Sea Turtle Patient - Andre

Sea Turtle AndreSpecies: Green Sea Turtle
(Chelonia Mydas)

Stranding Date
: June 15, 2010
Stranding Location: Juno Beach

Initial Weight
: 190 lbs.
Current Weight: 175.34 lbs.

Injury: Multiple boat propeller strikes


Admission Note:

Andre, an adult male green sea turtle was found stranded on Juno Beach as a result of multiple boat propeller strikes. Dr. Nancy Mettee removed more than 3lbs. of sand from the body cavity only to find severe infection and organ displacement. Andre is receiving advanced wound healing therapy using the VAC. Despite his critical injuries, Andre appears to be strong at this time.

Benefits of VAC Therapy:
•    Allows continuous wound therapy without interfering with activities.
•    Assists in tissue granulation.
•    Applies controlled, localized negative pressure to help uniformly draw wounds closed.
•    Helps remove interstitial fluid allowing tissue decompression.
•    Helps remove infectious materials.
•    Provides a closed, moist wound healing environment.
•    Helps promote flap and graft survival.


Progress Notes:

7/19/2011 -  Andre continues to eat well and thrive. We have sent out bloodwork to assess Andre’s health and determine if his blood values are in the optimal ranges. We are pleased with his progress thus far and are optimistic for a release in the near future.

7/12/2011 -  With the benefit of KCI’s negative pressure wound vacuum Andre continues to improve daily. His appetite is up and he is steadily gaining weight. We are pleased with his progress and optimistic for a release in the near future.

6/29/2011 -  We continue to utilize the negative pressure wound therapy and are pleased with the results at every bandage change.  Andre’s activity level and appetite remain good. Andre enjoys a variety of food including lettuce and other vegetation.

6/20/2011 -  Dr. Mettee debrided Andre’s carapace wound and re-applied the negative pressure wound vacuum to achieve the best results possible. The goal is to utilize the V.A.C system for Andre’s remaining time here to get the best adherence of the pleura to the underside of the carapace.

6/13/2011 -  Andre’s V.A.C bandages have been holding for a week at a time, resulting in significant healing of the carapace wound.  Andre’s appetite is up and he is gaining weight. He has been much more active in his tank. We are very pleased with Andre’s progress and remain optimistic about a release in the near future. This is great news as this week will be the one year anniversary of his arrival at Loggerhead Marinelife Center. It is amazing to see how far he has come with such severe injuries in just one year.

6/6/2011 -  Andre’s bandage has been holding well and we are seeing significant healing of the carapace wound. Andre’s activity level and appetite are up and he continues to make progress.

5/30/2011 -  We are pleased with the level of healing as Andre continues to benefit from KCI’s negative pressure wound V.A.C. system and are still hopeful for a summer release.

5/13/2011 -  Andre's orthodontics have been removed after achieving the desired closure results. A surgical debride was performed in hopes to get the healthy new tissue to adhere to the ventral side of the carapace. We are again utilizing the K.C.I. negative pressure V.A.C. system to reach Andre's rehabilitation goals. The progress we are seeing reinforces our plans for a summer release. Monitor Andre's progress on our live webcam here>>

4/29/2011 -  Andre's orthodontics are proving beneficial to the carapace growth and continue to aid in the healing process. New bloodwork was taken this week, and we are optimistic for an early summer release if he continues to improve at this rate.  Monitor Andre's progress on our live webcam here>>

4/22/2011 -  Andre continues to heal at a rapid rate and gain weight with a much improved appetite. We seem to have a much improved attachment success with his current orthodontics and are optimistic that this will yield positive results.

4/15/2011 -  We continue to use orthodontics to accelerate the growth and shifting of Andre's carapace in hopes to better protect his large wound. In almost two months we have seen 1.5cm of growth while utilizing the orthodontic expanders. We also see continued adhesion of the plura to the inside of the shell. Andre is eating well and has a great disposition.

3/22/2011 -  Orthodontics we re-applied to andre's carapace utilizing a new etching technique which to date has proven to be more successful than previous applications. So far we are pleased with the progress the orthodontics have provided in the way of growth and shifting of the carapace. Hopes are for an early Summer release of Andre back to his ocean home.

3/4/2011 -  Andre continues to heal at an amazing and no longer needs to be on the V.A.C. full time. We continue to utilize the V.A.C. system after major wound debridements for best opportunity to increase the healing rate and reattachment of the pleura to the carapace.

Orthodontics Applied to Andre's Shell in Experimental Procedure.

The idea to use orthodontics on a sea turtle has been brewing in LMC Staff Veterinarian Dr. Nancy Mettee’s head for quite some time. Dr. Mettee has been treating “Andre,” an adult male green sea turtle, since June 15, 2010 for two massive boat injuries that left the inside of his body exposed. She was looking for something that would create tension in some areas of the carapace and movement in other areas. Orthodontics have this effect within humans skulls, so Dr. Mettee thought application to a sea turtle’s shell may have similar results. To her knowledge, it would be the first time orthodontics were ever used to help manipulate fractures in a sea turtle’s shell.

She and Dr. Alberto A. Vargas, DMD, MS, of Vargas Orthodonticsin Jupiter partnered to test the procedure on “Penyu,” a sub-adult loggerhead sea turtle with less complex boat strike injuries. After six weeks of orthodontic treatment, Drs. Mettee and Vargas found significant improvement in the healing of Penyu’s injuries with new shell growth measuring over one centimeter in some areas. On February 15th, they attached orthodontic palate expanders to Andre’s shell. Unfortunately, the appliances detached soon after because green sea turtle shells are much different than loggerhead shells.  Drs. Mettee and Vargas will move forward researching ways to adhere the appliances to Andre.

10/20/2010 -  Andre underwent a procedure under light anesthesia on 10/19. Dr. Mettee debrided the wound area and freshened the edges. She laced the dorsal pleura (protective lining of the lung) to the existing carapace with sutures in hopes of decreasing the time needed to reattach to the periosteum. We continue to provide Andre with daily nutritional support.

10/15/2010 - Andre continues to receive 24 hour V.A.C. therapy, with bandage changes occuring every 4-6 days. Andre wound site continues to heal very well. He is being treated with antibiotics, nutritional support, and vitamin therapy.

10/06/2010 -
Andre continues to receive 24 hour V.A.C. therapy, bandage changes occur every 4-6 days. He continues to eat very well and is behaving normally. Andre received his last iron injection on 09/29. Blood work will be re-checked on 10/12. Andre's wound site was debrided on 09/28, and revealed very healthy tissue. His lung volume appears to be normal.  Andre's periosteum (membrane that lines the outer surface of bones) is beginning to adhere to the pleura (protective lining of the lung).

9/26/2010 -  Andre continues to receive V.A.C. therapy and undergoes a bandage change every 5-6 days. Andre's buoyancy issue is improving and will continue to improve as the wound site heals. He currently is receiving weekly iron injections along with nutritional support. We will re-check blood levels on 10/13. 

9/19/2010 - Andre was moved into a big tank on 09/11. Andre continues to have buoyncy issues; however, this should resolve as his wound continues to heal. Andre is extremely strong and swimming very well. He has finished his course of antibiotics and received out lab blood work on 09/15. Andre's blood work revealed very healthy results. We will culture his wound site during the next bandage change. He has a strong appetite and good activity level. We are currently doing weekly bandage changes.

9/12/2010 - Andre was moved into a big tank on 09/11. He is buoyant on his right, rear side; however, this should improve as the wound continues to heal. Andre is strong and swimming very well. He has finished his course of antibiotics and will receive outlab blood work on 09/15. Andre has a strong appetite and good activity level. He continues to be treated with V.A.C. therapy; we are currently doing weekly bandage changes.

9/05/2010 -
Andre continues to make daily progress. We will re-check his blood work on 09/15.

8/31/2010 -  Andre continues to receive weekly iron injections to correct the issue with the low RBC count, which often indicates anemia. Andre also continues to receive antibiotic injections to correct the elevated WBC count, indicating an infection. Andre continues to receive 24 hr/day treatments with the V.A.C. system, along with nutritional support.

8/21/2010 - Andre completed received blood work this past week; results indicated a slighted elevated White Blood Cell (WBC) count and a low Red Blood Cell (RBC) count. Andre will be treated with iron injections and  antibiotics until the issues are resolved. Andre continues to be treated with V.A.C. therapy.

8/13/2010 - Andre underwent surgery this past Saturday. He received a biologically active prosthetic inside the body cavity. The implant, Strattice Reconstructive Tissue Matrix, is porcine derived and designed to promote scar tissue growth, helping to heal the carapace. Andre continues to receive 24 hour wound therapy from the V.A.C. system, along with antibiotics and an antifungal. 

8/07/2010 - Andre continues to be treated with antibiotics, anti-fungal medication, and 24 hour wound therapy from the V.A.C. system. The V.A.C. system has been very successful in expediting the healing process.

7/30/2010 - Andre is eating very well and his activity level has increased significantly. We continue to treat his wound with the V.A.C system, and are currently doing bandage changes twice weekly. Andre is being treated with an antibiotic along with an antifungal.

7/23/2010 - Andre continues to make great progress. He is now eating regularly and his activity level continues to rise. Test results have indicated osteomyelitis; an inflammation or infection of the bone. This is usually caused  by a bacteria or fungal infection. Andre is being treated with an antibiotic and an antifungal.

7/16/2010 - Andre underwent surgical debridement by Dr. Mettee on Wednesday, July 14, 2010. Debridement is the process of removing dead tissue from a wound bed; if not removed the dead tissue could impede the healing process. The debridement revealed very healthy, pink tissue. We are continuing with Andre’s antibiotics at this time. Andre is still receiving wound therapy treatments using the VAC system as well.

7/9/2010 - We are continuing to treat Andre's wound site using VAC therapy. Andre has been making positive progress daily. His strength and activity levels have improved significantly.

 

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