Options for skin coverage: reconstruction and skin grafts
Abstract
Surgical skin reconstruction is increasingly being used in small animal practice to achieve maximal skin coverage. This reconstruction can take the form of either skin flaps or free skin grafts depending on the location of the tissue deficit. A variety of skin flaps are available for use, with or without the inclusion of the direct cutaneous arteries (DCAs) to maintain their vascular supply. Where closure of the deficit is not achievable using a local skin flap then a free skin graft may be selected. The ultimate success of the skin graft ‘take’ will depend greatly on surgical technique as well as post-operative care which is where the role of the veterinary nurse is vitally important in pro-actively achieving a good outcome. Relatively ‘new’ techniques such as the use of negative pressure wound therapy or vacuum assisted closure (VAC) is also being introduced to the management of both open wounds and skin flaps and grafts and so far the studies suggest that its use can result in a much more favourable outcome for wound closure.
Wound assessment is important in terms of planning wound reconstruction. It is important to ensure that traumatic wounds are free of infection, devitalized or necrotic tissue, or contamination before closure is performed. In order to achieve this a period of debridement and/or open wound management to allow granulation may be required for several days before reconstruction is carried out. In surgical wound management, reconstruction can be planned out, as the skin is not as compromised as in traumatic wounds; it is elastic, vascular and even more freely available than in the trauma patient (Anderson, 1997a). The landmarks of the direct cutaneous artery (DCA) supply to the skin, skin tension lines and structural features, such as joints/orifices, should be taken into account during this planning. The appropriate areas can then be clipped and prepared and a plan for the reconstruction can be drawn on the skin before scrubbing up using a surgical marker.
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