STEPS TO IMPROVE WOUND HEALING AFTER ONCOLOGICAL SURGERY IN VETERINARY PATIENTS: TOWARDS A CASE SERIES AND QUALITATIVE VALIDATION

Abstract

Oncoplastic surgery (OPS) is a widely used approach to remove different types of tumors in veterinary patients. However, depending on the tissue site, OPS can be a difficult option, as the wound may not heal appropriately due to constant interruption by the patient, the tissue could lack elasticity and reconstructive flaps from the own patients are difficult to obtain. New protocols to improve wound healing in OPS are needed to minimize the use of flaps, reduce the time of regeneration and improve the recovery of tissue functionality. After 5 years of testing state-of-the-art surgical repairing techniques, a series of steps are suggested by Andrés Villagomez to improve OPS wound healing. A case-series of 50 patients were treated with this protocol, which on average decreased the time of granulation from 15 to 6 days. Primary wounds are treated with autologous activated platelet-rich plasma (PRP) in a gel form throughout the wound. Then, a 0.3% last generation dressing cellulose Suprasorb X® is placed to provide moisture or absorb excess exudate. Immediately after, a hydrocolloid dressing (Suprasorbe H®) is applied in the form of a self-adhesive sheet to generate a protective layer that simulates the effect of "synthetic skin". Next, a sterile gauze is placed, fixed on using a self-adhesive polyester bandage (Fixomull®). This bandage could be maintained without losing its action for up to 15 days (however, the granulation tissue has been observed in almost 90% in the first 7 days). The decision to extend the dressing time (PRP / Suprasorb X and H) depends on the quantity and quality of the granulation tissue. If a suitable granulation tissue is not obtained, the dressing should continue for 5 to 7 more days. If adequate granulation tissue is obtained, it is not recommended to maintain the bandage for more days, as this can cause hyper granulation. Once optimal granulation tissue has been formed, a new dressing is placed for 7 more days, based on zinc oxide (sterile gauze + zinc oxide) which is covered with the self-adhesive polyester bandage. The purpose of the last dressing is to stop the advancement of the granulation tissue and stimulate definitive healing. It is important to note that the dressing change will depend on each patient, and sudden flexion and extension movements should be avoided. The environment and pre-existing hormonal diseases could affect the success of the protocol and should be taken into consideration during its application.