Author

Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, March 20, 2014

Case outcome: Punch skin grafts help Toro make a full recovery from his severe burn injuries!

Outcome on Toro:

Burns in dogs and cats are classified as either full or partial skin thickness. This classification system is different than the 1st degree, 2nd degree, and 3rd degree scheme used in people. The blood supply to the skin is dogs and cats is different than in humans. Dog and cat skin does not blister as in people, hence the need for a different classification system for burn injury. Toro’s burns were a combination of both partial and full thickness.

Our initial therapy consisted of supportive care with analgesics, antibiotics, and wound management. The wounds were clipped, cleaned, lavaged with sterile saline, and surgically debrided where necessary. Wet to dry tie-over bandages were placed over all wounds including along his back and down the right thigh. The bandages were changed daily under general anesthesia.
 
Wet to dry tie-over bandages being applied to Toro. 
Completed tie-over bandage on Toro
The wound progressed well and good granulation beds developed in all areas. 
Appearance of wounds 4 days after admission; daily wet to dry
bandages had been applied under general anesthesia.
Four days after admission, punch skin grafts were performed on the granulated areas to encourage epithelializatization. Non-adherent tie-over dressings were used over the wounds after grafting to prevent dislodgement of the skin punches.
Punch skin grafts are being harvested from adjacent skin and applied
to several areas of the granulation tissue.
Appearance of Toro's wounds immediately after punch
skin grafting procedure performed.
6 days after punch grafting was performed.
9 days after punch grafting performed. Note multiple rounds areas
of epithelium forming at the site of each graft. 
Toro was discharged 15 days after admission to the hospital. Oral analgesics were prescribed and further bandage changes performed by the referring veterinarian. A recheck exam was done on Toro 18 days after admission. His bandages were removed and topical silver sulfadiazine cream was prescribed for topical treatment of his remaining wounds.
15 days after admission. Toro was discharged from the hospital
Two months later Toro came back to OSU for a recheck. His wounds were almost completely healed and he was doing well. Toro’s aggressive personality remained, however.
 
Here is Toro 2 months after initial treatment at Ohio State.
Toro's left side.
Close up of the epithelialized and contracted wounds over the right flank.
The remaining small granulated wounds gradually healed over the next several days.
Punch Skin Grafts

Punch grafts are a practical form of free skin grafts that are easy to perform and require no special instrumentation. If performed properly and skin punches are placed in healthy granulation tissue they usually take very well. However, since little to no hair growth occurs punch grafts do not provide a high degree of cosmetic benefit.  In Toro our goal was to accelerate epithelial coverage of the large areas of granulation tissue.

For more information on skin grafts, see: Birchard SJ, Smeak DD. Selected skin graft and reconstructive techniques. In: Saunders Manual of Small Animal Practice. 3rd edition, Birchard and Sherding, eds., Elsevier, St. Louis, 2006. Pg 557.

Thank you for participating in the story of Toro! I'll be happy to answer any questions you have about Toro either here or on facebook.