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.     

Chronic axillary wound repair in a cat with omentalisation and omocervical skin flap

A mature, neutered male domestic cat was presented with a chronic axillary wound of unknown origin and at least three years' duration. The diagnostic investigation included screening tests for feline leukaemia virus and feline immunodeficiency virus, tissue culture and histological examination. No underlying aetiology or perpetuating cause could be identified. An omental flap was created, passed via a subcutaneous tunnel, and packed into the wound site after excision of all chronic granulation tissue. The skin defect was closed using an omocervical axial pattern skin flap. A small area of the distal edge of the flap became necrotic but the defect healed by second intention. To the author's knowledge, this is the first clinical report of the use of an omocervical skin flap for repair of a chronic axillary wound in a cat. This flap offers a useful alternative where the use of a thoracodorsal axial pattern flap is not possible due to the extent of the lesion.     

Healing of segmental grafts of digital pad skin in dogs.

Pad grafts would be indicated in instances of severe paw trauma when there has been loss of the major weight-bearing pads (ie, metatarsal and metacarpal pads) as well as loss of the digital pads. A practical technique for replacing pad tissue on the remaining paw tissue could avert limb amputation for lack of weight-bearing tissue in the area. Small segmental digital pad grafts were placed in granulation tissue beds in dogs. Although the grafts were from thick pad skin, they healed well. However, intervening wound areas did not become covered with the heavier keratinized epithelium of the pads. The thinner, more rapidly growing, less keratinized epithelium from the wound edges covered most of the wound.     

Use of a semitendinosus myocutaneous flap for soft-tissue reconstruction of a grade IIIB open tibial fracture in a dog

OBJECTIVE: To describe the clinical use of a semitendinosus myocutaneous flap for soft-tissue reconstruction of a grade IIIB open tibial fracture. STUDY DESIGN: Case report. ANIMALS: A 5-year-old castrated male Labrador retriever with a grade IIIB open tibial fracture. METHODS: A myocutaneous flap was created by elevating the origin of the semitendinosus muscle and the associated overlying skin. The flap was rotated distally based on the distal vascular pedicle into a soft-tissue defect overlying the central and distal third of the tibia. RESULTS: The flap allowed one-stage reconstruction of a severe soft-tissue defect overlying denuded bone in a grade IIIB open tibial fracture. The muscular portion of the flap survived; however, there was necrosis of 3 cm of skin extending distally beyond the muscular portion of the flap. CONCLUSION: Distal rotation of the semitendinosus muscle and overlying skin can be used in the treatment of severe soft-tissue defects of the canine crus. CLINICAL RELEVANCE: Complex soft-tissue injuries to the canine crus can be treated with a myocutaneous flap as a reasonable alternative to other reconstructive techniques.     

Surgical correction of ear curling caused by scar tissue formation in a horse

An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses.     

Bilateral skin fold rotation-advancement flaps for the closure of large lumbosacral wounds in three dogs

Three dogs were presented for the management of disease processes resulting in large skin defects over the dorsal lumbosacral region. One had severe dog bite wounds, one had a large burn sustained from a heating pad and one had a large myxosarcoma in the region. In each case, the extent and location of the resulting skin defect were assessed as factors likely to prevent reconstruction using simple tension-relieving techniques alone or in combination with established reconstructive techniques, such as axial pattern flaps or skin stretching devices. Bilateral skin fold rotation-advancement flaps (SFRAFs) based on the flank folds were mobilised dorsally and allowed complete wound closure in two dogs and subtotal closure in the other dog. All wounds healed without major complications and an acceptable cosmetic outcome was achieved in each case. Minor flap debridement was required in two dogs. The use of bilateral SFRAFs is a useful technique alone or in combination with other reconstructive techniques for the closure of large dorsal lumbosacral skin defects when existing techniques are not sufficient. Small flank folds, such as those of obese dogs, may yield unexpectedly large SFRAFs.     

Treatment of leiomyosarcoma in a tiger (Panthera tigris) with stereotactic radiotherapy

A 10‐year‐old male captive tiger (Panthera tigris) developed right‐sided facial asymmetry and enlargement. Computed tomography revealed a destructive mass of the right maxillary bone with right nasal cavity involvement. Histopathology indicated a spindle cell sarcoma. A single fraction of 22 Gy using stereotactic radiotherapy was prescribed. After treatment, the facial conformation returned to normal and the tiger resumed normal behavior. Diagnostics 4 months later indicated severe metastatic disease. Humane euthanasia and necropsy were performed. This is the first case utilizing stereotactic radiotherapy for the treatment of cancer in a tiger.     

Persistent right aortic arch and aberrant left subclavian artery in a white Bengal tiger (Panthera tigris).

A 3-mo-old male white Bengal tiger (Panthera tigris) presented with the chief complaint of regurgitation of solid food since weaning at 2 mo of age. Compared with its littermates, the tiger was in poor body condition and weighed only 10.3 kg when its littermates were estimated at 20-25 kg. Thoracic radiographs showed a megaesophagus cranial to the heart base. A contrast esophagram more clearly outlined the megaesophagus, and fluoroscopy demonstrated normal motility of the caudal esophagus. Endoscopic examination revealed a structure coursing dorsally from right to left over the esophagus and a constrictive band on the left of the esophagus at the heart base. Nonselective angiography confirmed the presence of a persistent right aortic arch, as well as an aberrant left subclavian artery. A left fourth intercostal thoracotomy was performed, and the ligamentum arteriosum was double ligated and divided. The left subclavian artery did not cause significant compromise of the esophagus and was not manipulated at surgery. The tiger recovered well from anesthesia and surgery. Solid food was slowly introduced over a 2-mo period without any regurgitation. The cub gained weight rapidly after surgery.     

Birth of Siberian tiger (Panthera tigris altaica) cubs after transvaginal artificial insemination.

A captive 9-yr-old female Siberian tiger (Panthera tigris altaica) at the Lisbon Zoo was treated with equine chorionic gonadotropin followed 80 hr later by human chorionic gonadotropin to stimulate follicular development and ovulation, respectively. Forty-one hours after the second hormone administration, the tiger was subjected to transvaginal artificial insemination with diluted fresh semen containing 500 x 10(6) motile spermatozoa obtained from an 8-yr-old male Siberian tiger via electroejaculation. After anesthesia, the female tiger was placed in an inclined position with the hind limbs elevated during and after the insemination and was maintained in this position for 15 min to minimize semen reflux. An anesthetic reversal agent was then administered. After a 103-day gestation, the female gave birth to three apparently healthy cubs that survived 24-48 hr. These results demonstrate that transvaginal artificial insemination can be successfully performed in the Siberian tiger to produce full-term offspring.     

Reconstruction of the lower eyelid by third eyelid lateral advancement and local transposition cutaneous flap after "en bloc" resection of squamous cell carcinoma in 5 cats

OBJECTIVE: To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. STUDY DESIGN: Prospective clinical study. ANIMALS: Five cats with lower eyelid squamous cell carcinoma (SCC). METHODS: En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. RESULTS: Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. CONCLUSIONS: After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. CLINICAL RELEVANCE: Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.     

Necrotising fasciitis associated with Escherichia coli in a dog

CASE HISTORY: Lameness and limb pain associated with a laceration in the inner thigh of a Border Collie dog progressed over 4 days to extensive necrosis of the full-thickness of skin and subcutaneous (S/C) tissue. A successful outcome was achieved using surgical debridement and intensive supportive care, followed by limited local closure, axial pattern flap development, and free skin grafting. CLINICAL FINDINGS: Clinical findings included severe pain, depression, pyrexia and hypoalbuminaemia, and full-thickness loss of skin from the caudal thigh to the hock. Histopathologically, debrided tissue showed extensive necrosis of the dermis, adipose and muscle tissues, and the presence of numerous Gram-negative rods. Escherichia coli was cultured from deep tissue samples. DIAGNOSIS: Necrotising fasciitis (NF) associated with E. coli infection. CLINICAL RELEVANCE: NF associated with E. coli has not been previously reported in dogs. The importance of early diagnosis and surgical debridement is noted and the relevant medical literature is reviewed.     

Subcutaneous atypical mycobacteriosis in captive tiger quolls (Dasyurus maculatus)

From July 1989 to October 1998, 9/37 (24%) adult captive tiger quolls (Dasyurus maculatus) were diagnosed with atypical mycobacterial infection involving the subcutis and skin. Females were more often affected than males (seven females, two males). Grossly, lesions presented as focal thickenings, plaques, and abscesses within the subcutis, often with fistulous tracts. The subcutis and skin overlying cervical and thoracic regions were the primary sites of infection. Cytology of subcutaneous impression smears from all nine affected tiger quolls revealed pyogranulomatous inflammation admixed with several acid-fast bacilli. Histologically, all tiger quolls had nodular to diffuse pyogranulomatous panniculitis and cellulitis. Small numbers of acid-fast bacilli were noted histologically in 7/9 (78%) animals. Skin cultures from seven tiger quolls were positive for one or more different Runyon group IV mycobacteria. The disease described in these tiger quolls is similar to subcutaneous atypical mycobacteriosis of humans and domestic animals.     

Rapid Tissue Expansion for the Development of Rotational Skin Flaps in the Distal Portion of the Hindlimb of Dogs: An Experimental Study

In phase I, tissue expanders were implanted subcutaneously over the lateral crural region of four dogs. The expanders were inflated daily to maintain a constant intraluminal pressure for 7 days. All animals tolerated the pressurized expanders well. Some animal patient discomfort was associated with repeated injections into the subcutaneous filling port. One dog developed a limited area of tissue loss and exposure of the expander. Tissue response to the expanders included epidermal hyperplasia, dermal collagen compression with early fibroplasia, and subcutaneous granulation tissue formation adjacent to the expander pocket. In phase II, a second group of four dogs underwent rapid skin expansion over 7 days. The pressure applied to the expanding skin was determined daily and adjusted to approximate the value reported for capillary pressure in the dog. Tissue discoloration occurred in two dogs, suggestive of impaired circulation. Skin flaps were developed from expanded skin and rotated over the talocrural region. Wound dehiscence occurred along the distal flap margin in three phase II dogs. These wounds healed by second intention. Branches of the caudal saphenous artery were identified, using angiography, as the primary blood supply to the skin flaps.     

Evaluation of the Cranial Rectus Abdominus Muscle Pedicle Flap as a Blood Supply for the Caudal Superficial Epigastric Skin Flap in Dogs

This study evaluates the cranial rectus abdominus muscle pedicle flap as the sole blood supply for the caudal superficial epigastric skin flap. This flap was composed of a cranially based rectus abdominus muscle pedicle flap that was attached to the caudal superficial epigastric island skin flap (including mammary glands 2 to 5) via the pudendoepigastric trunk. Selective angiography of the cranial epigastric artery in eight cadaver dogs proved that the arterial vasculature in the cranial rectus abdominus was contiguous with that in the caudal superficial epigastric skin flap. In the live dog study, three of six of the flaps failed because of venous insufficiency. Necrosis of mammary gland 2 occurred in two of six flaps. One of six flaps survived with the exception of the cranial most aspect of mammary gland 2. Angiography of the cranial epigastric artery proved that arterial blood supply to these flaps was intact. Histological evaluation of the failed flaps showed full-thickness necrosis of the skin and subcutaneous tissues, the presence of severe congestion, and venous thrombosis. Retrograde venous blood flow through the flap was inconsistent, and hence resulted in failure of this myocutaneous flap. Use of this flap for clinical wound reconstruction cannot be recommended.     

Use of cancellous bone grafting to promote granulation tissue in a distal limb wound in a dog

A 5‐year‐old female spayed Shetland sheepdog presented for evaluation of bandage sores on the left pelvic limb after a splint was placed to stabilise a digit fracture incurred approximately 2 weeks previously. Multiple areas of necrosis were identified upon bandage removal. After debridement of devitalised tissue, a 4 cm wound on the plantar surface of the metatarsal bones (with exposed bone and tendons) remained. The Papineau technique (which involves removal of infected or necrotic tissue, placement of autogenous cancellous bone graft within a wound, and delayed skin closure) was used to treat this wound. Use of bone graft in this manner aims to promote early granulation tissue formation and reduce the time until wound reconstruction can be performed. Autogenous cancellous bone graft was harvested from the proximal humerus and placed within the metatarsal wound. Once a healthy granulation tissue bed was noted to cover the bone graft, a meshed full thickness skin graft was placed. To our knowledge, this is the first report of the Papineau technique being used for this purpose in a dog.     

Repair of sinocutaneous fistulae in two horses

Chronic facial defects extending into the sinuses of two mares were repaired using periosteal flaps. Partial osseous bridging was established over the defects following repair. Previous attempts to close the defects with skin alone had failed. A periosteal flap is a simple surgical technique that provides the foundations for successful repair, despite the chronicity of some fistulae.     

Complete patellar ligament replacement using a fascia lata autograft in a dog

A novel technique for the repair of a chronically lacerated patellar ligament in a pet greyhound is described. The injury had been sustained traumatically, and a previous surgical repair had proved unsuccessful. On further surgical investigation, identification of the ruptured ligament ends was not possible. A double fascia lata graft was employed to reconstruct the lateral and medial portions of the ligament. This repair was augmented with 27 kg monofilament nylon anchored through tunnels from the proximal tibia to the patella and quadriceps tendon. A concurrent skin deficit was managed with a superficial epigastric axial pattern flap. To the authors' knowledge, only one previous case requiring complete patellar ligament replacement has been documented in the veterinary literature. This report details a simplified surgical technique which may have advantages over the previously described technique.     

The use of acupuncture beads to control exuberant granulation tissue in equine skin wounds: A preliminary study

Skin lacerations on the hind legs of horses often cause large defects on the cranial surface of the hock and cannon regions. The treatment of these present significant logistic problems due to the amount of movement of the area and the difficulties of bandaging and immobilisation, as well as a tendency to form exuberant granulation tissue (or ‘proud flesh’) Acupuncture beads were used as a means of suppressing granulation and maximising epithelial ingrowth, using the principle that ‘acupuncture has been shown to help bring the body back towards normality’. The aim in these cases was healing of the skin lesions with the least effort and cost possible. The technique eliminated the need for resection of any granulation tissue after the beads were implanted, the amount of bandaging was drastically reduced and eliminated in a lot of cases, and the results were cosmetically very acceptable and functional. Digital photography and measurements of the changes in the size of the lesions were used to document the results. This study shows that the formation of exuberant granulation tissue or ‘proud flesh’ in equine skin wounds on the cranial surface of the hock and cannon bone can be controlled by a single acupuncture bead treatment. Long‐term follow‐up of the cases over 18+ months confirms the ongoing effects of the acupuncture beads, resulting in the completion of wound healing and reduction of fibrosis.     

Simultaneous use of bilateral caudal superficial epigastric axial pattern flaps for wound closure in a dog

A neutered male German shorthaired pointer sustained severe bite wounds to the left caudal flank and thigh area. Thorough wound lavage and debridement was performed immediately and also three days after presentation. Daily wound dressing resulted in the production of a mature granulation tissue bed. Prior to wound closure, colour flow Doppler ultrasonography was used to confirm blood flow through the right and left caudal superficial epigastric arteries and veins. Sixteen days after presentation, right and left caudal superficial epigastric axial pattern flaps were simultaneously elevated to cover the defect. The right flap was elevated as an island flap, rotated 120 degrees and used to cover the caudodorsal aspect of the defect. The left flap was elevated and rotated dorsally to cover the cranioventral aspect of the defect. Ninety per cent wound coverage was achieved and flap survival was total. The donor site defect was closed primarily and no dehiscence occurred. Three months postsurgery, the entire defect was closed and limb function was normal.     

Investigation and clinical application of a novel axial pattern flap for nasal and facial reconstruction in the dog

OBJECTIVE: To describe the vascular supply to a facial skin flap based at the commissure of the lip in the dog and report on its use in four dogs. STUDY DESIGN: Experimental and prospective clinical study. Animals Five canine cadavers and four client-owned dogs. METHODS: In the cadavers, the ventral aspect of the zygomatic arch, the ventral margin of the caudal mandible and the wing of the atlas were marked as anatomical boundaries of a skin flap that was elevated from the subcutaneous tissues to the level of the medial canthus of the eye. Methylene blue dye and barium sulphate solution were independently infused through a common carotid (three dogs) or facial artery (two dogs) catheter. Distribution of dye throughout the harvested skin was assessed subjectively. After contrast infusion the flap was excised and radiographed. The technique was used to reconstruct large facial or nasal defects in four dogs after tumour or skin lesion excision. RESULTS: Cadaver dissections and contrast studies clearly demonstrated three direct cutaneous arteries, the superior and inferior labial arteries and the angularis oris artery, arborising within the base of the flap. A separate direct cutaneous branch of the angularis oris artery was identified. An arterial plexus was identified within the distal flap, within which this artery communicates with the transverse facial artery and a cutaneous branch of the masseteric artery. Dye infusion caused discolouration of the elevated skin and vasculature within the flap. The flap survived in all clinical cases with marginal distal necrosis in one dog. CONCLUSIONS: The complex facial flap described is perfused by three direct cutaneous arteries and functions reliably in clinical cases.