Fig. 1: Ginger |
Physical examination of Ginger was normal except for a large (8cm diameter) open wound over the right elbow that appeared to be a decubital ulcer. (Fig. 2)
Fig. 2: The non-healing chronic open wound over the right elbow on Ginger |
A fine needle aspirate of the peripheral scar tissue was performed to rule out neoplasia and the cytology results indicated chronic inflammation. Routine preoperative CBC and serum chemistry profile were normal. The plan was to anesthetize Ginger, perform an extensive surgical debridement of the fibrotic peripheral tissues, and reconstruct the skin using an axial pattern skin flap.
Ginger was anesthetized and the right elbow and surrounding skin clipped and prepared for aseptic surgery. The donut shaped abnormal scar tissue was removed using blunt and sharp dissection. (Fig. 3)
Fig. 3: The right elbow of Ginger immediately after surgical debridement of the chronic wound. |
One week after the surgical debridement Ginger was re-admitted to the hospital for the skin flap procedure. Ginger was placed under general anesthesia and a thoracodorsal axial pattern skin flap was performed to reconstruct the elbow decubitalulcer. (Fig. 4)
(for more information see: axial pattern skin flaps)
Complete coverage of the wound was achieved with the skin flap. A spica bandage was placed over the leg and thorax to protect the incisions and Ginger was recovered from anesthesia.
The following day Ginger’s bandage was changed and she was discharged from the hospital. Bandage changes occurred every 2-3 days until the incisions were healed and staples removed. (Fig. 5)
Fig. 5: Appearance of the surgical incisions on Ginger 10 days postoperatively. |
Fig. 6: Appearance of Ginger's right elbow area 5 months after reconstruction. |
Several aspects of the postoperative care are key to the success of this procedure. A well-padded bandage to protect and cushion the skin flap is mandatory for at least 10-14 days postoperatively. Exercise restriction is also important along with frequent postoperative rechecks to monitor for flap survival and healing.
One clinical study of 10 dogs having thoracodorsal axial pattern flaps found complications to be common but good functional and cosmetic outcome resulted in 6 of 7 dogs long term follow up. (1)
References
1. Aper R, Smeak, D: Complications and Outcome After Thoracodorsal Axial Pattern Flap Reconstruction of Forelimb Skin Defects in 10 Dogs, 1989–2001 32:4, 2003, Pages 378-384.
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