Veterinary Wound Healing Association 5th Congress, Hannover, Germany. May 10-12 2001
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| TECHNIQUES FOR MANAGING LARGE WOUNDS ON THE TRUNK Steven F. Swaim, D.V.M., M.S. Professor - Small Animal Surgery Director - Would Healing/Reconstructive Surgery Program Scott-Ritchey Research Center and Dept. of Clinical Sciences College of Veterinary Medicine Auburn University, AL, U.S.A. Veterinary practitioners often encounter large open wounds on the trunk of a dog or cat. Occasionally, the loss of tissue may appear to be so large that it seems there is not enough tissue to allow reconstruction. However, by taking advantage of the abundance of skin on the animal’s trunk, the skin’s vascular anatomy, the wound healing process, and some special techniques, such wounds can be closed. "WALKING" SUTURES The skin around a wound is undermined, preserving blood supply via the direct cutaneous vessels. The skin is undermined deep to the cutaneous trunci muscle. After undermining, 2-0 to 3-0 absorbable suture material is used to place "walking" sutures. Starting at the juncture of undermined skin with underlying tissues, the suture needle is passed into the deep area of the dermis as the first bite. The second bite is taken toward the center of the wound. As the suture is tied, the skin is stretched toward the center of the wound. Other sutures are placed in line with this suture, basically, parallel to the long axis of the wound to form the first row of walking sutures. Second and third rows are placed in like manner to gradually advance the skin over one side of the wound. The same procedure is repeated on the opposite side of the wound. After "walking" sutures have been placed, and the wound edges are almost in contact with each other, the 2-0 or 3-0 absorbable suture material is used to place a continuous subcuticular suture to appose the wound edges. Final skin apposition is with 2-0 or 3-0 nonabsorbable simple interrupted sutures or staples. "Walking" sutures close dead space, advance the skin over the wound and distribute tension around the wound without concentrating it at the wound edge. These provide enhanced healing of large wound of the trunk. There are combinations of "walking" suture techniques. These include "walking" sutures and open wound healing, double "walking" sutures and "walking" sutures with "dog ear" grafts. SKIN EXPANDERS Another technique for stretching skin to cover trunk wounds is to super glue velcro patches around the periphery of the wound and stretch elastic bands that have the other portion of velcro on them between patches on opposite sides of the wound. The elastic bands apply centripetal tension to the skin to stretch it, and they hold a bandage over the wound. The elastic bands are tightened daily for about 3 days. At 3 days, the stretched skin is sutured over the wound. Return to index of Abstracts | About the VWHA |