Case: Skin flap to close a chronic wound
24th March 2016
Mist had a locally aggressive tumour – a spindle cell sarcoma – succesfully removed with good margins by a local practice. The surgical wound unfortunately broke down. The resulting wound was large but this was NOT a disaster – a disaster would have been a neatly closed wound with residual tumour left behind by the surgeon.
Mist was then referred to us, initially by way of photos emailed across. Ugly though the wound was, this was a glitch, not a major surgical problem. Complicating fractures were that the owner had an external fixator on their own leg because of a fracture, and Mist was something of a handful! There wasn’t an ounce of aggression in this dog, but “still” was a concept she struggled with.
We asked that the surgical site be left alone until the pathology report had confirmed that the tumour had been successfully been removed with margins, and for three weeks post-op while the blood supply around it consolidated and while the wound “granulated” making it more resistant to infection.
Mist was then transported across to us by pet ambulance and we created a flap from her right inguinal fold, the flap of skin naturally present in her groin. A slim drain was placed to deal with any fluid accumulation under the flap. This needed careful placement to avoid interfering with the blood supply to the flap.
The flap covered the wound satisfactorily. In view of Mist’s propensity to jump around and to eat sutures and dressings, we placed some reinforcing stent sutures, an Elizabethan collar, an inflatable collar, and gave her light sedation. We asked our friends at Pool House Hospital in Burton on Trent to have her for three weeks post-op until the wound was secure and the owner could manage her at home.