1887

Special considerations in wound management

image of Special considerations in wound management
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Abstract

This chapter considers a number of specific types of wound that may require surgical management, such as pharyngeal stick injuries, chronic draining sinuses, bullet, burn and bite wounds. It also discusses the surgical management of some specific skin conditions such as skin fold pyoderma and perianal fistulas. Causes of sinus tracts include bacterial infection, penetrating foreign bodies (e.g. plant awns, wood splinters, insect mouth parts), bone sequestra, surgical implants (e.g. sutures, meshes, orthopaedic implants) and neoplasia. Sinus tracts can occur at many locations on the body, depending on the cause, its point of entry/location and any migratory path. The interdigital spaces, ear canals, oral mucosa, conjunctiva and nares are common points of entry. All sinus tracts should be thoroughly investigated and explored surgically to determine and eliminate (if possible) the cause. It is important to develop a systematic approach to the investigation of sinus tracts. If the cause is not eliminated, the problem will recur. Chronic sinus tracts can be extremely frustrating to manage for the patient, client and veterinary surgeon, as small fragments of foreign material can be elusive and repeated surgical intervention may be required. The chapter looks at Chronic draining sinus tracts; Oropharyngeal stick injuries; Perianal fistulation (anal furunculosis); Bite wounds; Burns management; Projectile injuries; Redundant skin folds and skin fold pyoderma (intertrigo); Footpad surgery; Mammary gland surgery; and Wound bed vascular augmentation using omentum. : Management of a shotgun injury to the face. : Anal sacculectomy; Episioplasty; Caudectomy; Fusion podoplasty; Phalangeal fillet (Digital pad transfer); Footpad grafts; and Mastectomy.

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Figures

Image of 11.2
11.2 Classification of dermoid sinuses.
Image of 11.3
11.3 Potential paths of pharyngeal stick injuries: from lateral wound; from dorsal wound.
Image of 11.4
11.4 Positive contrast oesophogram showing leakage of contrast from an oesophageal tear. (© Alison L. Moores)
Image of 11.5
11.5 Cervical oesophageal laceration due to a penetrating stick injury in a dog. The oesophageal stethoscope can be seen in the oesophageal lumen. The laceration has been repaired with full thickness appositional sutures. (© Alison L. Moores)
Image of 11.6
11.6 Perianal fistulas (anal furunculosis) in an 8-year-old German Shepherd Dog.
Image of 11.7
11.7 A 2-year-old Yorkshire Terrier with a chronic body wall wound secondary to bites sustained during an attack by a Rottweiler. Note the fractured ribs.
Image of 11.8
11.8 The area around cervical bite wounds has been clipped to allow thorough assessment.
Image of 11.10
11.10 Bite wounds to the neck of a young Dachshund resulted in severe laryngeal trauma. Following a ventral surgical approach, the endotracheal tube can be seen through a ventral defect in the larynx.
Image of 11.11
11.11 A 12-week-old kitten attacked by a Jack Russell Terrier has omentum protruding from an abdominal bite wound and has been clipped, prepared and draped for exploratory laparotomy.
Image of 11.12
11.12 Lateral and VD radiographs of a young male Labrador rescued from a house fire. Smoke inhalation had caused severe pulmonary oedema.
Image of 11.13
11.13 Extensive burn wounds on a Springer Spaniel. The burn covers much of the dog’s back. Following aggressive debridement and wound closure. (Courtesy of Dr Brad Coolman)
Image of 11.14
11.14 The dog in Figure 11.13 photographed 12 weeks after initial presentation. Note the extensive hairless scar tissue. There are still some areas of the wound where granulation tissue has not yet epithelialized. (Courtesy of Dr Brad Coolman)
Image of 11.15
11.15 Bullet fragments being removed from the frontal sinus of a cat. Closure of the wound following removal of the bullet fragments.
Image of 11.16
11.16 Cheiloplasty. The upper lip is retracted to expose the lower lip. Placing a gag between the canine teeth can be useful to aid exposure. A scalpel is used to make an elliptical incision and the infected material is excised. Healthy skin edges are apposed and sutured using a simple interrupted pattern.
Image of 11.17
11.17 Prominent dorsal skin fold over the vulva in a bitch with a history of recurrent urinary tract infections.
Image of 11.19
11.19 Chronic non-healing inguinal wound in a cat. An omental pedicle has been exteriorized from the abdomen and used to augment the wound bed. A caudal superficial epigastric axial pattern flap (see Chapter 7) has been rotated to cover the omentalized wound. Flap sutured in place. Healed wound 2 weeks after surgery and just prior to suture removal.
Image of On presentation the area of the right upper lip delineated by the sutures was cold and had a leathery feel. There was a large amount of scabbing with purulent exudates beneath it.
On presentation the area of the right upper lip delineated by the sutures was cold and had a leathery feel. There was a large amount of scabbing with purulent exudates beneath it. On presentation the area of the right upper lip delineated by the sutures was cold and had a leathery feel. There was a large amount of scabbing with purulent exudates beneath it.
Image of Note the devitalized flap of lip that is purple. A large fistula can be seen above the canine tooth, extending up into the nasal cavity.
Note the devitalized flap of lip that is purple. A large fistula can be seen above the canine tooth, extending up into the nasal cavity. Note the devitalized flap of lip that is purple. A large fistula can be seen above the canine tooth, extending up into the nasal cavity.
Image of CT scan, showing numerous shotgun pellets.
CT scan, showing numerous shotgun pellets. CT scan, showing numerous shotgun pellets.
Image of Note the multiple puncture wounds caused by the shotgun pellets.
Note the multiple puncture wounds caused by the shotgun pellets. Note the multiple puncture wounds caused by the shotgun pellets.
Image of A tie-over bandage technique was used to hold the wet-to-dry dressing in place.
A tie-over bandage technique was used to hold the wet-to-dry dressing in place. A tie-over bandage technique was used to hold the wet-to-dry dressing in place.
Image of Day 6.
Day 6. Day 6.
Image of Day 11.
Day 11. Day 11.
Image of Day 14.
Day 14. Day 14.
Image of Lip flap raised.
Lip flap raised. Lip flap raised.
Image of Immediately postoperatively.
Immediately postoperatively. Immediately postoperatively.
Image of The dehisced flap has been repaired.
The dehisced flap has been repaired. The dehisced flap has been repaired.
Image of The dog 4 weeks after surgery.
The dog 4 weeks after surgery. The dog 4 weeks after surgery.
Image of Probe in anal sac.
Probe in anal sac. Probe in anal sac.
Image of Incising on to the probe.
Incising on to the probe. Incising on to the probe.
Image of Anal sac removal.
Anal sac removal. Anal sac removal.
Image of Closing the defect.
Closing the defect. Closing the defect.
Image of Two concentric crescent-shaped incisions (arrowed).
Two concentric crescent-shaped incisions (arrowed). Two concentric crescent-shaped incisions (arrowed).
Image of Closure of the primary wound without tension.
Closure of the primary wound without tension. Closure of the primary wound without tension.
Image of Teardrop-shaped incision around the tailbase.
Teardrop-shaped incision around the tailbase. Teardrop-shaped incision around the tailbase.
Image of Excising interdigital web skin.
Excising interdigital web skin. Excising interdigital web skin.
Image of Dissecting the footpad.
Dissecting the footpad. Dissecting the footpad.
Image of Suturing the footpads and dorsal skin strips.
Suturing the footpads and dorsal skin strips. Suturing the footpads and dorsal skin strips.
Image of Ventral aspect of the paw, showing a large defect in the metacarpal or metatarsal pad. A ventral midline incision has been made to allow access to the phalangeal bones. The neurovascular pedicle should be identified and preserved.
Ventral aspect of the paw, showing a large defect in the metacarpal or metatarsal pad. A ventral midline incision has been made to allow access to the phalangeal bones. The neurovascular pedicle should be identified and preserved. Ventral aspect of the paw, showing a large defect in the metacarpal or metatarsal pad. A ventral midline incision has been made to allow access to the phalangeal bones. The neurovascular pedicle should be identified and preserved.
Image of A circumferential incision is made around the base of the nail to allow it to be removed with the bones of the phalanx.
A circumferential incision is made around the base of the nail to allow it to be removed with the bones of the phalanx. A circumferential incision is made around the base of the nail to allow it to be removed with the bones of the phalanx.
Image of Digital pad sutured in place.
Digital pad sutured in place. Digital pad sutured in place.
Image of Harvesting rectangular footpad grafts.
Harvesting rectangular footpad grafts. Harvesting rectangular footpad grafts.
Image of Suture material passed through the graft.
Suture material passed through the graft. Suture material passed through the graft.
Image of Grafts secured in the granulation bed.
Grafts secured in the granulation bed. Grafts secured in the granulation bed.
Image of Midline incision is continued in an elliptical fashion around the glands to be excised.
Midline incision is continued in an elliptical fashion around the glands to be excised. Midline incision is continued in an elliptical fashion around the glands to be excised.
Image of The cranial border of the wound is elevated and dissection continued along the abdominal fascia. The caudal superficial epigastric artery and vein are ligated as close to the inguinal ring as possible.
The cranial border of the wound is elevated and dissection continued along the abdominal fascia. The caudal superficial epigastric artery and vein are ligated as close to the inguinal ring as possible. The cranial border of the wound is elevated and dissection continued along the abdominal fascia. The caudal superficial epigastric artery and vein are ligated as close to the inguinal ring as possible.
Image of Wound edges are apposed in the middle of the wound using a combination of walking and subcuticular sutures.
Wound edges are apposed in the middle of the wound using a combination of walking and subcuticular sutures. Wound edges are apposed in the middle of the wound using a combination of walking and subcuticular sutures.
Image of Wound edges sutured with an appositional pattern.
Wound edges sutured with an appositional pattern. Wound edges sutured with an appositional pattern.

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