Tension-relieving techniques and local skin flaps

Abstract

Most skin defects seen in small animal patients are created either by traumatic injury or by surgical resection of a diseased area of tissue. In cats and dogs the elasticity of skin, along with the frequent presence of adjacent loose skin in many areas of the body, allows the primary closure of many wounds. However, techniques to reduce tension or to harvest skin from adjacent areas can help, in some cases, to produce a tension-free closure that is less likely to result in wound-healing complications. A working knowledge of such techniques is essential, as their required use cannot always be predicted preoperatively. In situations where primary closure was anticipated but cannot be achieved due to unforeseen circumstances, these techniques can become invaluable. Many of the techniques described in this chapter are very simple and will often be used in combination during wound reconstruction. The chapter considers Blood supply to the skin; Skin tension; Techniques to overcome skin tension; and Complications of skin flaps. Case examples: Hemimaxillectomy and transposition flap for a maxillary mass; Axillary flaps after excision of a thoracic mass. Operative techniques: Walking sutures; Skin stretching; V-Y plasty; Z-plasty; Single pedicle advancement flap; Bipedicle advancement flap; Rotation flap; Transposition flap; Axillary fold flap; Inguinal fold flap