Dallas Zoo house call! How VAC wound care helped fix a tortoise’s leg


Dr. Hoxworth teams up with the Dallas Zoo to care for #12, a tortoise that developed a non-healing sore on his leg. Photo by Kim Alexander.

It’s not too often that my work takes me away from the clinic. I’m a plastic surgeon and reconstructive wound care specialist, so while I see a lot of variety in cases every day, there’s not much change in scenery.

That changed the summer of 2017 when I was called upon to visit a special patient in a very special place: the Dallas Zoo. One of the zoo’s tortoises, whose name is #12, had a wound on his leg that just wouldn’t heal, and his caregivers had exhausted their options for treating it on their own. After multiple calls to area experts pointed the Dallas Zoo team to UT Southwestern, we arranged a meeting to figure out how to help #12.

Diagnosing and treating a wounded tortoise

Tortoise #12 is about 30 years old and has lived at the Dallas Zoo for 10 years. During a routine checkup, his caregivers noticed a small sore forming on the underside of his right rear leg. This is the point where the leg goes in and out of his shell – the human equivalent of the back of the knee. Because of the location of the wound and the amount of movement a tortoise does throughout the day, #12’s wound wouldn’t heal and became progressively worse. The wound had begun to break down and ulcerate, making him vulnerable to potential infection, amputation, or even death.

I had a conference call with #12’s caregivers at the Dallas Zoo, who sent me photos of the wound and described their concerns. We suggested using a negative pressure wound therapy device called vacuum-assisted closure, or VAC. Essentially, we’d apply a sealed dressing to #12’s wound and hook the dressing to an external pump to create negative pressure, or a vacuum effect. This type of therapy helps increase blood flow to the wound and decrease excess fluid to help it heal.

My team contacted KCI/Acelity, a company from which we often get human VAC devices, and discovered that the company actually had an animal health division. Even better! Once we received the device and related equipment, I visited #12 and his caregivers, along with Dr. Christopher Bonar, Director of Animal Health at the Dallas Zoo, in August. Together, we applied the device to #12 and brainstormed how to expedite his healing, as well as options for the future should #12 or another tortoise experience a similar wound.

Although #12 was not sedated, he tolerated the installation of the wound VAC well due to the comfort and assistance provided by the zoo’s team during the procedure. The tortoise weighs more than 300 pounds, and the zoo staff built a special table to hold him during the procedure. Needless to say, it took many people to move him and keep him stationary. After about an hour of adjusting the position of the VAC and using various supplies to obtain a good seal (with many breaks in the action while #12 emptied his bladder!), we were able to accomplish the negative pressure required for the VAC to work properly.

After the successful installation of the VAC, Dr. Bonar treated my team to a “behind the scenes” tour of his facility. I was in awe of the creative modifications that Dr. Bonar and the Dallas Zoo hospital staff regularly use to address the health of their wide variety of animal residents.

Tortoise #12 is about 30 years old and has lived at the Dallas Zoo for 10 years. Photo by Kim Alexander.

Differences between human and tortoise wound care

As you can imagine, treating a human for a wound is much different from treating a tortoise. For starters, there are vast differences in our amounts of skin and its texture. Humans have a lot of skin, and ours is soft and supple, allowing us the option of using “donor skin” from an unaffected area of the body as part of reconstruction of a severe wound. A tortoise has much less skin, and it is firmer and not as pliable. Much of the surface area of a tortoise’s body is its large, hard shell, which is not conducive for grafting.

In general, people are much more cooperative about medical treatment. When we suture, or close, a human’s ulcerated wound, it’s less challenging for the patient to take precautions not to disturb the area. In the case of our tortoise friend, asking him to take it easy was not an option.

Before we applied the VAC device, the Dallas Zoo team had closed #12’s wound with sutures, but the tortoise still managed to pull them apart as he moved throughout his day. The Dallas Zoo team worked on a plan to safely limit #12’s activities without hindering him too much in his daily life. Tortoises are surprisingly active creatures, and they depend on their mobility to eat, socialize, and thrive, just as humans do.

We’re hopeful that the VAC device we applied to #12 will be as effective for his wound as it is in human patients. There is no predictable timeline as to how long the wound will take to heal. As #12 begins to heal, we’re keeping in touch with his caregivers at the Dallas Zoo to troubleshoot issues that arise and follow up on his progress.

Dr. Hoxworth bonds with #12 after his treatment. Photo by Kim Alexander.

Why it’s important to seek expert wound care right away

The tortoise’s caregivers did the right thing by reaching out right away for expert wound care, and their fast action is what I advise my human patients to do as well. The longer you wait, the worse your sore can become, putting your health and quality of life at risk.

The wound #12 suffered is quite similar to a pressure wound in a human. Pressure wounds occur when continual irritation causes a flesh wound to develop, and constant pressure prevents it from healing and makes it worse.

Sores can cause serious infections of the skin and blood and, if left untreated, unfortunately can result in amputation of an infected arm or leg. However, we often are able to salvage the limbs of patients who’ve been told elsewhere that amputation is the only option.

At UT Southwestern’s University Hospital Wound Care Clinic, we treat a variety of pressure wounds such as:

  • Arm and leg wounds
  • Complex abdominal wounds
  • Diabetic ulcers
  • Nonhealing surgical wounds
  • Pressure ulcers from using a wheelchair or being bedbound
  • Traumatic injury wounds
  • Wounds occurring after cancer treatments

If you are concerned about a wound or have the beginnings of a sore or ulcer, don’t hesitate to seek medical care. Call 214-645-8300 to request an appointment with a wound care expert, or request an appointment online.