Skin wounds under tension do not heal well. Luckily, canine and feline skin has amazing elasticity and, unlike humans, lacks firm attachments to bone, muscle and underlying connective tissue.
“Oh S—t” Moments
Every oncological surgeon has these. My membership training taught me to focus on “first time wide margin excision of cancers” and to preoperatively plan for, but not worry about, the tissue deficit left as a result. We always have a plan A, B and sometimes C for difficult wound closures but despite that, just after a large mass has been successfully removed, I always allow myself a comforting expletive.
Plan A – Primary Closure
In regions of plentiful skin, undermining of wound edges by “blunt dissection” and preservation of local blood supply, allows closure of even large wound deficits in three to four layers, with each progressively reducing tension on the final skin closure.
Plan B – Local Skin Flaps
There are two main types but at Milton Village Vet we use a lot of axial pattern flaps [Dr Matt LOVES them]. These are well established regions of skin all over the body “fed” by a single “arborizing” blood vessel called a direct cutaneous artery. APFs are carefully dissected free, ensuring the vessel is preserved, then swivelled and sutured into an adjacent wound bed. Blood supply stops the flap from “dying off”, improves healing and reduces wound tension. It’s a win/win/win.
Plan C – Skin Grafts
Some wounds or skin cancers occur on the extremities of limbs where there is both limited skin and poor access to skin flaps. To avoid amputations or large slow healing open wounds, we harvest “distant” full thickness skin grafts, carefully prepare them before suturing them into the recipient wound bed. The first five days are crucial as fragile new blood vessels (re)grow into the graft.
Warning unsolicited advice ahead
Dr Matt is one of only a few membership accredited [Australian and New Zealand College of Veterinary Scientists] small animal surgeons on the South Coast. Whilst not specialists, membership accredited surgeons are the next best thing. Dr Matt is available for first and second opinions on all surgical cases.