Skin Reconstruction in Dogs

Dogs

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Reconstructive surgery of the skin, also known as plastic surgery, is sometimes necessary to repair large wounds. Typical wounds are those created by trauma, such as being hit and dragged by a car, or those associated with burns, gunshots or animal bites. The wounds can also be created after the removal of a large tumor where there is insufficient skin to close the defect.

Any animal that has a large area of skin loss may be a candidate for reconstructive skin surgery. Wounds or defects that might require reconstructive surgery include:

  • Extremely large wounds
  • Chronic, non-healing wounds
  • Large tumors of the skin or underlying tissue

    Diagnosis

  • Your veterinarian will ask you many questions to determine the history of the wound and its progression. These questions might include the following:

    If there is a wound:

  • How did the wound occur?
  • How long has it been present?
  • What therapies have been tried and with what results?

    If there is a tumor:

  • How long has the tumor been there?
  • How quickly has it grown?
  • Has it been tested by a biopsy or fine needle aspirate? This is a test in which the doctor inserts a fine needle into the tumor and uses a syringe to aspirate some of the tumor cells. The cells are then placed onto a slide for microscopic examination.

  • Skin reconstruction is major surgery that must be done under general anesthesia. Therefore, your veterinarian will want to determine your pet's overall health to ascertain the risk associated with anesthetizing your pet and also to determine the best anesthetic regime to use. Your veterinarian will also perform a complete examination of your pet, including checking the body temperature and listening to the heart and lungs.

  • Blood will be drawn from your pet and submitted for analysis. Your veterinarian will want to determine if your pet is anemic or has an abnormal white cell count, which could indicate the presence of an infection. Blood tests can also identify abnormalities in kidney or liver function, which is important to know since these organs metabolize or help eliminate most anesthetic drugs.

  • Your veterinarian will examine the wound closely to determine the optimal time to perform surgery. Some wounds are sufficiently healthy so that surgery can be done immediately, while others are best treated for a period of time, perhaps by bandaging, before surgery is done. He/she will also examine the skin adjacent to the wound or tumor to determine what reconstructive procedure would be best suited for your pet's wound.

    Treatment

    The timing and type of reconstructive skin surgery varies depending on the type of wound and its appearance and location.

    Some wounds need to be cleaned of dirt, hair and other contaminants before they can be closed. Other wounds may heal on their own over a long period of time and not require surgery. Complex wounds may require more than one surgery to completely close them.

    Home Care and Prevention

    Follow your veterinarian's instructions on wound and bandage care closely in order to obtain the best results. Be patient. Many wounds take months and may require numerous visits to your veterinarian before they heal completely.

    It may be difficult to prevent your pet from becoming injured; however, many large wounds are caused by automobile accidents. To prevent these injuries keep your dog in a fenced yard and take him out for walks only on a leash.

    Examine your pet regularly to identify tumors when they are small. Small tumors are more easily removed and the resulting wound is more readily closed than when large tumors are present.

    • A large wound on the back of a dog requiring reconstructive surgery.

    • Skin flaps are created to close up the wound.

    • Post surgical view of the wound.

    • Same patient one month post surgical procedure.

    Reconstructive skin surgery or plastic surgery is sometimes needed to repair large wounds. Burn wounds and those caused by vehicular accidents, gunshots, bites or the removal of large tumors may be candidates for reconstructive surgery. Reconstructive surgery encompasses a large variety of surgical techniques, including special suturing or stitching techniques, skin grafts and skin flaps. Surgeons may use special patterns of suture placement to relieve tension on the closed wound edges.

    An area of skin may be removed from one part of the body, such as the animal's side, and sutured to another area where there has been skin loss. This is called a skin graft and is most commonly used to replace skin that has been lost on the paws or lower limbs.

    Flaps of skin that remain attached at one end can be raised from the body and rotated to cover an adjacent area that has an open wound. This is only possible if there is enough loose skin available adjacent to the wound to be able to close the area from where the flap was raised. If there is not enough loose skin available, then the skin may be stretched. Skin can be stretched either by using expanding devices placed under the skin or by placing stretching bands on the surface of the skin. Skin has natural elastic properties, the most common example of which is the ability of the abdominal skin to stretch during pregnancy.

    It may be particularly difficult to get wounds that occur over a joint to heal because of the joint motion. Sometimes, the surgeon may make an incision on the opposite side of the joint to release the skin, allowing the wound to be closed over the joint. The open wound on the opposite side where there is less motion is then left to heal on its own.

    Sometimes the goal of the surgeon is to close the wound only partially, allowing the remaining wound to heal on its own. The body has a great capacity for healing many skin wounds without surgery.

    Diagnosis

  • Initially, your veterinarian will want to obtain a history and perform a physical examination. This initial examination may be followed by specific tests.

  • History. Your veterinarian will ask you many questions regarding the development and progression of the wound. If your pet was just involved in a traumatic event, he may require emergency stabilization before the skin wound is tended to. If the wound has been a chronic problem your veterinarian will ask about previous therapies and the results of those treatments. If there is a large tumor present, and its removal will create a large wound that may need reconstructive surgery, then your veterinarian will ask you about the development and progression of the tumor. If the tumor has been evaluated before, either by a biopsy or a fine needle aspirate, bring these results to your veterinarian's attention.

  • Physical exam. Your veterinarian will perform a complete physical exam. The wound will be examined closely to determine if it is clean enough to be closed surgically or if it needs further treatment to create a clean and healthy wound. The surrounding skin will be examined to determine what reconstructive procedure would be best suited to close the wound.

  • Radiographs (X-rays). Many wounds of the lower limb and paw are associated with fractured or dislocated bones and/or ligament tears. X-rays are necessary to determine whether the orthopedic injuries require surgical repair. If your pet was hit by a car or experienced other types of trauma, X-rays of the chest are often taken to check for injuries to the lungs, heart, ribs, and/or diaphragm, which is the muscle that divides the chest and abdomen and is responsible for breathing. These injuries may be life threatening and may need to be treated before the skin wounds are repaired.

  • Blood and urine tests. Blood tests are submitted to evaluate the white blood cell count, which is usually elevated with an infection, and the number of red blood cells to determine if your pet is anemic. The function of the kidneys is evaluated through testing the blood and urine, and liver function is ascertained through blood tests. All of these tests are important in determining whether your pet should undergo anesthesia and what type of anesthesia should be used.

    Therapy

  • Emergency stabilization. If your pet was hit by a car or has experienced other major trauma, your veterinarian may need to provide initial emergency stabilization therapy in the form of intravenous fluids and oxygen. If there is a dirty or contaminated wound present, your pet will also be given antibiotics. Pain medications will also likely be given.

  • Wound preparation. If the wound was surgically created, no preparation is necessary prior to reconstructive surgery. If the wound was created by an injury, then the wound is likely to be dirty and contaminated with gravel, hair, and other foreign material. The wound must be clean and have a healthy blood supply before reconstructive surgery can be done.

    The dirt, hair, and necrotic (dead) tissue are removed, or debrided, manually while the dog is anesthetized. Another very effective method is by using a wet-to-dry bandage, which sticks to the wound as it dries. As it is removed it pulls off the dirt and necrotic tissue with it. Pulling the bandage off is painful, so the patient needs to be heavily sedated or anesthetized during each bandage change. The bandage needs to be changed frequently, usually once or twice a day.

    As the wound becomes cleaner it will appear red and a little bumpy. These tiny red bumps are the buds of new blood vessels that will supply the wound. This type of red tissue is called a granulation bed. When a granulation bed has formed, your veterinarian will stop using adherent wet-to-dry bandages and will apply non-adherent dressings to protect the wound. Once the wound is at this stage it can be closed using any number of reconstructive techniques.

  • Healing by second intention. This phrase means that the wound is allowed to heal on its own. The skin edges around the wound contract and skin cells migrate toward the center of the wound. Very large wounds do not heal completely by second intention, but they can become significantly smaller and require less extensive reconstructive surgery later on. If your veterinarian chooses to allow the wound to heal by second intention, he/she will likely wait several months to allow the healing to go as far as it can before attempting reconstructive surgery.

  • Reconstructive surgery. Many different techniques are used to reconstruct wounds, and the technique chosen depends on the individual wound, as well as surgeon preference. If any of these reconstructive techniques result in only partial closure of the wound, then the rest of the wound may be able to heal by second intention or further reconstructive surgery may be necessary.

    Tension relieving sutures. These refer to patterns of suture placement that are designed to hold the skin edges together, especially when the closure is tight or under a lot of tension.

    Skin flaps. Areas of loose skin can be raised, leaving one border attached to the body, and the raised skin rotated to cover an adjacent defect. Loose skin is usually available near the neck and on the trunk (body) of the patient. Loose skin can also be created using skin stretching devices that are placed under the skin and inflated gradually, or by bands that are attached to the surface of the skin and gradually tightened.

    Skin grafts. Areas of loose skin can be completely removed from the body and placed on a wound far from its original location.

  • Post-operative care. Skin grafts are usually bandaged and the limb immobilized to allow the blood vessels in the granulation bed to penetrate and grow into the skin graft. Improper exercise restriction and bandage care can result in death of the delicate skin graft. With any type of reconstructive surgery, it is important that the patient not be allowed to lick or chew at the stitches or bandage. This can lead to infection or re-opening of the wound. The patient should wear an Elizabethan collar.

  • Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially, if your pet does not rapidly improve. Administer all prescribed medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.

    Follow your veterinarian's instructions for wound and bandage care explicitly. Reconstructive surgery can fail if your pet is allowed to do things he shouldn't be doing like running, licking at the stitches and getting the bandage wet.

    Have regular follow-up visits with your veterinarian as recommended. Healing is a dynamic process and the course of treatment can change as the wound changes.

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