NorthStar VETS Cool Case Romeo


The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. This is the story of Romeo, a patient of Dr. Heather Knapp-Hoch and Dr. Kelly Kraus of our Surgery team, and how advanced wound management and a skin graft helped save this dog’s leg.

About Romeo

Dr. Kraus with a healed Romeo

Dr. Kraus with a healed Romeo

Romeo is a 7-year-old male neutered Cock-a-poo who came to NorthStar VETS in January after being hit by a car. After initial stabilization, he was transferred to the Surgery department for management of degloving wounds sustained to the right forelimb.

About this type of wound

Figure 1

Figure 1

A “degloving” wound is one in which a large portion of skin is stripped off the body, and they are a common injury when a high-velocity object (car) shears across a limb. These wounds are notoriously difficult to manage, because as well as skin damage, there may also be damage to the joints, ligaments, vessels, and nerves. Because these wounds are often contaminated with asphalt, dirt, and hair, combined with the damage to the delicate blood vessels supplying the skin, just stitching the skin back together often fails.

Romeo’s initial wound removed approximately eighty percent of the skin from the wrist down (Fig. 1), and also damaged part of the pad tissue. The carpal (wrist) joint was open and several important ligaments were missing. The options at that point were either amputation of the leg, which the surgeons did not recommend, or allowing his body to try and heal the wounds, followed by likely reconstructive surgery, which is what was elected.

How things went for Romeo

Figure 2

Figure 2

Surgeons use a variety of techniques to help severe wounds heal. Some possible methods include surgery for removal of unhealthy tissues (debridement), vacuum-assisted wound therapy (“VAC” therapy), and management with sequential bandaging to allow the body to start to heal. Drs. Kraus and Knapp-Hoch managed Romeo’s initial wounds with a combination of surgical debridement and open wound management with bandaging. In the beginning, part of Romeo’s pad, one of his digits, and a large portion of skin required removal (Fig. 2). Once all the unhealthy tissue had “declared” itself and had been removed, the doctors used various types of bandages, in combination with a splint, for Romeo’s tissue to heal enough to accept a graft. This time also allowed the wrist to scar in place after the ligament loss. The process from initial injury to obtaining a tissue bed healthy enough to accept a graft took approximately 1 month.

About the skin graft

Figure 3

Figure 3

A free skin graft involves removing a healthy piece of skin from another area of the body and transplanting it to a new location. When a skin graft is transferred, it relies upon nourishment from the bed onto which it was placed. That is why it is so important that the tissue bed is healthy, like Romeo’s granulation bed (Fig 3). Drs. Kraus and Knapp-Hoch performed Romeo’s skin graft (Fig 4) using a piece of skin from his side. He was kept in a splint and bandage for 2 weeks while his body finished healing, and the majority of the graft (around ninety-five percent) survived, which was excellent news for Romeo (Fig. 5). After hair regrowth (Fig. 6), Romeo is looking fantastic and living a normal life.

Figure 4

Figure 4

Figure 5

Figure 5

Figure 6

Figure 6

Learn more about the Surgery service at NorthStar VETS

Heather Knapp-Hoch, DVM, MS, DACVSHeather Knapp-Hoch, DVM, MS, DACVS
Originally from New Jersey, Dr. Knapp-Hoch is excited to return home and join the NorthStar VETS surgical team. Dr. Knapp-Hoch earned her Bachelor of Science in biology from Long Island University in 2001. She then traveled across the US to obtain a Masters degree in genetics and cell and molecular biology from Washington State University where she also obtained her Doctorate of Veterinary Medicine in 2007. Dr. Knapp-Hoch then completed a small animal rotating internship at Cornell University in 2008. Following her internship she completed a three-year surgical residency at Cornell University in 2011. She obtained board certification in 2012 and practiced as a small animal clinical instructor at Cornell University from 2011-2014.

Dr. Knapp-Hoch’s special areas of interest include surgical oncology and minimally invasive surgery including laser ablation of ectopic ureters. She is proficient in advanced wound management and has a special interest in the use of negative pressure wound therapy (NPWT) to treat difficult surgical and traumatic wounds. She is trained in both the tibial plateau leveling osteotomy (TPLO) and the tibial tuberosity advancement (TTA) surgical procedures for cranial cruciate ligament disease.

Kelly Kraus, VMD, DACVSKelly Kraus, VMD, DACVS
Dr. Kraus is originally from Connecticut. She obtained a Bachelor of Science degree from Loyola University in Baltimore, Maryland in 2003 before moving to Philadelphia, where she did molecular genetics research for two years at the University of Pennsylvania. Dr. Kraus then completed veterinary school at the University of Pennsylvania in 2009. After graduating, she completed a rotating internship at Oradell Animal Hospital in Paramus, NJ. She then moved to Texas to complete a one-year internship in surgery at Gulf Coast Veterinary Specialists. She was fortunate to then move back to New Jersey for a three-year residency in surgery at Red Bank Veterinary Hospital, which she completed in 2014.

She is excited to be part of the surgery team at Northstar Vets. Her special surgical interests include, but are not limited to, wound management and reconstructive surgery, surgical oncology, cardiothoracic surgery, and hepatobiliary surgery. Dr. Kraus also enjoys management of orthopedic conditions. She is trained in the tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament disease. Outside of work, Dr. Kraus enjoys spending time with her family, cooking, traveling, and helping her local SPCA.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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One Response to NorthStar VETS Cool Case Romeo

  1. Susan Schwartz says:

    What a terrific success story. I know for a fact that the surgeons at Northstar at THE BEST around and the two surgeons (who are no longer with Northstar) worked very hard to save my girl’s life four years ago, and she was able to live cancer free for nearly the entire remainder of her life. They are truly a blessing, as is everyone at Northstar. Despite the fact that I no longer have a pet in my life, I will continue to praise both the medical team and this wonderful facility forever! There are not enough words to properly express a thank you for all of their terrific work and caring of our beloved pets.

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