound healed completely. At 6 months after delayed closure, no recurrence of fistula, osteomyelitis, wound dehiscence, or soft-tissue breakdown was observed, and the patient’s daily comfort and functional independence were improved compared with the preoperative condition. Conclusions: A quadrilateral pinwheel flap may provide an effective tension-dispersing local fasciocutaneous option for selected scarred trunk defects in high-risk patients. However, when chronic wounds are compounded by deep infection and enteric fistula, durable healing depends not on flap design alone but on staged multidisciplinary management incorporating definitive source control, vascularized tissue transfer for dead-space elimination, NPWT, and appropriately timed closure. Full article

Background: Diabetic foot ulcers (DFUs) represent a major chronic complication of diabetes mellitus, often leading to severe infection, amputation, and reduced quality of life. Among various factors affecting DFUs, plantar pressure plays a pivotal role in ulcer formation and recurrence. Despite growing interest in this domain, few studies have comprehensively evaluated the research landscape concerning plantar pressure in the context of DFUs from a bibliometric perspective. Aim: To conduct a comprehensive bibliometric analysis and visualization of global research trends, hotspots, and collaborative networks in the field of plantar pressure-related diabetic foot studies from 2000 to 2024. Methods: A systematic search was conducted in the Web of Science Core Collection (WoSCC) on 16 February 2025, for articles published between 2000 and 2024 using terms related to “diabetic foot” and “plantar pressure”. A total of 2518 records were retrieved, from which 2110 English-language articles and reviews were included. Bibliometric and visual analyses were performed using Microsoft Excel 2021, VOSviewer (v1.6.20), CiteSpace (v6.4.R1), Charticulator, and Scimago Graphica. Analyses included publication trends, country/institution/author collaborations, journal distributions, keyword co-occurrence and clustering, citation bursts, and reference co-citation networks. Results: A total of 2110 publications were identified, showing an overall increase in annual publication output from 2000 to 2024, with some year-to-year fluctuations. The United States led in publication volume (678 articles), citation frequency, and H-index, followed by the United Kingdom and China. Armstrong, David was the most prolific and also had the highest H-index among the listed authors, while the University of Amsterdam was the leading institution. “Journal of Wound Care” had the highest publication count, whereas “Diabetes Care” ranked first in citation frequency. Keyword analysis revealed major research clusters including “diabetic foot”, “plantar pressure”, “wound healing”, “offloading”, and “negative pressure wound therapy”. Recent trends show an increased focus on microcirculation, regenerative medicine, customized footwear, and wound care technologies. Conclusions: The bibliometric analysis reveals research trends and current hotspots in plantar pressure management for diabetic foot ulcers, with a particular focus on managing plantar pressure through personalized offloading strategies and custom footwear. These findings highlight the practical value of tailoring interventions to individual patient needs, emphasizing the importance of biomechanical factors in ulcer prevention and healing. Full article

A 2-year-old female Labrador Retriever, with a body condition score of 6/9, underwent ovariohysterectomy 24 h prior at another center and was urgently referred for a possible exploratory laparotomy. The dog presented with lethargy, abdominal pain, and a haematoma with active bleeding in the surgical wound, indicating a possible haemoabdomen. An abdominal-Focused Assessment with Sonography for Trauma (A-FAST) revealed fluid in all four quadrants (abdominal fluid score-AFS 4/4) without abdominal distension, corresponding to an effusion with a packed cell volume of 15% and 4 g/dL of protein. Haematological analysis showed a slight decrease in haematocrit (HCT) and red blood cells, with neutrophilia, while the rest of the blood tests were within normal limits. Physical examination parameters were mostly normal, except for cardiac auscultation where tachycardia, irregular rhythm, and pulse deficit were noted, with normal blood pressure. The electrocardiogram (ECG) indicated both monomorphic and polymorphic ventricular tachycardia with isolated episodes of sinus tachycardia. Treatment included the administration of metamizole, methadone, and maintenance fluid therapy, along with compressive abdominal bandaging. Lidocaine and continuous infusion of fentanyl therapy were initiated. The dog’s HCT, platelets, temperature, and blood pressure remained in the normal range. During the first 8 h, both the ECG and A-FAST showed no relevant changes. From the 9th hour onward, there was a predominance of sinus rhythm, the free fluid decreased to AFS 1/4, allowing for the gradual suspension of lidocaine. Tests for Leishmania, Ehrlichia, Anaplasma, Babesia, and Dirofilaria were negative. The evolution remained favorable, and the dog was discharged after 72 h, showing a good outcome in the cardiology follow-up 5 days later. Full article