Principles of reconstructive surgery for the tumor patient

Abstract

Small animal oncologic surgery is a relatively new and rapidly expanding field of veterinary science. Many exciting and innovative techniques for surgical resection of invasive tumors have been developed and published in the last decade. Paralleling these developments have been major advancements in the frontiers of reconstructive options to close the defects after major ablative surgery. A more thorough understanding of the biologic behavior of tumors in our patients has permitted us to rationally approach selected patients with high doses of surgery with curative intent, palliation, or as part of a multimodality treatment plan. Invasive oncologic procedures require thorough preoperative planning and staging to accomplish the goal of tumor-free margins. Patient factors, specifically tumor type, grade, anatomic location, and extent of local invasion, will subsequently dictate the appropriate resection and reconstructive options available. Resection of the tumor with a wide margin of normal tissue is the surgeon's primary objective. The reconstructive phase of the surgery endeavors to restore functional and cosmetic integrity to the regional anatomy. Each resection and reconstruction procedure must be customized for the patient's disease. Thoughtful preoperative planning, timing, and intraoperative flexibility to unforeseen circumstances will minimize complications. Armed with a number of reconstructive options for each case, the surgeon develops intraoperative flexibility and latitude to be more aggressive during the primary resection. If the surgeon self-imposes limitations on the aggressive removal of the primary tumor by virtue of tissue closure concerns, the completeness of resection and patient survival may well be jeopardized. As familiarity and experience with different reconstructive options increases, the surgeon will have greater confidence in removing large volumes of diseased tissue.