A one-stop reference for the surgical treatment of wounds in small animal patients
Wound management and reconstructive surgery are among the most challenging and innovative subspecialties of veterinary surgery for the management of traumatic injuries and neoplastic conditions commonly encountered in small animals. Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition presents detailed procedures for surgical reconstruction and essential information on the principles of wound healing and wound management for dogs and cats. Coverage encompasses the pathophysiology and management of the wide variety of wounds encountered in small animal practice and the most current reconstructive techniques for closing the most challenging defects.
This updated edition is presented with additional full color images and now includes color in each illustration, to enhance the reader’s understanding of each subject and successful execution of the surgical techniques covered. It imparts new and updated information on a wide variety of topics, including skin and muscle flap techniques, skin fold disorders, facial and nasal reconstructive surgery, foot pad surgery, urogenital reconstructive surgery, and includes a new chapter on reconstructive surgery of the pinna.
- Provides a key reference for general practitioners, surgeons, surgical residents, veterinary students, and small animal technicians in a single source
- Discusses current and new wound management and reconstructive surgical techniques for all body regions, including the face, ear, mouth, eye, nose, trunk, external genitalia, and foot
- Contains 35 brand-new plate illustrations, updated and enhanced color plate illustrations and drawings, and additional clinical photographs throughout
- Features a new chapter dedicated to the surgical management of pinnal injuries and disorders, including new reconstructive surgical options developed by the author
- Includes information boxes to emphasize important points and the author’s personal observations, drawing on more than forty years of surgical experience
Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition is a valuable one-stop reference for veterinary surgeons, residents, and small animal practitioners.
Table of Contents
Foreword xi
Preface xii
Acknowledgments xiii
About the Companion Website xiv
1. The Skin 1
Skin Function 2
Skin Structure 2
Cutaneous Adnexa 5
The Hypodermis 8
Cutaneous Circulation 8
Pinna: Cutaneous Considerations 10
Congenital Skin Disorders 10
2. Basic Principles of Wound Healing 17
Introduction 18
Wound Healing 18
Acute Versus Chronic Open Wounds 29
Species Variations in Wound Healing 29
“Artificial Skin” 30
3. Basic Principles of Wound Management 33
Introduction 34
Patient Presentation 34
Mechanisms of Injury and Wound Terminology 34
Wound Classification 35
Options for Wound Closure 37
“Pointers” in Selecting the Proper Closure Technique 43
Basic Wound Management in Six Simple Steps 44
Exposed Bone: Osteostixis 49
Acute Versus Chronic Wounds 50
4. Topical Wound Care Products and Their Use 53
Wound Exudate 54
Wound Drainage Systems 54
Negative Pressure Wound Therapy (NPWT) 60
Concept of Moist Wound Healing (MWH) 67
Topical Wound Care Products 69
The Maggot and Leach in Wound Care 79
Common Topical Antiseptic and Cleansing Agents 81
Alternative Forms of Wound Therapy 85
Concluding Remarks 89
Plate 1: Vacuum‐Assisted Closure 92
5. Dressings, Bandages, External Support, and Protective Devices 95
Introduction 96
Dressings: The Primary Layer 96
Dressings: The Secondary Layer 111
Dressings: The Tertiary Layer 112
Preventing Bandage Displacement 113
Tie‐Over Dressing/Bandage Technique 114
Pressure Points: Bandage Options 115
Bandage “Access Windows” 115
Bandaging Techniques for Skin Grafts 115
Bandaging Techniques for Skin Flaps 115
Splints, Casts, Reinforced Bandages 115
Miscellaneous Protective Devices 116
Plate 2: Basic Bandage Application for Extremities 124
Plate 3: Tape Stirrups and Padding Dos and Don’ts 126
Plate 4: Elasticon Bandage Platforms and Saddles 128
Plate 5: Spica Bandages/Splints 130
Plate 6: Schroeder‐Thomas Splint 132
Plate 7: Schroeder‐Thomas Splint: Security Band Application 136
Plate 8: Body Brace 138
Plate 9: Tape Hobbles for the Rear Extremities 140
6. Common Complications in Wound Healing 143
Improper Nutritional Support 144
Medications and Their Influence on Healing 145
Hypovolemia and Anemia 146
The Nonhealing Wound: General Considerations 146
Failure to Heal by Second Intention 147
Scarring and Wound Contracture 152
Infection and Biofilm Formation 154
Draining Tracts 158
Use of Tourniquets for Lower Extremity Procedures 165
Seromas 166
Hematomas 167
Exposed Bone 167
Wound Dehiscence 169
7. Management of Specific Wounds 173
Bite Wounds 174
Burns 183
Inhalation Injuries 195
Chemical Burns 196
Electrical Injuries 197
Radiation Injuries 201
Frostbite 204
Projectile Injuries 205
Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227
Impalement Injuries 227
Pressure Ulcers 228
Hygroma 234
Snakebite 239
Brown Recluse Spider Bites 240
Porcupine Quills 240
Lower Extremity Shearing Wounds 243
Plate 10: Pipe Insulation Protective Device: Elbow 248
Plate 11: Pipe Insulation to Protect the Great Trochanter 250
Plate 12: Vacuum Drain Management of Elbow Hygromas 252
8. Regional Considerations 255
The Canine and Feline Profiles 256
Plates 13A and 13B: Surgical Technique Menu 258
9. Tension‐Relieving Techniques 265
Introduction 266
Skin Tension in the Dog and Cat 266
Plate 14: Tension Lines 282
Plate 15: Effects of Skin Tension on Wound Closure 284
Plate 16: Patient Positioning Techniques 286
Plate 17: Undermining Skin 288
Plate 18: Geometric Patterns to Facilitate Wound Closure 290
Plate 19: V‐Y Plasty 292
Plate 20: Z‐Plasty (Option I) 294
Plate 21: Z‐Plasty (Option II) 296
Plate 22: Multiple Z‐Plasties 298
Plate 23: Relaxing/Release Incisions 300
Plate 24: The “Hidden” Intradermal Release/ Relaxing Incision 302
Plate 25: Multiple Release Incisions for Extremity Wounds 304
Plate 26: Suture Options to Alter Skin Traction and Retraction 306
Plate 27: Walking Suture Technique 308
Plate 28: Skin Stretchers to Offset Incisional Tension 310
Plate 29: “Tension” Suture Patterns 312
Plate 30: Retention Sutures 314
Plate 31: Stent 316
Plate 32: Skin “Directing” for Maximum Coverage 318
Plate 33: Relaxing Incision to Reduce Flap Tension 320
10. Skin‐Stretching Techniques 323
Physiology of Skin Stretching 324
Presuturing 324
Load Cycling 324
Skin Stretchers 326
Skin Expanders 335
Plate 34: Presuturing Technique 338
Plate 35: Application of Skin Stretchers 340
Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342
Plate 37: Skin Stretcher Substitution for Presuturing 344
Plate 38: Skin Expanders 346
11. Local Flaps 351
Introduction 352
Advancement Flaps 353
Rotating (Pivoting) Flaps 356
Plate 39: Single Pedicle Advancement Flap 370
Plate 40: Bipedicle Advancement Flap 372
Plate 41: Transposition Flap (90 degrees) 374
Plate 42: Transposition Flap (45 degrees) 378
Plate 43: Transposition Flap (Oblique Angle) 380
Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382
Plate 45: Transposition Flaps in Partial Wound Closure 384
Plate 46: Interpolation Flap 386
Plate 47: Rotation Flap 390
Plate 48: Forelimb Fold Flap 392
12. Distant Flap Techniques 395
Distant Flaps 396
Direct Flaps 396
Indirect Flaps 396
The Delay Phenomenon 400
Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402
Plate 50: Direct Flap Closure of Knee Defect 406
Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408
Plate 52: Indirect Flap: Delayed Tube Flap 414
13. Axial Pattern Skin Flaps 417
Introduction: Axial Pattern Flaps 418
Island Arterial Flaps 418
Reverse Saphenous Conduit Flaps 421
Secondary Axial Pattern Flaps 421
Options to Extend the Length of Axial Pattern Flaps 427
Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430
Plate 54: Skin Position and Axial Pattern Flap Development 432
Plate 55: Omocervical Axial Pattern Flap 434
Plate 56: Thoracodorsal Axial Pattern Flap 436
Plate 57: Lateral Thoracic Axial Pattern Flap 438
Plate 58: Superficial Brachial Axial Pattern Flap 440
Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442
Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444
Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446
Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448
Plate 63: Flank Fold Flap: Hind Limb 450
Plate 64: Genicular Axial Pattern Flap 452
Plate 65: Reverse Saphenous Conduit Flap 454
Plate 66: Caudal Auricular Axial Pattern Flap 456
Plate 67: Superficial Temporal Axial Pattern Flap 458
Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 460
14. Free Grafts 463
Free Skin Grafts 464
Classification of Free Grafts 465
Graft Thickness 465
Partial‐Coverage Grafts 466
Dermatomes 467
Preservation by Refrigeration 467
Intraoperative Considerations 472
Bandaging Technique for Skin Grafts 472
Use of Plates 473
Plate 69: Punch Grafts 476
Plate 70: Pinch Grafts 478
Plate 71: Strip Grafts 480
Plate 72: Stamp Grafts 482
Plate 73: Sheet Grafts 484
Plate 74: Dermatome: Split‐Thickness Skin Graft Harvesting 486
Plate 75: Mesh Grafts (With Expansion Units) 488
Plate 76: Mesh Grafts (With Scalpel Blades) 490
15. Facial Reconstruction 493
Introduction: Facial Reconstructive Surgery 494
Plate 77: Repair of Upper Lip Avulsion 515
Plate 78: Repair of Lower Labial Avulsion 516
Plate 79: Wedge Resection Technique 518
Plate 80: Rectangular Resection Technique 520
Plate 81: Full‐Thickness Labial Advancement Technique (Upper Lip) 522
Plate 82: Full‐Thickness Labial Advancement Technique (Lower Lip) 524
Plate 83: Buccal Rotation Technique 526
Plate 84: Lower Labial Lift‐Up Technique 528
Plate 85: Upper Labial Pull‐Down Technique 530
Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532
Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536
Plate 88: Feline Facial Axial Pattern Flap 538
Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540
Plate 90: Unilateral Rostral Labial Pivot Flaps 542
Plate 91: Bilateral Rostral Labial Pivot Flaps 544
Plate 92: Oral Commissure Advancement Technique 546
Plate 93: Brachycephalic Facial Fold Correction 548
Plate 94: Cheilopexy Technique for Drooling 550
16. Myocutaneous Flaps and Muscle Flaps 553
Introduction 554
Myocutaneous Flaps 554
Muscle Flaps 554
Plate 95: Latissimus Dorsi Myocutaneous Flap 568
Plate 96: Cutaneous Trunci Myocutaneous Flap 570
Plate 97: Latissimus Dorsi Muscle Flap 572
Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574
Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576
Plate 100: External Abdominal Oblique Muscle Flap 578
Plate 101: Caudal Sartorius Muscle Flap 580
Plate 102: Cranial Sartorius Muscle Flap 582
Plate 103: Temporalis Muscle Flap 584
Plate 104: Transversus Abdominis Muscle Flap 586
Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588
Plate 106: Flexor Carpi Ulnaris Muscle Flap 590
Plate 107: Cranial Tibial Muscle Flap 592
Plate 108: Internal Obturator Muscle Flap 594
Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 596
17. Oral Reconstructive Surgical Techniques 599
Introduction 600
Cleft Palate 601
Palatal Defects/Oronasal Fistulas 602
Plate 110: Mucosal Flaps 606
Plate 111: Palatoplasty: Bipedicle Advancement Technique 608
Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612
Plate 113: Palatine Mucosal Flap 614
Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616
Plate 115: Full‐Thickness Labial Flap Closure of Oronasal Fistulas 618
Plate 116: Cartilage Grafts for Palatal Fistulas 620
Plate 117: Angularis Oris Mucosal Flap 622
18. Foot Pad Reconstruction 625
Introduction 626
Pad Laceration and Lesion Excision 626
Digital Pad Transfer 631
Metacarpal/Metatarsal Pad Transfer 632
Accessory Carpal Pad 632
Pad Grafting 634
Digital Flaps for Wound Closure 634
Fusion Podoplasty 634
Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642
Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644
Plate 120: Digital Pad Transfer 646
Plate 121: Metatarsal/Metacarpal Pad Transfer 648
Plate 122: Pad Grafting 650
Plate 123: Segmental Pad Grafting Technique 652
Plate 124: Fusion Podoplasty 654
19. Major Eyelid Reconstruction 657
Introduction 658
The Eyelids 658
Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660
Plate 126: Lip‐to‐Lid Procedure 662
Plate 127: Oral Mucosal Graft onto Skin Flap 666
Plate 128: Third Eyelid–Skin Flap Reconstruction of the Lower Eyelid 668
20. Nasal Reconstruction Techniques 671
Introduction: Nasal Anatomy 672
Traumatic Wound Management 672
Neoplasia 673
Neoplasms and Surgical Margins 673
Nasal Reconstruction Options 673
Options for Managing Nasal Stenosis 682
Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692
Plate 130: Bilateral Sulcus Flap Technique 694
Plate 131: Septal Resection Technique 696
Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698
Plate 133: Alar Fold Flaps 700
Plate 134: Musculofascial Island Labial Flap 702
Plate 135: Labial Mucosal Inversion Technique 706
Plate 136: Nasal Reconstruction with the “Lip‐to‐ Lid Technique” Variation 708
Plate 137: Oral Mucosal Graft with Nasal Stenting 710
Plate 138: Intranasal Septal Window Technique 712
Plate 139: Cantilever Suture Technique 714
21. Cosmetic Closure Techniques 719
Cosmetic Considerations 720
Causes of Scars 720
Minimization of Scarring 720
Dog Ears 722
Plate 140: Scar Concealment 724
Plate 141: W‐Plasty 726
Plate 142: Dog Ear: Surgical Correction 728
22. Preputial Reconstructive Surgery 731
Introduction 732
Surgical Conditions 732
Surgical Techniques 742
Plate 143: Preputial Ostium Enlargement 756
Plate 144: Preputial Ostium Reduction 758
Plate 145: Preputial Advancement Technique 760
Plate 146: Phallopexy 764
Plate 147: Urethral Reconstruction for Subanal Hypospadias 766
Plate 148: Preputial Urethrostomy Technique 768
Plate 149: Urine Diversion Technique 770
23. Pinnal Reconstructive Surgery 773
Introduction 774
Anatomy of the Pinna 774
Surgical Conditions 779
Wound Management and Reconstructive Surgical Techniques 780
Aural Hematoma Management Options 786
Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796
Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798
Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800
Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802
Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804
Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806
Plate 156: Direct Flap Reconstruction of the Pinna 808
Plate 157: Resection of the Terminal Third of the Pinna 810
Plate 158: Inverted “Triangle” Resection of the Central Third of the Pinna 812
Plate 159: Incisional Drainage of Aural Hematomas 814
Plate 160: Bandaging the Pinna 816
Plate 161: Vacuum Drain Management of Aural Hematomas 818
24. Miscellaneous Reconstructive Surgical Techniques 821
Omentum 822
Scrotum 822
Tail Fold Intertrigo (Screw Tail) 823
Disorders of the Vulva 827
Managing Skin Fold Inversion of Urethrostomies 835
Fecal Incontinence: Treatment Options 835
Plate 162: Omental Flap Options 838
Plate 163: Scrotal Flap Technique 840
Plate 164: Caudectomy for Tail Fold Intertrigo 842
Plate 165: Episioplasty 844
Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846
Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848
Index 851
