The “cone of shame” and other postoperative protective devices

Over the years I feel as though my clients think that I derive pleasure from putting the “cone of shame” on all the dogs and cats. In a way, the cone is the trademark of an animal touched by a veterinarian, however, there is no way around it, cones are the worst. The animals hate them, their people hate them, the house they live in hates them (think door jams), but they are still recommended every day by veterinarians everywhere. But are there other options? Let’s dive in!

The considerations we as veterinarians take when determining an approach for protecting an animal’s body part from itself or the outside world are as follows:

1.    What body part are we protecting?

2.    What kind of wound/surgery are we protecting?

3.    What are the consequences of not protecting it?

4.    What options or combinations of options are there?

Body part

This is the logical place to start. Protecting an abdominal incision is going to be a different situation than protecting the face and neck. An abdominal incision will get laid on and it will move with every step or jump the animal takes. The face is going to be close to water when they drink, it will receive pets, etc. A paw will require both protection from the animal’s mouth as well as from the ground they walk on. Paws are also prone to yeast infections if they are not exposed to air.

Type of wound or infection

There are gradients of wounds. Surgical wounds can range from small skin incisions to much longer incisions that incorporate the underlying tissue and sometimes the abdominal wall. Wounds do the same. There are small wounds that involve one layer of tissue, and more severe wounds that involve deeper tissues. The degree of protection needed will depend on the type of wound or incision and how many layers of tissue are involved.

The consequences

This is one of the most important considerations on the list. There is a very wide range of consequences that an animal or owner may encounter if protection of a wound or incision fails. Abdominal incisions for example carry a huge risk if they aren’t protected. When an animal is spayed, she has an abdominal wall incision, a subcutaneous incision, and a skin incision, all of which are closed separately. If an animal opens those stitches, she runs the risk of her internal organs being exposed to the outside world, ultimately resulting in humane euthanasia. That is obviously the scenario we want to avoid most. On the other hand, when we do biopsies, those are incisions that are just skin deep and are very small. If those sutures get pulled out early, the risk to the animal is quite low. Another surgery that we see often is the Tibial Plateau Leveling Osteotomy, or the ACL surgery done in dogs. If the dog licks that incision or opens that incision post operatively, they run the risk of acquiring an infection at the hardware. If that happens then at least one more surgery will need to be done to remove that hardware. While that is not generally a life-threatening consequence, it is a very expensive, painful, and a time-consuming consequence.  

Protective devices

1.    Elizabethan collar: the Elizabethan collar or the “cone of shame” is a protection device that is designed to protect a wound or incision from the mouth of the same animal (or paw). Sizing is very important. Technically, the collar is sized appropriately if the outer rim of the cone is just longer than the tip of the animal’s nose when the cone is situated as far down the neck as possible (toward the shoulders).

a.    Pros: if sized appropriately, it is quite effective, animals can eat and drink with it on (even if they tell you they can’t), easy to clean, they are pretty cute!

b.   Cons: everyone hates them, they are uncomfortable, in cats they touch their whiskers which can throw off their sense of where their body is in place

2.    Soft cones and donut collars: soft cones can be a good option for wounds or incisions that are around the shoulders. They are pretty floppy, and it doesn’t take long for dogs and cats to work around them.

a.    Pros: more comfortable, donuts can be used well in conjunction with the Elizabethan collar for particularly flexible pets

b.   Cons: effective for a small subset of wound locations, more difficult to clean

3.    Body suits: these are particularly good options for female dogs after their spay surgery. They are basically onesies made for dogs and cover their abdomen. Bodysuits are also made for the boys, but they tend to urinate on them more frequently.

a.    Pros: comfortable, washable, can be used with an Elizabethan collar if needed

b.   Cons: some animals can still mess with their incisions through the suit

4.    Bandages: bandages are particularly useful for paws. They accomplish protection from the animal and from the ground they walk on. In some cases, a bandage can be used by itself and sometimes animals need an Elizabethan collar (not soft collar or donut!) as well.

a.    Pros: relatively comfortable, good vet wrap colors!

b.   Cons: not breathable, tightness – they fall off if too loose and can cut off blood flow if too tight

5.    Socks: socks can be a great option for paw protection particularly if we don’t need to protect it from the environment, only from the animal. Torn toenails or wounds on the top of the paw are good examples of scenarios where socks are useful. Socks will always fall off if they aren’t secured in place. A client of mine taught me a useful trick for keeping the sock on. Place a tape bracelet around the area between the dewclaw and the top of the paw with the sticky side out. This bracelet should be loose. Then put the sock on the paw and stick the inner sock to the sticky part of the tape. One tape bracelet can last a full day or two.

a.    Pros: comfortable, easy to clean, breathable

b.   Cons: not durable, get lost easily

I hope this helps you when you think about post operative protection. We recommend these options for a variety of reasons, but mainly to ensure your pet can get back to their happy, healthy self. There are so many factors to consider, and I am sure you all have other tricks and protective devices. In fact, if you send us yours, maybe we will do a follow up blog post on those!

Daphne Johnson, DVM