Presenter: Aylin Atilla VMD, MS, DACVS-SA, Assistant Professor at the University of Calgary
A dog with several lacerations to its pads was recently treated at our practice and unfortunately turned out to be a case demonstrating how wound management can be as frustrating as it is satisfying. These wounds were sutured and dressed and to my satisfaction started to heal extremely well. The decision was made to leave the dressing off and allow the owner to place a sock over the wounds which was to be secured with vet wrap. Frustratingly the owner decided to ignore this advice and tied a plastic bag rather too tightly around the sock causing pressure necrosis over the cranial aspect of the hock. This resulted in a large open wound which was impossible to suture and we now hope will heal by secondary intention.
What, however, do we do if this wound does not heal? Last week’s veterinary webinar organised by ‘The Webinar Vet’ helps to answer this question with Aylin Atilla discussing the use of local subdermal plexus flaps. These are the simplest solution to non-healing wounds and although the skin used does not have a direct cutaneous artery, it’s vascular supply is provided by the local subdermal plexus. This means subdermal plexus flaps can be performed anywhere on the body as along as some basic rules are observed. One of these rules is ensuring the length to width ratio of the flap is kept to 2:1 in order to maintain a viable vascular supply. Anything greater than 3:1 is likely to necrose. Aylin also recommends only applying sutures to the margin of the skin flap and not the middle as this could compromise blood supply.
The various techniques used to perform local subdermal plexus flaps were discussed in detail by Aylin who gave a number of case examples to demonstrate each technique from the simple H Plasty to the more complex rotational flap and Z Plasty. For perhaps the braver amongst us and for those who continue to be amazed by the healing properties of the body, Aylin discussed the ‘Pouch’ flap particularly useful for defects across the distal limb. A pouch is created in the skin of the body wall 1-2cms wider than the defect and the leg is lifted into the pouch so the limb defect is covered. The skin edges are then sutured to the limb defect and the leg is bandaged to the body wall. The dressings are changed daily and after two weeks the base of the flap is incised so it remains attached to the defect of the distal limb. The wound on the body wall can then be easily sutured together.
Aylin advises that prior to performing a ‘Pouch’ flap, always ensure the dog tolerates the limb being bandaged to the body wall which should always be tested prior to the surgery. Owners should also be warned the direction and colour of the fur may be different on the defect compared to the rest of the limb.
Aylin supported her veterinary webinar with some excellent case examples of all the techniques discussed which were an inspiration, a comfort and a great source of reference for the next time a large wound emerges either via the joys of excising a large mass or through an overzealous owner using a plastic bag to hold on a sock.
The Stethoscope (MRCVS)