Full‐Thickness Skin Grafting to Cover Equine Wounds Caused by Laceration or Tumor Resection

Objective: To describe and evaluate full‐thickness skin grafting of equine wounds. Study Design: Case series. Animals: Adult horses (n=6). Methods: A full‐thickness graft was harvested from the pectoral region with the horse anesthetized or standing and sedated after local anesthetic infiltration. Grafts were attached to the cutaneous margin of the wound with staples and/or sutures if the horse was anesthetized or if the recipient site was desensitized. Cyanoacrylate glue was used to attach the grafts to the cutaneous margin of the wound of 3 horses. Medical records were reviewed for history, physical examination findings, grafting technique, postoperative complications, and outcome. Results: Three horses had full‐thickness skin grafting to cover a fresh defect created by excision of a cutaneous neoplasm, and 3 horses had full‐thickness skin grafting to cover a fresh or granulating laceration. Grafts were completely accepted in 5 horses. The superficial layers of all grafts sloughed, but the final cosmetic appearance of accepted grafts was good. Conclusions: Full‐thickness skin grafting can be performed in standing sedated horses with good cosmesis, especially when the meshed graft is expanded minimally. Clinical Relevance: Good acceptance of a full‐thickness graft can be expected, regardless of whether the graft is applied to a fresh or granulating wound.     

Effects of hyperbaric oxygen on full-thickness meshed sheet skin grafts applied to fresh and granulating wounds in horses

OBJECTIVE: To determine the effects of hyperbaric oxygen therapy (HBOT) on full-thickness skin grafts applied to fresh and granulating wounds of horses. ANIMALS: 6 horses. PROCEDURES: On day 0, two 4-cm-diameter circular sections of full-thickness skin were removed from each of 2 randomly selected limbs of each horse, and two 4-cm-diameter circular skin grafts were harvested from the pectoral region. A skin graft was applied to 1 randomly selected wound on each limb, leaving the 2 nongrafted wounds to heal by second intention. On day 7, 2 grafts were harvested from the pectoral region and applied to the granulating wounds, and wounds grafted on day 0 were biopsied. On day 14, 1 wound was created on each of the 2 unwounded limbs, and the wounds that were grafted on day 7 were biopsied. All 4 ungrafted wounds (ie, 2 fresh wounds and 2 wounds with 1-week-old granulation beds) were grafted. The horses then received HBOT for 1 hour daily at 23 PSI for 7 days. On day 21, the grafts applied on day 14 were biopsied. RESULTS: Histologic examination of biopsy specimens revealed that grafts treated with HBOT developed less granulation tissue, edema, and neovascularization, but more inflammation. The superficial portion of the graft was also less viable than the superficial portion of those not treated with HBOT. CONCLUSIONS AND CLINICAL RELEVANCE: The use of HBOT after full-thickness skin grafting of uncompromised fresh and granulating wounds of horses is not indicated.     

The Effects of Skin Graft Thickness on Graft Viability and Change in Original Graft Area in Dogs

The viability and change in original graft area of full thickness grafts (FTG) and split thickness skin grafts (STG) placed on fresh and granulating recipient beds were evaluated. Two 6 × 6 cm skin grafts were placed on each side of the trunk in ten dogs. Grafting procedures included FTG and STG on fresh and granulating wounds. Graft viability was determined on the 10th postoperative day by visual inspection. The change in original graft area was evaluated by comparing the original surface area of the grafts with the surface areas of the grafts at 10, 30, 60, and 90 days after surgery. The means graft viability for FTG and STG on fresh beds was 81% and 55%, respectively. FTG and STG on granulating beds had a mean graft viability of 58% and 47%, respectively. The mean percentage of original graft area at 90 days for FTG and STG on fresh beds was 82% and 97%, respectively. FTG and STG on granulating beds had an overall percentage of original graft area of 105% and 130%, respectively. There were no statistical differences found when comparing FTG with STG placed on fresh beds or granulating beds. However, the general trend indicated that FTG had a greater percentage of viability and contracted more than STG in dogs. This is contrary to previous findings.     

Effects of split-thickness and full-thickness skin grafts on secondary graft contraction in horses.

Full-thickness, circular (4-cm diameter) cutaneous wounds were created on the metacarpi and metatarsi of 6 horses. Immediately after wounding, 1 wound on each horse received a meshed, split-thickness skin graft (0.64 mm) obtained from the ventrolateral aspect of the horse's thorax by use of a pneumatic dermatome, whereas a second wound received a meshed, full-thickness skin graft obtained from the pectoral area. In addition, sections of split-thickness and full-thickness grafts were refrigerated in a solution of McCoy's 5A medium, to which equine serum (10%) and gentamicin sulfate solution (16 mg/dl) were added. Ten days after wounding, 1 granulating wound on each horse was grafted with a stored, meshed, split-thickness graft, and 1 granulating wound on each horse was grafted with a stored, meshed, full-thickness graft. Areas of wounds were calculated from photographs taken of wounds on days 1, 5, 10, 15, 20, 25, and 30 after wounding. Time course of contraction was determined by use of a first-order mathematic model of changes in area through time. Rate constants of contraction for fresh or granulating wounds receiving full-thickness grafts did not differ significantly from those for fresh or granulating wounds receiving split-thickness grafts. Rate constants of contraction for grafted fresh wounds, however, were significantly less than those of grafted granulating wounds, regardless of whether a split-thickness or full-thickness graft was applied.     

Tunnel grafting for wound repair in horses: a novel technique in graft production and placement

There are several skin grafting methods described in the human and animal literature. Currently, there are five types of free grafts used in horses: pinch and punch grafts, split and full-thickness sheet or mesh grafts and tunnel grafts. Published methods of tunnel grafting describe the use of alligator forceps. The alligator forceps create a poor tunnel and are excessively traumatic to the granulation bed. This technique utilised a 13G Jamshidi needle that was placed across the granulation bed and created a uniform tunnel. The Jamshidi needle was atraumatic to the granulation bed increasing the opportunity for graft survival. A twin bladed scalpel allowed for the quick creation of uniform width grafts. Removal of the overlying tunnel ‘roof’ took place 5–14 days later to allow graft expansion. This case series included five horses with distal limb wounds and one with a wither injury. Four horses required general anaesthesia for graft placement and three required general anaesthesia for the removal of the tunnel roof. The acceptance of the grafts varied from 70% to 100%. Graft expansion to cover the granulation tissue took 2–5 months. This case series demonstrates that this technique of graft production and placement is an easy method for achieving successful skin grafting. Compared to other graft types, tunnel grafts are more readily accepted. Cosmetic and functional results achieved are better than those with pinch and punch grafts. Tunnel grafting does not require expensive equipment or advanced training, and in some cases can be performed under standing sedation.     

Fixation of skin grafts in the horse using stainless steel staples.

Three horses with a chronic wound on the distal part of a leg were treated successfully by grafting. Small split skin grafts were fixed onto pieces of adhesive tape. The tape pieces were spread over and fixed to the granulation surface with stainless steel staples. A tight pressure bandage including strongly compressed cellular rubber was then applied over the wound. The combination of staple fixation and strong pressure proved effective in immobilising the skin graft. It was stressed that a firm covering of granulation tissue was a prerequisite for success and therefore the technique should not be used for fresh wounds.     

Preservation of Skin by Refrigeration for Autogenous Grafting in the Horse

Eighteen stored split thickness meshed skin grafts were applied to surgically created lesions on the metacarpal and metatarsal regions of six horses. Donor skin was harvested from the sternal region, meshed and stored at 4 degrees C in a cell culture medium containing 10% serum. Stored grafts were applied to the wounds at 1, 2, and 3 week intervals. Acceptance of the grafts stored for 1 week was generally poor (1 of 6 grafts), whereas that of the 2 and 3 week old grafts was generally excellent (10 of 12 grafts). Poor acceptance of the 1 week old grafts was attributed to streptococcal infection of the recipient wounds. Using the storage medium and grafting technique described, excellent acceptance can be expected after graft storage of up to 3 weeks.     

Treatment of equine leg wounds using skin grafts: Thirty-five cases, 1975-1988

A retrospective study was conducted on 35 equine patients with lower leg wounds that were managed utilizing skin graft procedures. Two pinch graft, five punch graft, seven tunnel graft, eight split-thickness mesh graft and thirteen full-thickness mesh expansion graft procedures were performed in the initial treatment. The average wound size was 188 cm². Twentyfour cases had pregrafting complications: 10 wounds developed sequestra; three wounds were grossly contaminated and infected; and 11 cases developed granulation tissue complications prior to grafting. Graft failure following the initial procedure was seen in 12 cases and occurred with all techniques except pinch grafting. Graft failure was often attributable to poor quality of granulation tissue as well as anatomic site, especially the dorsal surface of the tarsus. An average of two additional grafting procedures was required to successfully treat initial failures. Pinch grafts took the longest time to epithelialize (70 days), followed by punch grafts (47 days). Both were similar in terms of being the least durable and least cosmetically acceptable of all techniques used. Split-thickness and full-thickness mesh expansion grafts were technically the most difficult, but showed the most rapid epithelialization (28 days), greatest durability, and the best cosmetic appearance. Tunnel grafts provided a practical technique for grafting cases which were either not suited for, or which had failed with, mesh expansion grafts.     

The modified Meek technique as a novel method for skin grafting in horses: evaluation of acceptance, wound contraction and closure in chronic wounds

REASONS FOR PERFORMING STUDY: The acceptance of skin grafts in horses is unpredictable and the final cosmetic result can be disappointing. Besides movement and infection, graft failure is often caused by chronic inflammation, inherently present during second intention healing of limb wounds in horses. In human burns affected by infection and inflammation, the acceptance of the island skin grafts of the modified Meek technique appeared to be better than meshed sheet skin grafts. HYPOTHESIS: The percentage take of Meek micrografts is higher than of other techniques; and rates of both wound contraction and epithelialisation are increased. METHODS: Large traumatic limb wounds of 13 horses healing by second intention were grafted using the modified Meek technique. Photographs of the wounds were taken at set intervals. Wound areas, and areas of acceptance and rejection were determined using a digital image post processor (Scion Image). The percentages of take, wound contraction and epithelialisation were calculated. RESULTS: The initial mean wound area was 7500 mm2. Graft acceptance was mean +/- s.d. 93.7 +/- 5.9%. Wound closure was due to contraction (55.2 +/- 11.1%) and epithelialisation (44.8 +/- 11.1%) and resulted in a 96.7 +/- 3.6% reduction of the initial wound area 29.1 +/- 6 days after grafting. All wounds showed functional and cosmetic healing. CONCLUSIONS: The method for skin grafting in horses achieved higher percentages of take than reported previously and consistent cosmetic and functional results. The grafts increased not only the rate of epithelialisation but also had a strong positive effect on wound contraction, resulting in rapid closure and smaller scars. POTENTIAL RELEVANCE: The modified Meek technique proved to be a novel technique for skin grafting equine wounds in clinical practice, which can be performed easily. The molecular background of the increase of wound contraction by the grafts may provide a clue in the search for medicinal stimulation of wound contraction during second intention healing.     

Treatment of large distal extremity skin wounds with autogenous full-thickness mesh skin grafts in 5 cats

Five cats with large, distal extremity abrasion wounds were treated with an autogenous, full-thickness, mesh skin graft. Survival of the mesh grafts in all five cats was considered between 90 and 100%. Successful grafting requires asepsis, an adequately prepared recipient bed consisting of healthy granulation tissue, proper harvesting and preparation of the graft, meticulous surgical technique and strict postoperative care. Factors that are essential for the survival of skin grafts include good contact between the graft and the recipient bed, normal tension on the sutured graft, strict immobilization after grafting and prevention of accumulation of blood or serum under the graft. Meshing the graft provides more graft flexibility over uneven surfaces and allows adequate drainage. In contrast to previous proposals, the authors recommend no bandage change before the fourth day after grafting. Full-thickness mesh skin grafting can be used to successfully treat large distal skin wounds in cats.     

Management of exuberant granulation tissue

Exuberant granulation tissue is common in large, lower limb wounds of horses, particularly horses of large body size. Methods of control include chemical cautery, cryogenic surgery, and surgical resection. Surgical resection is preferred because it is easy to perform, provides tissue for histologic evaluation, and preserves the epithelial margin. Effective treatments to prevent the formation of granulation tissue include leaving granulating wounds open to the air or, possibly, bandaging with topical steroids. Bandaging or casting may promote exuberant granulation tissue in wounds in which it has already formed, but bandaging and casting are still important in the early management of lower limb or hock wounds in horses. The use of skin grafts or delayed secondary wound closure is frequently necessary to prevent the recurrence of exuberant granulation tissue.     

The Mesh Expansion Method of Suturing Wounds on the Legs of Horses

Wound closure utilizing tension-relieving incisions located in the skin adjacent to the wound of horses was evaluated in three experiments. Healing of lower limb wounds was compared in four treatment groups; wounds sutured under tension, wounds sutured with 7 mm and 10 mm tension relieving incisions, and unsutured controls. The wounds sutured using 10 mm tension relieving incisions healed significantly faster than the other three groups (p > 0.05). The mesh expansion technique was further evaluated in four-week-old granulating wounds. The technique was found to be unsuccessful because the tension relieving incisions that were used were too small and postoperative support was inadequate. The technique was evaluated in two clinical patients, both of which had large metatarsal lacerations. Tension relieving incisions of approximately 15 mm were made and full leg walking bar casts were applied. Both wounds had healed almost completely on removal of the casts four weeks postoperatively.     

Comparison of full- and partial-thickness autogenous skin transplantation in dogs: a pilot study.

Thin partial-thickness (0.063 cm), medium (0.127 cm) partial-thickness, and full-thickness skin autografts were transplanted to surgically created granulating foreleg wounds of dogs. Thin partial-thickness grafts had an 89% survival, medium partial-thickness grafts had 47% survival, and full-thickness grafts had a 58% survival. Of the successful grafts, only the thin partial-thickness grafts did not grow adequate hair after transplantation.     

Electrical stimulation on skin wound healing in the horse: preliminary studies

The effect of low-level direct-current stimulation on skin wound healing in the horse was assessed. Self-sustaining electrical circuits with electrodes were implanted subcutaneously in or near the wound. Stimulation by direct current (10 or 20 microA) was used to determine the effect on equine skin healing. The efficacy of electrotherapy was evaluated by sequentially comparing the clinical appearance of the wound and measuring the size of the granulating wound bed. The histologic appearance of the healing stimulated wounds was compared with that in nonstimulated control wounds created on 9 horses. Seemingly, electrical stimulation had no discernible effect on experimentally created skin wounds. Clinical observation and histologic examination of the wounds indicated that severe tissue reaction from the implanted electrodes and concurrent local infection produced local detrimental effects to wound healing.     

Use of a tilapia skin xenograft for management of a large bite wound in a dog

A 13-year-old neutered male miniature dachshund suffered ~30% total skin loss following an attack by another dog. After numerous failed attempts at wound management and closure, the wound was successfully healed by epithelialization using tilapia skin grafts. At each tilapia skin graft placement, the wound bed appeared pink, clean, and healthy with excellent progression of epithelialization at all edges. With use of the tilapia grafts, epithelialization occurred at a rate of 1.76 mm/day. As a result, the wound reached complete closure by epithelialization with no evidence of wound contracture in 102 days.Key clinical message:Tilapia skin grafts were successfully used for management of a large bite wound in a dog and may promote accelerated epithelialization in full thickness skin wounds.     

Skin grafts and skin flaps in the horse.

Although most equine wounds can be easily treated and heal without consequence, there are many that present special challenges. Skin grafts area valuable part of the veterinarian's armamentarium for treatment of complicated wounds, particularly limb wounds. Attention to preparation of the recipient site and proper aftercare are critical to successful grafting. With better understanding of equine wound and graft physiology and the promise foretold by advances in human skin grafting, the outcome of treatments of difficult equine wounds should continue to improve in the future.     

FC‐60 The role of a fresh oleaster leaf preparation in healing of experimental wounds in calves: a histopathologic study

Oleaster (Elaeagnus angustifolia) is a small tree that grows throughout Iran. Using smashed tree leaves combined with olive oil is proposed in one ancient Iranian text as a good remedy for wound healing. Our objective was to evaluate this remedy experimentally. The study was carried out in two female 10‐month‐old Holstein calves. An area of 10 × 10 cm on each side of the thorax was surgically prepared and infiltrated with local anaesthetic. Eight uniform skin wounds were created in two rows with an 8‐mm biopsy punch on each prepared area. Each side of an animal was used to evaluate one treatment (Groups 1–4). To make the mixture, fresh oleaster leaves (50 gm) were smashed with a pestle and mixed with olive oil (25 gm). The wounds were treated for 7 days. The wounds of Groups 1–3 were rinsed daily with normal saline, after which the mixture of oleaster and olive oil (Group 1) or only the olive oil (Group 2) was applied. In Group 4, no treatment was applied. All wounds were left open. On day 8, skin biopsies were taken from the wounds for histopathologic study. Group 1 wounds all showed mild granulation tissue, scab formation and complete re‐epithelialization. In Group 2, there was mild granulation tissue, massive scab formation and minimal re‐epithelialization. In Groups 3 and 4, mild granulation tissue, severe scab formation and very limited re‐epithelialization were observed. We conclude that a fresh oleaster leaf preparation can be an effective remedy for wound healing. Funding: Self‐funded.     

Tissue Engineering in Wound Repair: The three “R”s—Repair,Replace, Regenerate

Horses are predisposed to traumatic wounds that can be labor intensive and expensive to manage. Skin has a considerable potential for efficient and functional repair however, while cutaneous repair is a regenerative process in the fetus, this capability declines in late gestation as inflammation and scarring alter the outcome of healing. The historical gold standard for replacement of lost skin is the autologous skin graft. However, the horse's lack of redundant donor skin limits the practicality of full‐thickness grafting to smaller wounds; moreover, graft failure is relatively common in equine patients as a result of infection, inflammation, fluid accumulation beneath the graft, and motion. Tissue engineering has emerged as an interdisciplinary field with the aim to regenerate new biological material for replacing diseased or damaged tissues or organs. In the case of skin, the ultimate goal is to rapidly create a construct that effects the complete regeneration of functional skin, including all its layers and appendages. Moreover, an operational vascular and nervous network, with scar‐free integration within the surrounding host tissue, is desirable. For this to be achieved, not only is an appropriate source of cells required, but also a scaffold designed from natural or synthetic polymers. The newly created tissue might finally meet the numerous needs and expectations of practitioners and surgeons managing a catastrophic wound in a horse     

Wound Drainage from Under Full-thickness Skin Grafts in Dogs Part II. Effect on Cosmetic Appearance

Four skin grafting procedures were performed on both sides of the chests of 12 dogs to evaluate the effect of wound drainage on the survival and cosmetic appearance of the grafts. The techniques evaluated were a sheet graft, (control), continuous low level suction, piecrust incisions, and nonexpanded mesh graft. Graft viability was assessed on the 10th postoperative day by visual inspection. The mean survival rate for all grafts was 90%. No significant difference between graft types was observed.
Hair growth on each graft was assessed 3 months postoperatively as "normal" (resembled that on the surrounding skin), "moderate" (thickness of hair growth was less than normal but would nearly conceal the underlying skin), "sparse" (a few hairs were present and the skin below was easily visible), and "none" (no hair growth). No statistical differences in categories of hair growth were detected within types or between types of grafts. Hair growth also was assessed as "acceptable" (those areas having normal and moderate hair growth) and "nonacceptable" (hair growth sparse or none). No difference between graft types was noted. All types exhibited a significantly greater area of acceptable than nonacceptable hair growth.