Atlas of Small Animal Wound Management and Reconstructive Surgery

Wound management and reconstructive surgery are among the most challenging and innovative subspecialties of veterinary surgery. As treatment options for traumatic injuries and cancers have advanced, so too has the focus and importance grown of understanding wound healing, wound management and atraumatic surgical technique. Atlas of Small Animal Wound Management and Reconstructive Surgery, Third Edition is a valuable, one–stop reference for veterinary surgeons, residents, and small animal practitioners. This full–color reference presents essential information on basic principles of wound healing and wound management, common complications, and general surgical considerations. Also, new to this edition, the text presents a wider variety of topics including skin fold disorders, urogenital surgery, new flap techniques, and an expanded chapter on facial reconstruction. It also contains significant updates on wound healing physiology and equipment and dressing materials.

Preface.

1. The Skin.

Skin Function.

Skin Structure.

Cutaneous Adnexa.

The Hypodermis.

Cutaneous Circulation.

Congenital Skin Disorders.

2. Basic Principles of Wound Healing.

Introduction.

Wound Healing.

Species Variations in Wound Healing.

Artificial Skin.

3. Basic Principles of Wound Management.

Introduction.

Patient Presentation.

Mechanisms of Injury and Wound Terminology.

Wound classification.

Options for Wound Closure.

Healing by Adnexal Re–epithelialization.

Pointers in Selecting the Proper Closure Technique.

Basic Wound Management in Six Basic Steps.

4. Wound Care Products and Their Use.

Wound Drainage Systems.

Topical Wound Care Products.

Alternative Forms of Wound Therapy.

Concluding Remarks.

Plate 1: Vacuum–Assisted Closure.

5. Dressings, Bandages, External Support, and Protective Devices.

Introduction.

Composition of a Bandage.

Preventing Bandage Displacement.

Tie–over Dressing/Bandage Technique.

Pressure Points: Bandage Options.

Bandage Access Windows .

Bandaging Techniques for Skin Grafts.

Bandaging Techniques for Skin Flaps.

Splints, Casts, Reinforced Bandages

Miscellaneous Protective Devices.

Plate 2: Basic Bandage Application for Extremities.

Plate 3: Tape Stirrups and Padding Dos and Don ts.

Plate 4: Elasticon Bandage Platforms and Saddles.

Plate 5: Spica Bandages/Splints.

Plate 6: Schroeder–Thomas Splint.

Plate 7: Schroeder–Thomas Splint: Security Band Application.

Plate 8: Body Brace.

6. Common Complications in Wound Healing.

Improper Nutritional Support.

Hypovolemia and Anemia.

The Nonhealing Wound: General Considerations.

Failure to Heal by Second Intention.

Scarring and Wound Contracture.

Infection.

Draining Tracts.

Use of Tourniquets for Lower Extremity Procedures.

Seromas.

Hematomas.

Exposed Bone.

Wound Dehiscence.

7. Management of Specific Wounds.

Bite Wounds.

Burns.

Inhalation Injuries.

Chemical Burns.

Electrical Injuries.

Radiation Injuries.

Frostbite.

Projectile Injuries.

Pressure Sores.

Hygroma.

Snakebite.

Brown Recluse Spider Bites.

Porcupine Quills.

Plate 9: Pipe Insulation Protective Device: Elbow.

8. Regional Considerations.

The Canine Profile.

The Feline Profile.

Plate 10: Surgical Technique Menu.

9. Tension Relieving Techniques.

Introduction.

Skin Tension in the Dog and Cat.

Plate 11: Tension Lines.

Plate 12: Effects of Skin Tension on Wound Closure.

Plate 13: Patient Positioning Techniques.

Plate 14: Undermining Skin.

Plate 15: Geometric Patterns to Facilitate Wound Closure.

Plate 16: V–Y Plasty.

Plate 17: Z–Plasty (Option I).

Plate 18: Z–Plasty (Option II).

Plate 19: Multiple Z–Plasties.

Plate 20: Relaxing/Release Incisions.

Plate 21: The Hidden Intradermal Release Incision.

Plate 22: Multiple Release Incisions for Extremity Wounds.

Plate 23: Walking Suture Techniques.

Plate 24: Skin Stretchers to Offset Incisional Tension.

Plate 25: Tension Suture Patterns.

Plate 26: Retention Sutures.

Plate 27: Stent.

Plate 28: Skin Directing for Maximum Coverage.

Plate 29: Relaxing Incision to Reduce Flap Tension.

10. Skin–Stretching Techniques.

Physiology of Skin Stretching.

Presuturing.

Skin Stretchers.

Skin Expanders.

Plate 30: Presuturing Technique.

Plate 31: Application of Skin Stretchers.

Plate 32: Skin–Stretcher Substitution for Presuturing.

Plate 33: Skin Expanders.

11. Local Flaps.

Introduction.

Advancement Flaps.

Rotating (Pivoting) Flaps.

Plate 34: Single Pedicle Advancement Flap.

Plate 35: Bipedicle Advancement Flap.

Plate 36: Transposition Flap (90 degrees).

Plate 37: Transposition Flap (45 degrees).

Plate 38: Interpolation Flap.

Plate 39: Rotation Flap.

Plate 40: Forelimb Fold Flap.

12. Distant Flap Techniques.

Distant Flaps.

Direct Flap.

Indirect Flap.

The Delay Phenomenon.

Plate 41: Direct Flaps: Single–Pedicle (Hinge) Flap.

Plate 42: Direct Flap: Bipedicle (Pouch) Flap.

Plate 43: Indirect Flaps: Delayed Tube Flaps.

13. Axial Pattern Skin Flaps.

Introduction: Axial Pattern Flaps.

Island Arterial Flaps.

Reverse Saphenous Conduit Flap.

Secondary Axial Pattern Flaps.

Plate 44: Four Major Axial Pattern Flaps of the Canine Trunk.

Plate 45: Skin Position and Axial Pattern Flap Development.

Plate 46: Omocervical Axial Pattern Flap.

Plate 47: Thoracodorsal Axial Pattern Flap.

Plate 48: Lateral Thoracic Axial Pattern Flap.

Plate 49: Superficial Brachial Axial Pattern Flap.

Plate 50: Caudal Superficial Epigastric Axial Pattern Flap.

Plate 51: Cranial Superficial Epigastric Axial Pattern Flap.

Plate 52: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch.

Plate 53: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch.

Plate 54: Flank Fold Flap: Hind Limb.

Plate 55: Genicular Axial Pattern Flap.

Plate 56: Reverse Saphenous Conduit Flap.

Plate 57: Caudal Auricular Axial Pattern Flap.

Plate 58: Superficial Temporal Axial Pattern Flap.

Plate 59: Lateral Caudal (Tail) Axial Pattern Flap.

14. Free Grafts.

Free Skin Grafts.

Classification of Free Grafts.

Graft Thickness.

Partial Coverage Grafts.

Dermatomes.

Preservation by Refrigeration.

Intraoperative Considerations.

Bandaging Technique for Skin Grafts.

Plate 60: Punch Grafts.

Plate 61: Pinch Grafts.

Plate 62: Strip Grafts.

Plate 63: Stamp Grafts.

Plate 64: Sheet Grafts.

Plate 65: Dermatome: Split–Thickness Skin Graft Harvesting.

Plate 66: Mesh Grafts (With Expansion Units).

Plate 67: Mesh Grafts (With Scalpel Blades).

15. Facial Reconstruction.

Introduction: Facial Reconstructive Surgery.

Plate 68: Repair Of Lower Labial Avulsion.

Plate 69: Repair of Upper Lip Avulsion.

Plate 70: Wedge Resection Technique.

Plate 71: Rectangular Resection Technique.

Plate 72: Full–Thickness Labial Advancement Technique (Upper Lip).

Plate 73: Full–Thickness Labial Advancement Technique (Lower Lip).

Plate 74: Buccal Rotation Technique.

Plate 75: Lower Labial Lift–Up Technique.

Plate 76: Upper Labial Pull–Down Technique.

Plate 77: Labial/Buccal Reconstruction With Inverse Tubed Skin Flap.

Plate 78: Skin Flap for Upper Labial And Buccal Replacement (Facial Axial Pattern Flap).

Plate 79: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip).

Plate 80: Rostral Labial Pivot Flaps.

Plate 81: Oral Commissure Advancement Technique.

Plate 82: Brachycephalic Facial Fold Correction.

Plate 83: Cheilopexy Technique For Drooling.

16. Myocutaneous Flaps and Muscle Flaps.

Introduction.

Myocutaneous Flaps.

Muscle Flaps.

Plate 84: Latissimus Dorsi Myocutaneous Flap.

Plate 85: Cutaneous Trunci Myocutaneous Flap.

Plate 86: Latissimus Dorsi Muscle Flap.

Plate 87: External Abdominal Oblique Muscle Flap.

Plate 88: Caudal Sartorius Muscle Flap.

Plate 89: Cran

Michael M. Pavletic, DVM, Diplomate ACVS, is director of surgical services at Angell Animal Medical Center in Boston, Massachussetts.