Skin Wound Recostruction
When a wound closure is not possible because of the lack of skin, a wound reconstruction technique may be required (skin transplants).
The most common reconstructions techniques are skin flap or a skin graft.
Axial Skin Flap
A skin flap is when a flap of skin is lifted from one part of the body and is placed to cover a wound into another part of the body. A part of this skin is attached to the body and blood circulation is conserved. This makes this type of reconstructive surgery stronger in comparison with a skin graft.
Pictures of a caudal superficial epigastric axial skin flap. This flap relays on the epigastric vein and artery (vessels of mammary glands) and is one of the most robust, especially in female dogs. The skin of mammary glands was used to cover a surgical wound after MCT high-grade removal with 3 cm margins and one deep fascia plane.
Skin Graft
A skin graft is when a free part of the skin is collected from a part of the body and it is placed on a distal wound. In this case, normal blood flow is lost. The skin will need new blood supply from the wound bed to survive.
Because of this reason, often the surgery will need a staged procedure. The first surgery would be a mass removal, followed by bandages. The reconstructive surgery will be performed after 4-6 days when the wound bed will be full of vessels (granulation tissue) and free from infections. However, some vet prefers to perform this surgery as one-stage procedure. New scientific studies reveal a good skin graft taking also if this is performed as one-stage procedure.
The postoperative care will be more challenging of the skin flap because bandages will be routinely changed every 2-4 days for 3-4 weeks. If the wound is close to the join a temporary locking of the joint with pins and bars may be required.
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Pictures of skin graft. The skin was harvested from the flank of the patient and it was to cover a surgical defected after appendicular soft tissue sarcoma. The mass was removed with 2 cm margins. The leg was bandaged for 5 days. Once granulation tissue was present, a skin graft was performed, The skin was prepared with mesh shape and it was used to cover the wound. The mesh shape grafts have a high success rate in comparison with non-meshed grafts.
Complications for Axial Skin Flap and Skin Graft
As all the transplants, skin graft or skin flap may be partially or completely rejected. In case of failing, a review surgery may be performed to remove necrotic tissue (dead skin) and healing with scar tissue may be considered. Frequent bandages changing will be required until the skin is completely healed.
Case studies
An MCT was excised with 3 cm margins and one deep plane fascia. The primary closing of the surgical wound was not possible due to the lack of skin following mass excisions. The prescapular lymph nodes and the entire mass were sent for histopathology.
A thoracodorsal axial pattern skin flap was used to cover the surgical wound. The surgery was successful, the mass was excised with wide margins, and the patient made a full recovery.
