Atlas of small animal wound management and reconstructive surgery

860 Pages·2018·86 MB·English

by  Pavletic

Atlas of
Small Animal Wound
Management and
Reconstructive
Surgery
Fourth Edition
Dedication
This book is dedicated to my wife, Adria; my daughters Afton and Maylin;
my late parents Merle and Gerry; my mother‐in‐law Mary and late father‐in‐law Frank;
my brothers Frank and Jeff; my sister‐in‐law Eileen; and brothers-in-law Mark and
Briant for their love, help, encouragement, and support during my career.
Atlas of
Small Animal Wound
Management and
Reconstructive Surgery
Fourth Edition
Michael M. Pavletic DVM
Diplomate American College of Veterinary Surgeons
Director of Surgical Services
Angell Animal Medical Center
Boston, Massachusetts, USA
This edition first published 2018 © 2018 John Wiley & Sons, Inc.
Edition History
W.B. Saunders Company (1e, 1993; 2e, 1999); John Wiley & Sons, Inc. (3e, 2010)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to
reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Michael M. Pavletic to be identified as the author of this work has been asserted in accordance with law.
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Library of Congress Cataloging‐in‐Publication Data
Names: Pavletic, Michael M., author.
Title: Atlas of small animal wound management and reconstructive surgery / Michael M. Pavletic.
Description: Fourth edition. | Hoboken, NJ : Wiley, 2018. | Includes bibliographical references and index. |
Identifiers: LCCN 2017058950 (print) | LCCN 2017060302 (ebook) | ISBN 9781119267515 (pdf) |
ISBN 9781119267522 (epub) | ISBN 9781119267508 (cloth)
Subjects: | MESH: Dogs–surgery | Cats–surgery | Animals, Domestic–surgery | Reconstructive Surgical
Procedures–veterinary | Surgical Flaps–veterinary | Wounds and Injuries–veterinary | Atlases
Classification: LCC SF991 (ebook) | LCC SF991 (print) | NLM SF 991 | DDC 636.7/089795–dc23
LC record available at https://lccn.loc.gov/2017058950
Cover images: courtesy of Michael Pavletic
Cover design by Wiley
Set in 9.5/12pt Palatino by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
Contents
Foreword xi Basic Wound Management in Six Simple
Preface xii Steps 44
Acknowledgments xiii Exposed Bone: Osteostixis 49
About the Companion Website xiv Acute Versus Chronic Wounds 50
1. The Skin 1 4. Topical Wound Care Products and Their Use 53
Skin Function 2 Wound Exudate 54
Skin Structure 2 Wound Drainage Systems 54
Cutaneous Adnexa 5 Negative Pressure Wound Therapy (NPWT) 60
The Hypodermis 8 Concept of Moist Wound Healing (MWH) 67
Cutaneous Circulation 8 Topical Wound Care Products 69
Pinna: Cutaneous Considerations 10 The Maggot and Leach in Wound Care 79
Congenital Skin Disorders 10 Common Topical Antiseptic and Cleansing
Agents 81
Alternative Forms of Wound Therapy 85
2. Basic Principles of Wound Healing 17
Concluding Remarks 89
Introduction 18 Plate 1: Vacuum‐Assisted Closure 92
Wound Healing 18
Acute Versus Chronic Open Wounds 29
5. Dressings, Bandages, External Support,
Species Variations in Wound Healing 29
and Protective Devices 95
“Artificial Skin” 30
Introduction 96
Dressings: The Primary Layer 96
3. Basic Principles of Wound Management 33 Dressings: The Secondary Layer 111
Introduction 34 Dressings: The Tertiary Layer 112
Patient Presentation 34 Preventing Bandage Displacement 113
Mechanisms of Injury and Wound Tie‐Over Dressing/Bandage Technique 114
Terminology 34 Pressure Points: Bandage Options 115
Wound Classification 35 Bandage “Access Windows” 115
Options for Wound Closure 37 Bandaging Techniques for Skin Grafts 115
“Pointers” in Selecting the Proper Closure Bandaging Techniques for Skin Flaps 115
Technique 43 Splints, Casts, Reinforced Bandages 115
v
vi Contents
Miscellaneous Protective Devices 116 Brown Recluse Spider Bites 240
Plate 2: Basic Bandage Application for Porcupine Quills 240
Extremities 124 Lower Extremity Shearing
Plate 3: Tape Stirrups and Padding Dos and Wounds 243
Don’ts 126 Plate 10: Pipe Insulation Protective Device:
Plate 4: Elasticon Bandage Platforms and Elbow 248
Saddles 128 Plate 11: Pipe Insulation to Protect the Great
Plate 5: Spica Bandages/Splints 130 Trochanter 250
Plate 6: Schroeder‐Thomas Splint 132 Plate 12: Vacuum Drain Management of Elbow
Plate 7: Schroeder‐Thomas Splint: Security Band Hygromas 252
Application 136
Plate 8: Body Brace 138 8. Regional Considerations 255
Plate 9: Tape Hobbles for the Rear
The Canine and Feline Profiles 256
Extremities 140
Plates 13A and 13B: Surgical Technique
Menu 258
6. Common Complications in Wound Healing 143
Improper Nutritional Support 144
9. Tension‐Relieving Techniques 265
Medications and Their Influence on
Introduction 266
Healing 145
Skin Tension in the Dog and Cat 266
Hypovolemia and Anemia 146
Plate 14: Tension Lines 282
The Nonhealing Wound: General
Plate 15: Effects of Skin Tension on Wound
Considerations 146
Closure 284
Failure to Heal by Second Intention 147
Plate 16: Patient Positioning Techniques 286
Scarring and Wound Contracture 152
Plate 17: Undermining Skin 288
Infection and Biofilm Formation 154
Plate 18: Geometric Patterns to Facilitate Wound
Draining Tracts 158
Closure 290
Use of Tourniquets for Lower Extremity
Plate 19: V‐Y Plasty 292
Procedures 165
Plate 20: Z‐Plasty (Option I) 294
Seromas 166
Plate 21: Z‐Plasty (Option II) 296
Hematomas 167
Plate 22: Multiple Z‐Plasties 298
Exposed Bone 167
Plate 23: Relaxing/Release
Wound Dehiscence 169
Incisions 300
Plate 24: The “Hidden” Intradermal Release/
7. Management of Specific Wounds 173
Relaxing Incision 302
Bite Wounds 174 Plate 25: Multiple Release Incisions for
Burns 183 Extremity Wounds 304
Inhalation Injuries 195 Plate 26: Suture Options to Alter Skin Traction and
Chemical Burns 196 Retraction 306
Electrical Injuries 197 Plate 27: Walking Suture Technique 308
Radiation Injuries 201 Plate 28: Skin Stretchers to Offset Incisional
Frostbite 204 Tension 310
Projectile Injuries 205 Plate 29: “Tension” Suture Patterns 312
Explosive Munitions: Ballistic, Blast, Plate 30: Retention Sutures 314
and Thermal Injuries 227 Plate 31: Stent 316
Impalement Injuries 227 Plate 32: Skin “Directing” for Maximum
Pressure Ulcers 228 Coverage 318
Hygroma 234 Plate 33: Relaxing Incision to Reduce Flap
Snakebite 239 Tension 320
Contents vii
10. Skin‐Stretching Techniques 323 Options to Extend the Length of Axial Pattern
Physiology of Skin Stretching 324 Flaps 427
Presuturing 324 Plate 53: Four Major Axial Pattern Flaps of the
Load Cycling 324 Canine Trunk 430
Skin Stretchers 326 Plate 54: Skin Position and Axial Pattern Flap
Skin Expanders 335 Development 432
Plate 34: Presuturing Technique 338 Plate 55: Omocervical Axial Pattern Flap 434
Plate 35: Application of Skin Stretchers 340 Plate 56: Thoracodorsal Axial Pattern Flap 436
Plate 36: Skin Stretchers to Enhance Length of
Plate 57: Lateral Thoracic Axial Pattern Flap 438
Axial Pattern Flaps 342
Plate 58: Superficial Brachial Axial
Plate 37: Skin Stretcher Substitution for
Pattern Flap 440
Presuturing 344
Plate 59: Caudal Superficial Epigastric
Plate 38: Skin Expanders 346
Axial Pattern Flap 442
Plate 60: Cranial Superficial Epigastric
11. Local Flaps 351
Axial Pattern Flap 444
Introduction 352 Plate 61: Deep Circumflex Iliac Axial
Advancement Flaps 353 Pattern Flap: Dorsal Branch 446
Rotating (Pivoting) Flaps 356 Plate 62: Deep Circumflex Iliac Axial Pattern
Plate 39: Single Pedicle Advancement Flap 370 Flap: Ventral Branch 448
Plate 40: Bipedicle Advancement Flap 372 Plate 63: Flank Fold Flap: Hind Limb 450
Plate 41: Transposition Flap (90 degrees) 374 Plate 64: Genicular Axial Pattern Flap 452
Plate 42: Transposition Flap (45 degrees) 378 Plate 65: Reverse Saphenous Conduit Flap 454
Plate 43: Transposition Flap (Oblique Plate 66: Caudal Auricular Axial Pattern
Angle) 380 Flap 456
Plate 44: Local Facial Flap Options vs. Auricular Plate 67: Superficial Temporal Axial
Axial Pattern Flap 382 Pattern Flap 458
Plate 45: Transposition Flaps in Partial Wound Plate 68: Lateral Caudal (Tail) Axial
Closure 384 Pattern Flap 460
Plate 46: Interpolation Flap 386
Plate 47: Rotation Flap 390
Plate 48: Forelimb Fold Flap 392 14. Free Grafts 463
Free Skin Grafts 464
Classification of Free Grafts 465
12. Distant Flap Techniques 395
Graft Thickness 465
Distant Flaps 396
Partial‐Coverage Grafts 466
Direct Flaps 396
Dermatomes 467
Indirect Flaps 396
Preservation by Refrigeration 467
The Delay Phenomenon 400
Intraoperative Considerations 472
Plate 49: Direct Flap: Single Pedicle (Hinge)
Bandaging Technique for Skin Grafts 472
Flap 402
Use of Plates 473
Plate 50: Direct Flap Closure of Knee Defect 406
Plate 69: Punch Grafts 476
Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408
Plate 70: Pinch Grafts 478
Plate 52: Indirect Flap: Delayed Tube Flap 414
Plate 71: Strip Grafts 480
Plate 72: Stamp Grafts 482
13. Axial Pattern Skin Flaps 417
Plate 73: Sheet Grafts 484
Introduction: Axial Pattern Flaps 418 Plate 74: Dermatome: Split‐Thickness Skin Graft
Island Arterial Flaps 418 Harvesting 486
Reverse Saphenous Conduit Flaps 421 Plate 75: Mesh Grafts (With Expansion Units) 488
Secondary Axial Pattern Flaps 421 Plate 76: Mesh Grafts (With Scalpel Blades) 490
viii Contents
15. Facial Reconstruction 493 Plate 103: Temporalis Muscle Flap 584
Introduction: Facial Reconstructive Surgery 494 Plate 104: Transversus Abdominis Muscle
Plate 77: Repair of Upper Lip Avulsion 515 Flap 586
Plate 78: Repair of Lower Labial Avulsion 516 Plate 105: Semitendinosus Muscle and
Plate 79: Wedge Resection Technique 518 Myocutaneous Flaps 588
Plate 80: Rectangular Resection Technique 520 Plate 106: Flexor Carpi Ulnaris Muscle Flap 590
Plate 81: Full‐Thickness Labial Advancement Plate 107: Cranial Tibial Muscle Flap 592
Technique (Upper Lip) 522 Plate 108: Internal Obturator Muscle Flap 594
Plate 82: Full‐Thickness Labial Advancement Plate 109: Superficial Gluteal Flap for Perineal
Technique (Lower Lip) 524 Hernia Closure 596
Plate 83: Buccal Rotation Technique 526
Plate 84: Lower Labial Lift‐Up Technique 528
17. Oral Reconstructive Surgical Techniques 599
Plate 85: Upper Labial Pull‐Down
Introduction 600
Technique 530
Cleft Palate 601
Plate 86: Labial/Buccal Reconstruction with
Palatal Defects/Oronasal Fistulas 602
Inverse Tubed Skin Flap 532
Plate 110: Mucosal Flaps 606
Plate 87: Skin Flap for Upper Labial and Buccal
Plate 111: Palatoplasty: Bipedicle Advancement
Replacement (Facial [Angularis Oris] Axial
Technique 608
Pattern Flap) 536
Plate 112: Cleft Palate Repair: Mucoperiosteal
Plate 88: Feline Facial Axial Pattern Flap 538
Flap Technique 612
Plate 89: Cleft Lip Repair (Primary Cleft,
Plate 113: Palatine Mucosal Flap 614
Cheiloschisis, Harelip) 540
Plate 114: Soft Palate/Pharyngeal Mucosal
Plate 90: Unilateral Rostral Labial Pivot
Flaps 616
Flaps 542
Plate 115: Full‐Thickness Labial Flap Closure of
Plate 91: Bilateral Rostral Labial Pivot Flaps 544
Oronasal Fistulas 618
Plate 92: Oral Commissure Advancement
Plate 116: Cartilage Grafts for Palatal Fistulas 620
Technique 546
Plate 117: Angularis Oris Mucosal Flap 622
Plate 93: Brachycephalic Facial Fold
Correction 548
Plate 94: Cheilopexy Technique for 18. Foot Pad Reconstruction 625
Drooling 550 Introduction 626
Pad Laceration and Lesion Excision 626
16. Myocutaneous Flaps and Muscle Flaps 553 Digital Pad Transfer 631
Introduction 554 Metacarpal/Metatarsal Pad Transfer 632
Myocutaneous Flaps 554 Accessory Carpal Pad 632
Muscle Flaps 554 Pad Grafting 634
Plate 95: Latissimus Dorsi Myocutaneous Digital Flaps for Wound Closure 634
Flap 568 Fusion Podoplasty 634
Plate 96: Cutaneous Trunci Myocutaneous Plate 118: Digital Flap Technique: Major Digital/
Flap 570 Interdigital Defects 642
Plate 97: Latissimus Dorsi Muscle Flap 572 Plate 119: Digital Flap Technique: Major Defects
Plate 98: Latissimus Dorsi Bipedicle of Digits Two or Five 644
Muscle Flap 574 Plate 120: Digital Pad Transfer 646
Plate 99: Triceps Replacement with Latissimus Plate 121: Metatarsal/Metacarpal Pad
Dorsi Muscle 576 Transfer 648
Plate 100: External Abdominal Oblique Plate 122: Pad Grafting 650
Muscle Flap 578 Plate 123: Segmental Pad Grafting
Plate 101: Caudal Sartorius Muscle Flap 580 Technique 652
Plate 102: Cranial Sartorius Muscle Flap 582 Plate 124: Fusion Podoplasty 654
Contents ix
19. Major Eyelid Reconstruction 657 Surgical Techniques 742
Introduction 658 Plate 143: Preputial Ostium Enlargement 756
The Eyelids 658 Plate 144: Preputial Ostium Reduction 758
Plate 125: Skin Flap Options for Cutaneous Plate 145: Preputial Advancement
Defects of the Eyelid Regions 660 Technique 760
Plate 126: Lip‐to‐Lid Procedure 662 Plate 146: Phallopexy 764
Plate 127: Oral Mucosal Graft onto Plate 147: Urethral Reconstruction for
Skin Flap 666 Subanal Hypospadias 766
Plate 128: Third Eyelid–Skin Flap Reconstruction Plate 148: Preputial Urethrostomy
of the Lower Eyelid 668 Technique 768
Plate 149: Urine Diversion Technique 770
20. Nasal Reconstruction Techniques 671
23. Pinnal Reconstructive Surgery 773
Introduction: Nasal Anatomy 672
Traumatic Wound Management 672 Introduction 774
Neoplasia 673 Anatomy of the Pinna 774
Neoplasms and Surgical Margins 673 Surgical Conditions 779
Nasal Reconstruction Options 673 Wound Management and Reconstructive
Options for Managing Nasal Stenosis 682 Surgical Techniques 780
Plate 129: Septal Coverage Using Cutaneous Aural Hematoma Management Options 786
Advancement Flaps 692 Plate 150: Skin Advancement Closure: Rostral
Plate 130: Bilateral Sulcus Flap Technique 694 Pinnal Base 796
Plate 131: Septal Resection Technique 696 Plate 151: Skin Advancement Closure: Caudal
Pinnal Base 798
Plate 132: Dorsal Nasal Splitting Technique to
Plate 152: Transposition Flap Technique for
Enhance Exposure of Septum 698
Smaller Medial Pinnal Defects 800
Plate 133: Alar Fold Flaps 700
Plate 153: Transposition Flap Technique for
Plate 134: Musculofascial Island Labial Flap 702
Minor Lateral Pinnal Defects 802
Plate 135: Labial Mucosal Inversion
Plate 154: Large Transposition Flap Closure
Technique 706
After Major Medial Pinnal Resection 804
Plate 136: Nasal Reconstruction with the “Lip‐to‐
Plate 155: Transposition Flap for Major
Lid Technique” Variation 708
Lateral Pinnal Defects 806
Plate 137: Oral Mucosal Graft with Nasal
Plate 156: Direct Flap Reconstruction of
Stenting 710
the Pinna 808
Plate 138: Intranasal Septal Window
Plate 157: Resection of the Terminal Third of
Technique 712
the Pinna 810
Plate 139: Cantilever Suture Technique 714
Plate 158: Inverted “Triangle” Resection of
the Central Third of the Pinna 812
21. Cosmetic Closure Techniques 719
Plate 159: Incisional Drainage of Aural
Cosmetic Considerations 720 Hematomas 814
Causes of Scars 720 Plate 160: Bandaging the Pinna 816
Minimization of Scarring 720 Plate 161: Vacuum Drain Management of Aural
Dog Ears 722 Hematomas 818
Plate 140: Scar Concealment 724
Plate 141: W‐Plasty 726 24. Miscellaneous Reconstructive Surgical
Plate 142: Dog Ear: Surgical Correction 728 Techniques 821
Omentum 822
22. Preputial Reconstructive Surgery 731 Scrotum 822
Introduction 732 Tail Fold Intertrigo (Screw Tail) 823
Surgical Conditions 732 Disorders of the Vulva 827