Free skin grafting for treatment of distal limb skin defects in cats

The technique and results of free skin grafts have been described in dogs, horses, rabbits, goats and mice. The procedure in cats is, however, described only indirectly in papers relating to dogs. A standard technique has been developed by the authors for use in cats, and is reported for 17 grafts in 16 cats with traumatic injury to the legs resulting in large areas of skin loss. This paper describes the preparation of the wound for grafting, the harvesting of the graft, graft placement, postoperative care and the results of the application of this technique. The success rate in this series of cases was high. This was attributed to proper preparation of the recipient site, collection of the graft and postoperative bandaging. The results suggest that the success rate of free skin grafts in cats is considerably higher than that achieved by the present authors in dogs, and reported for dogs by other surgeons in the literature.     

Distant abdominal and thoracic pedicle skin flaps for treatment of distal limb skin defects

The treatment of large skin defects of the distal limbs of dogs and cats can be difficult due to the lack of skin available for primary wound closure or the creation of local skin flaps. Distant pedicle skin flaps provide an acceptable alternative for wound closure with full thickness skin and provide a cosmetic result. Fourteen animals (10 dogs and four cats) that had distant pedicle skin flaps are reviewed. The technique allowed 100 per cent wound coverage in 10 of 14 animals and greater than 95 per cent skin flap survival occurred in 12 of 14 animals. Complications associated with the procedure were most commonly wound infection and partial suture line dehiscence, however these did not detract from the final outcome. Flap release was in one or two stages, however the outcomes did not appear to be affected by the release protocol.     

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.     

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.     

Skin-fold advancement flaps for closing large proximal limb and trunk defects in dogs and cats

OBJECTIVE: To describe the use of skin-fold advancement flaps for covering large skin defects in dogs and cats. STUDY DESIGN: Clinical study. ANIMALS: Eight client-owned animals: 6 dogs and 2 cats. METHODS: Six dogs and 2 cats underwent reconstruction of soft-tissue wounds resulting from traumatic, neoplastic, or infectious lesions. Skin-fold flaps were created by division of the medial and lateral attachment to the proximal limb or the dorsal and ventral attachment to the trunk, enabling closure of adjacent defects on the trunk or proximal limb, respectively. RESULTS: Skin-fold flaps proved effective for closing defects in all animals. Necrosis of a portion of the flap occurred in 2 dogs due to technical errors, but the resultant defects remained amenable to primary closure. All wounds ultimately healed primarily, without major complications. CONCLUSION AND CLINICAL RELEVANCE: The skin-fold advancement flap is a versatile technique that lends itself to use in a variety of locations, depending on which attachments are divided. The clinical results are comparable with those reported for axial pattern and subdermal plexus flaps.     

Complications and outcome after thoracodorsal axial pattern flap reconstruction of forelimb skin defects in 10 dogs, 1989-2001

OBJECTIVE: To determine (1) the frequency and extent of complications associated with thoracodorsal axial pattern flap reconstruction of forelimb skin defects in dogs and (2) outcome after treatment of such complications. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Ten dogs. METHODS: Medical records for 10 dogs that had a thoracodorsal axial pattern skin flap reconstruction of a forelimb skin defect were reviewed. RESULTS: Three dogs had complete flap survival. Partial necrosis of the distal flap, ranging from an estimated 2% to 53% (mean, 21%) of the flap surface area, occurred in 7 dogs. Six dogs required surgical management of the skin necrosis, resulting in successful resolution in 5 dogs, whereas, in 2 dogs, the wound healed by second intention. Positive bacterial cultures were obtained from 3 dogs with distal flap necrosis. Seroma formation was noted in 2 dogs; the entire flap survived in 1 dog, whereas the second dog developed distal flap necrosis. Edema and bruising of the distal portion of the flap were noted in 8 dogs; distal flap necrosis subsequently developed in 7 dogs. Partial incisional dehiscence, which healed by second intention, occurred in 2 dogs. Of 6 owners available for follow-up, all were satisfied with the functional outcome, but 1 owner was not satisfied with the cosmetic appearance. CONCLUSIONS: Partial flap necrosis was a frequent complication of thoracodorsal axial pattern flap reconstruction of forelimb skin defects and required additional wound care or surgical intervention to achieve healing. CLINICAL RELEVANCE: Thoracodorsal axial pattern flaps can provide full-thickness skin coverage of extensive skin defects of the forelimb, but owners should be aware of the likelihood of local wound complications.     

T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs

OBJECTIVE: To describe the surgical technique and clinical results of treatment for forelimb angular limb deformities, secondary to premature distal radial or ulnar physeal closure, by using T-plate fixation of a distal radial closing wedge osteotomy in 18 dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: 18 client-owned dogs. METHODS: The medical records of 18 dogs that underwent a distal radial closing wedge osteotomy with T-plate fixation for correction of a forelimb angular limb deformity were reviewed. Small pins (Kirschner wires) were used to obtain the appropriate alignment of the antebrachiocarpal and elbow joints and proper limb orientation. In-hospital follow-up evaluation was obtained at the time fracture healing was observed radiographically. Further long-term follow-up was obtained by owner interview. RESULTS: Osteotomy sites were radiographically healed within 4 to 12 weeks (mean, 8 weeks) after surgery in the 14 dogs that returned for in-hospital follow-up. Limb function was graded as good or excellent in all dogs. Long-term follow-up by owner interview rated limb function and cosmetic appearance as good to excellent in all dogs. Plate removal was necessary in one dog 7 months after surgery because of osteopenia in the radius. CONCLUSION: This surgical technique was considered successful in the treatment of angular limb deformities in all dogs. A good to excellent prognosis is to be expected with this technique, with minimal complications. CLINICAL RELEVANCE: The use of a T-plate for the correction of angular limb deformities has not been previously described in the literature. This technique permits accurate correction of the angular limb deformity and minimizes postoperative complications.     

Intercalary bone grafts for joint and limb preservation in 17 dogs with high-grade malignant tumors of the diaphysis

OBJECTIVE: To evaluate postoperative complications, limb function, and tumor control after intercalary resection and reconstruction for preservation of limb and joint function in dogs with high-grade malignant tumors of diaphyseal bone. STUDY DESIGN: Retrospective study. ANIMALS: Seventeen client-owned dogs. METHODS: The bone tumor database and medical records were reviewed (1986-2002) for dogs with diaphyseal tumors treated with intercalary resection and reconstruction with either an allograft or irradiated autograft. Clinical presentation, diagnostic findings, surgical management, and outcome were determined from medical records and telephone interviews with veterinarians and owners. Statistical analyses included chi2 to test associations between intra- and postoperative variables with complications, and Kaplan-Meier survival analysis for disease-free interval, metastasis-free interval (MFI), and median survival time. RESULTS: Intercalary limb-sparing surgery was performed in 17 dogs with diaphyseal tumors: osteosarcoma (OSA) (15), histiocytic sarcoma (1), and solitary metastasis from a pulmonary adenocarcinoma (1). One dog was excluded from further analysis when the spared limb was amputated 4 days postoperatively because of incomplete tumor resection. In 16 dogs, limb function was good to excellent. Complications occurred in 5 dogs (31.3%) and included superficial infection in 2 dogs (12.5%) and implant failure in 4 dogs (25%). All implant failures occurred in the ulna and there was a significant association between implant failure and non-cemented allografts (P=.042). Non-union of 1 or both osteotomies was diagnosed in 10 dogs (83.3%) and, despite lack of clinical signs in all cases, was significantly associated with the use of intracavitary locally released cisplatin (P=.046) and cemented intercalary grafts (P=.046). Local tumor recurrence was diagnosed in 1 dog (6.3%) and metastatic disease in 12 dogs (75.0%), including 10 dogs with OSA. The median MFI was 137 days. The local disease-free and overall limb-salvage rate was 94% and 100%, respectively. Overall median survival time was 393 days and the median survival time for dogs with OSA was 449 days. CONCLUSION: Intercalary limb-sparing surgery results in better postoperative limb function with fewer and less severe complications than historical reports of dogs treated with non-intercalary limb-sparing surgery. CLINICAL RELEVANCE: In dogs with diaphyseal tumors, intercalary limb-sparing surgery preserves normal joint function and results in good to excellent limb use with few complications and good local tumor control.     

Clinical evaluation of caudal superficial epigastric axial pattern flap reconstruction of skin defects in 10 dogs (1989-2001)

Ten dogs with caudal superficial epigastric axial pattern flap reconstruction of extensive skin defects were reviewed. Nine dogs had complete survival of the flap. In one dog, a small area of necrosis occurred near the flap tip. Other complications included seroma formation (n=3), partial incisional dehiscence (n=3), flap edema (n=9), and bruising (n=7). Use of the caudal superficial epigastric axial pattern flap provided full-thickness skin coverage of extensive skin defects of the rear limb and inguinal region, with relatively minor complications that were amenable to conservative management.     

The use of vacuum-assisted closure therapy for the treatment of distal extremity wounds in 15 dogs

Objective— To evaluate clinical outcome after vacuum-assisted closure (VAC) therapy in dogs with traumatic wounds located in the distal extremities and report our early experience with VAC.
Study Design— Retrospective study.
Animals— Dogs (n=15) with traumatic distal extremity wounds.
Methods— Medical records (1999–2003) of dogs with traumatic injuries to the distal extremities managed by VAC were evaluated. Data included signalment, location of wound, time until surgical intervention, wound reconstruction methods, orthopedic procedures, outcome, complications associated with VAC, and length of hospitalization.
Results— The mean number of days until reconstruction was 4.6 days (range, 2–7 days). Reconstructive surgery was successful in all cases. Mean hospitalization was 9.7 days (range, 6–16 days). Complications included dermatitis at the wound margin and loss of vacuum causing wound desiccation.
Conclusion— VAC therapy can be used to achieve adequate management of traumatic distal extremity wounds. VAC provides an effective method of securing skin grafts over the wound bed.
Clinical Relevance— VAC therapy can be used as an ancillary treatment for distal extremity wounds in dogs before surgical repair as well as a method for securing skin grafts to the wound bed.     

Effect of skin graft preparation and graft survival on the secondary contraction of full-thickness skin grafts in dogs

The effects of 4 skin grafting techniques and graft survival on the secondary contraction of full-thickness skin grafts were evaluated. A total of 48 skin grafts were done on 12 dogs, with 2 skin grafts placed on both sides of the thorax of each dog. The grafting techniques included the sheet graft, sheet graft with continuous low-level suction provided by a butterfly catheter and evacuated glass tube, pie-crust graft, and nonexpanded mesh graft. Graft viability was assessed by visual inspection 10 days after surgical operation. Thirty skin grafts (64%) had a viability of 90% or greater. The final area of these grafts ranged from 73% to 119% of the original area. The secondary graft contraction followed a similar pattern for all graft types. During the first 10 days after surgical operation, the grafts contracted to 83% of their original area. Enlargement of the grafts began between 10 and 21 days after surgical operation. By 12 weeks, the grafts had attained a mean value of 96% of the original area. A significant difference in final area was not observed among graft types. Grafts with a high percentage of viability generally contracted less than those with larger areas of necrosis, but statistical relationship between viability and degree of contraction could not be proven. The results of the present study indicate that full-thickness skin grafts may be successfully done in dogs and that the grafts can be expected to undergo minimal postoperative contraction when graft survival is nearly complete.     

Intraoperative radiation for limb sparing of the distal aspect of the radius without transcarpal plating in five dogs

Objectives— To evaluate intraoperative irradiation (IORT) as a method of limb spare with preservation of the radiocarpal joint.
Study Design— Prospective case series.
Animals— Dogs (n=5) with stage II sarcoma of the distal aspect of the radius.
Methods— A bone segment containing the tumor was isolated surgically, treated by IORT, reimplanted, and secured by internal fixation. In 1 dog, the postradiation tumor bed was curetted and filled with bone cement. Dogs were administered alternating adriamycin and carboplatin starting 2 weeks after IORT and monitored at regular intervals.
Results— Four dogs had osteosarcoma and 1 had undifferentiated sarcoma. Implant failure (n=3), deep tissue infection (3), and pathologic fracture (3) resulted in amputation (3) or pancarpal plating (2). The dog with undifferentiated sarcoma was euthanatized because of suspected tumor recurrence 4 months postoperatively. Osteotomy healing was documented by radiography (1), histopathology (2), or by direct observation (2).
Conclusions— A technique for limb-sparing surgery of the distal portion of the radius in dogs using IORT had advantages include healing of the autograft and a source for a perfectly fitting autograft but did not appear to offer any advantage with respect to infection rate. Long-term preservation of the radiocarpal joint was not successful.
Clinical Relevance— It was not possible to preserve the function of the radiocarpal joint and so this technique cannot be recommended currently. Further study is needed to evaluate whether or not IORT can be considered in combination with pancarpal plating and possibly curettage and cementation of the tumor to prevent subchondral bone collapse.     

Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs

Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p < 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.