Stenocereus thurberi rot and debridement
Posted: Mon Mar 27, 2023 12:08 am
PRE-OP DIAGNOSIS:
Necrotizing soft tissue infection of Stenocereus thurberi, likely secondary to thermal damage
POST-OP DIAGNOSIS:
Same
PROCEDURE:
Excisional debridement of necrotizing soft tissue infection
SURGEON:
Zachary Peckler, MD
DETAILS OF PROCEDURE:
Patient is a Stenocereus thurberi purchased by myself in February of 2022 from Arid Lands Wholesale. The patient was planted in my all-purpose cactus growing medium: 25% loamy potting soil, 25% 3/8" pumice, and 50% Turface MVP. All of last spring and summer the Stenocereus had grown vigorously without incident, nearly doubling its length. Last watering prior to winter dormancy was in October of 2022, and the cactus was over-wintered outside under a plastic shelter that kept it dry during the California winter rains. First watering of spring occurred on 3/15/2023 after the sun came out and daytime temps were in the high 60's; most of my other cacti were starting to show signs of growth and this is the usual time of year that temps get appropriate for the first spring watering.
I had been out of town on vacation for the last week, and when I returned I made morning rounds on my cacti. I noticed a dark band right at soil-level on the Stenocereus. The growing medium was completely dry to the tough. Reviewing temperature records from my home weather station revealed that while the latest atmospheric river rolled through the minimum overnight temp for the last two nights I was away reached 35F for several hours. This is highly atypical for my area, with temps basically never getting below 40F even during the coldest part of winter.
Further physical exam revealed that the tissue was frankly necrotic (rotting), and disintegrated to mush when probed with forceps. The patient was immediately prepped for emergency surgery to control the necrosis.
The patient and all instruments were sterilized with 70% isopropyl alcohol and draped in the usual sterile fashion. My chief resident enthusiastically assisted me with the procedure.
The patient was uprooted and surprisingly showed a well-developed healthy root system, with no sign of root rot or other pathology. The growing medium throughout the entire pot was bone dry. The patient's growing tip appeared healthy, and even had early signs of new spring growth. The necrosis was confined to the band I had observed right at soil-level, but it was circumferential and appeared to extend all the way into the core of the cactus.
The patient was transected with a sterilized utility knife 1cm above the ring of necrosis. At the core there was still a 0.5cm dark area that felt soft and mushy.
Given that there was still necrosis present, the patient was then transected again 2cm above the prior cut. The tissue appeared healthy throughout, and was firm when probed. There was still a small 2mm brown core, but this time it felt hard and woody and I had to really saw through it with the utility knife. Perhaps this represents the "skeletal" structures at the center of columnar cacti?
Post-operatively the patient was sent to the recovery room in stable condition. The cut surface will be left to callus over for several weeks before attempting to re-pot.
Haha! OK, this post was a little tongue in cheek. I'm an emergency surgeon who frequently has to debride patients with necrotizing fasciitis (the so-called "flesh-eating bacteria") and this situation struck me as similar enough that I wrote it up like one of my operative reports for fun.
But seriously, I'm pretty bummed. In 7 years of growing cacti seriously this is the first time any of them have rotted! I knew that on paper S. thurberi's cold tolerance was right on the edge of what my climate provided, so I had corresponded with Arid Lands prior to purchase--their S. thurberi they have for sale are grown outside and see temps down to 20F without issue so I decided to give it a shot.
I think I caught the rot early enough that I was able to control it. I'll keep a really close eye on this fellow and cut more off as needed. In the past when I've cut Opuntia and Cylindropuntia segments to get them rooted I haven't put anything on the cut end; just let them callus on their own. Would you guys recommend leaving the end alone like I've done in the past, or is there a product that I should be applying to it?
Necrotizing soft tissue infection of Stenocereus thurberi, likely secondary to thermal damage
POST-OP DIAGNOSIS:
Same
PROCEDURE:
Excisional debridement of necrotizing soft tissue infection
SURGEON:
Zachary Peckler, MD
DETAILS OF PROCEDURE:
Patient is a Stenocereus thurberi purchased by myself in February of 2022 from Arid Lands Wholesale. The patient was planted in my all-purpose cactus growing medium: 25% loamy potting soil, 25% 3/8" pumice, and 50% Turface MVP. All of last spring and summer the Stenocereus had grown vigorously without incident, nearly doubling its length. Last watering prior to winter dormancy was in October of 2022, and the cactus was over-wintered outside under a plastic shelter that kept it dry during the California winter rains. First watering of spring occurred on 3/15/2023 after the sun came out and daytime temps were in the high 60's; most of my other cacti were starting to show signs of growth and this is the usual time of year that temps get appropriate for the first spring watering.
I had been out of town on vacation for the last week, and when I returned I made morning rounds on my cacti. I noticed a dark band right at soil-level on the Stenocereus. The growing medium was completely dry to the tough. Reviewing temperature records from my home weather station revealed that while the latest atmospheric river rolled through the minimum overnight temp for the last two nights I was away reached 35F for several hours. This is highly atypical for my area, with temps basically never getting below 40F even during the coldest part of winter.
Further physical exam revealed that the tissue was frankly necrotic (rotting), and disintegrated to mush when probed with forceps. The patient was immediately prepped for emergency surgery to control the necrosis.
The patient and all instruments were sterilized with 70% isopropyl alcohol and draped in the usual sterile fashion. My chief resident enthusiastically assisted me with the procedure.
The patient was uprooted and surprisingly showed a well-developed healthy root system, with no sign of root rot or other pathology. The growing medium throughout the entire pot was bone dry. The patient's growing tip appeared healthy, and even had early signs of new spring growth. The necrosis was confined to the band I had observed right at soil-level, but it was circumferential and appeared to extend all the way into the core of the cactus.
The patient was transected with a sterilized utility knife 1cm above the ring of necrosis. At the core there was still a 0.5cm dark area that felt soft and mushy.
Given that there was still necrosis present, the patient was then transected again 2cm above the prior cut. The tissue appeared healthy throughout, and was firm when probed. There was still a small 2mm brown core, but this time it felt hard and woody and I had to really saw through it with the utility knife. Perhaps this represents the "skeletal" structures at the center of columnar cacti?
Post-operatively the patient was sent to the recovery room in stable condition. The cut surface will be left to callus over for several weeks before attempting to re-pot.
Haha! OK, this post was a little tongue in cheek. I'm an emergency surgeon who frequently has to debride patients with necrotizing fasciitis (the so-called "flesh-eating bacteria") and this situation struck me as similar enough that I wrote it up like one of my operative reports for fun.
But seriously, I'm pretty bummed. In 7 years of growing cacti seriously this is the first time any of them have rotted! I knew that on paper S. thurberi's cold tolerance was right on the edge of what my climate provided, so I had corresponded with Arid Lands prior to purchase--their S. thurberi they have for sale are grown outside and see temps down to 20F without issue so I decided to give it a shot.
I think I caught the rot early enough that I was able to control it. I'll keep a really close eye on this fellow and cut more off as needed. In the past when I've cut Opuntia and Cylindropuntia segments to get them rooted I haven't put anything on the cut end; just let them callus on their own. Would you guys recommend leaving the end alone like I've done in the past, or is there a product that I should be applying to it?