Cirurgia Geral e Ortopédica

Atlas of Small Animal Wound Management and Reconstructive Surgery, 4th Edition

De: Michael M. Pavletic (Editor)
ISBN: 9781119267508
2018, Wiley
Capa dura
Páginas: 880

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  • A one-stop reference for the surgical treatment of wounds in small animal patients

    Wound management and reconstructive surgery are among the most challenging and innovative subspecialties of veterinary surgery for the management of traumatic injuries and neoplastic conditions commonly encountered in small animals. Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition presents detailed procedures for surgical reconstruction and essential information on the principles of wound healing and wound management for dogs and cats. Coverage encompasses the pathophysiology and management of the wide variety of wounds encountered in small animal practice and the most current reconstructive techniques for closing the most challenging defects.

    This updated edition is presented with additional full color images and now includes color in each illustration, to enhance the reader’s understanding of each subject and successful execution of the surgical techniques covered. It imparts new and updated information on a wide variety of topics, including skin and muscle flap techniques, skin fold disorders, facial and nasal reconstructive surgery, foot pad surgery, urogenital reconstructive surgery, and includes a new chapter on reconstructive surgery of the pinna.

    • Provides a key reference for general practitioners, surgeons, surgical residents, veterinary students, and small animal technicians in a single source
    • Discusses current and new wound management and reconstructive surgical techniques for all body regions, including the face, ear, mouth, eye, nose, trunk, external genitalia, and foot
    • Contains 35 brand-new plate illustrations, updated and enhanced color plate illustrations and drawings, and additional clinical photographs throughout
    • Features a new chapter dedicated to the surgical management of pinnal injuries and disorders, including new reconstructive surgical options developed by the author
    • Includes information boxes to emphasize important points and the author’s personal observations, drawing on more than forty years of surgical experience

    Atlas of Small Animal Wound Management and Reconstructive Surgery, Fourth Edition is a valuable one-stop reference for veterinary surgeons, residents, and small animal practitioners.

  • Foreword xi

    Preface xii

    Acknowledgments xiii

    About the Companion Website xiv

    1. The Skin 1

    Skin Function 2

    Skin Structure 2

    Cutaneous Adnexa 5

    The Hypodermis 8

    Cutaneous Circulation 8

    Pinna: Cutaneous Considerations 10

    Congenital Skin Disorders 10

    2. Basic Principles of Wound Healing 17

    Introduction 18

    Wound Healing 18

    Acute Versus Chronic Open Wounds 29

    Species Variations in Wound Healing 29

    “Artificial Skin” 30

    3. Basic Principles of Wound Management 33

    Introduction 34

    Patient Presentation 34

    Mechanisms of Injury and Wound Terminology 34

    Wound Classification 35

    Options for Wound Closure 37

    “Pointers” in Selecting the Proper Closure Technique 43

    Basic Wound Management in Six Simple Steps 44

    Exposed Bone: Osteostixis 49

    Acute Versus Chronic Wounds 50

    4. Topical Wound Care Products and Their Use 53

    Wound Exudate 54

    Wound Drainage Systems 54

    Negative Pressure Wound Therapy (NPWT) 60

    Concept of Moist Wound Healing (MWH) 67

    Topical Wound Care Products 69

    The Maggot and Leach in Wound Care 79

    Common Topical Antiseptic and Cleansing Agents 81

    Alternative Forms of Wound Therapy 85

    Concluding Remarks 89

    Plate 1: Vacuum‐Assisted Closure 92

    5. Dressings, Bandages, External Support, and Protective Devices 95

    Introduction 96

    Dressings: The Primary Layer 96

    Dressings: The Secondary Layer 111

    Dressings: The Tertiary Layer 112

    Preventing Bandage Displacement 113

    Tie‐Over Dressing/Bandage Technique 114

    Pressure Points: Bandage Options 115

    Bandage “Access Windows” 115

    Bandaging Techniques for Skin Grafts 115

    Bandaging Techniques for Skin Flaps 115

    Splints, Casts, Reinforced Bandages 115

    Miscellaneous Protective Devices 116

    Plate 2: Basic Bandage Application for Extremities 124

    Plate 3: Tape Stirrups and Padding Dos and Don’ts 126

    Plate 4: Elasticon Bandage Platforms and Saddles 128

    Plate 5: Spica Bandages/Splints 130

    Plate 6: Schroeder‐Thomas Splint 132

    Plate 7: Schroeder‐Thomas Splint: Security Band Application 136

    Plate 8: Body Brace 138

    Plate 9: Tape Hobbles for the Rear Extremities 140

    6. Common Complications in Wound Healing 143

    Improper Nutritional Support 144

    Medications and Their Influence on Healing 145

    Hypovolemia and Anemia 146

    The Nonhealing Wound: General Considerations 146

    Failure to Heal by Second Intention 147

    Scarring and Wound Contracture 152

    Infection and Biofilm Formation 154

    Draining Tracts 158

    Use of Tourniquets for Lower Extremity Procedures 165

    Seromas 166

    Hematomas 167

    Exposed Bone 167

    Wound Dehiscence 169

    7. Management of Specific Wounds 173

    Bite Wounds 174

    Burns 183

    Inhalation Injuries 195

    Chemical Burns 196

    Electrical Injuries 197

    Radiation Injuries 201

    Frostbite 204

    Projectile Injuries 205

    Explosive Munitions: Ballistic, Blast, and Thermal Injuries 227

    Impalement Injuries 227

    Pressure Ulcers 228

    Hygroma 234

    Snakebite 239

    Brown Recluse Spider Bites 240

    Porcupine Quills 240

    Lower Extremity Shearing Wounds 243

    Plate 10: Pipe Insulation Protective Device: Elbow 248

    Plate 11: Pipe Insulation to Protect the Great Trochanter 250

    Plate 12: Vacuum Drain Management of Elbow Hygromas 252

    8. Regional Considerations 255

    The Canine and Feline Profiles 256

    Plates 13A and 13B: Surgical Technique Menu 258

    9. TensionRelieving Techniques 265

    Introduction 266

    Skin Tension in the Dog and Cat 266

    Plate 14: Tension Lines 282

    Plate 15: Effects of Skin Tension on Wound Closure 284

    Plate 16: Patient Positioning Techniques 286

    Plate 17: Undermining Skin 288

    Plate 18: Geometric Patterns to Facilitate Wound Closure 290

    Plate 19: V‐Y Plasty 292

    Plate 20: Z‐Plasty (Option I) 294

    Plate 21: Z‐Plasty (Option II) 296

    Plate 22: Multiple Z‐Plasties 298

    Plate 23: Relaxing/Release Incisions 300

    Plate 24: The “Hidden” Intradermal Release/ Relaxing Incision 302

    Plate 25: Multiple Release Incisions for Extremity Wounds 304

    Plate 26: Suture Options to Alter Skin Traction and Retraction 306

    Plate 27: Walking Suture Technique 308

    Plate 28: Skin Stretchers to Offset Incisional Tension 310

    Plate 29: “Tension” Suture Patterns 312

    Plate 30: Retention Sutures 314

    Plate 31: Stent 316

    Plate 32: Skin “Directing” for Maximum Coverage 318

    Plate 33: Relaxing Incision to Reduce Flap Tension 320

    10. SkinStretching Techniques 323

    Physiology of Skin Stretching 324

    Presuturing 324

    Load Cycling 324

    Skin Stretchers 326

    Skin Expanders 335

    Plate 34: Presuturing Technique 338

    Plate 35: Application of Skin Stretchers 340

    Plate 36: Skin Stretchers to Enhance Length of Axial Pattern Flaps 342

    Plate 37: Skin Stretcher Substitution for Presuturing 344

    Plate 38: Skin Expanders 346

    11. Local Flaps 351

    Introduction 352

    Advancement Flaps 353

    Rotating (Pivoting) Flaps 356

    Plate 39: Single Pedicle Advancement Flap 370

    Plate 40: Bipedicle Advancement Flap 372

    Plate 41: Transposition Flap (90 degrees) 374

    Plate 42: Transposition Flap (45 degrees) 378

    Plate 43: Transposition Flap (Oblique Angle) 380

    Plate 44: Local Facial Flap Options vs. Auricular Axial Pattern Flap 382

    Plate 45: Transposition Flaps in Partial Wound Closure 384

    Plate 46: Interpolation Flap 386

    Plate 47: Rotation Flap 390

    Plate 48: Forelimb Fold Flap 392

    12. Distant Flap Techniques 395

    Distant Flaps 396

    Direct Flaps 396

    Indirect Flaps 396

    The Delay Phenomenon 400

    Plate 49: Direct Flap: Single Pedicle (Hinge) Flap 402

    Plate 50: Direct Flap Closure of Knee Defect 406

    Plate 51: Direct Flap: Bipedicle (Pouch) Flap 408

    Plate 52: Indirect Flap: Delayed Tube Flap 414

    13. Axial Pattern Skin Flaps 417

    Introduction: Axial Pattern Flaps 418

    Island Arterial Flaps 418

    Reverse Saphenous Conduit Flaps 421

    Secondary Axial Pattern Flaps 421

    Options to Extend the Length of Axial Pattern Flaps 427

    Plate 53: Four Major Axial Pattern Flaps of the Canine Trunk 430

    Plate 54: Skin Position and Axial Pattern Flap Development 432

    Plate 55: Omocervical Axial Pattern Flap 434

    Plate 56: Thoracodorsal Axial Pattern Flap 436

    Plate 57: Lateral Thoracic Axial Pattern Flap 438

    Plate 58: Superficial Brachial Axial Pattern Flap 440

    Plate 59: Caudal Superficial Epigastric Axial Pattern Flap 442

    Plate 60: Cranial Superficial Epigastric Axial Pattern Flap 444

    Plate 61: Deep Circumflex Iliac Axial Pattern Flap: Dorsal Branch 446

    Plate 62: Deep Circumflex Iliac Axial Pattern Flap: Ventral Branch 448

    Plate 63: Flank Fold Flap: Hind Limb 450

    Plate 64: Genicular Axial Pattern Flap 452

    Plate 65: Reverse Saphenous Conduit Flap 454

    Plate 66: Caudal Auricular Axial Pattern Flap 456

    Plate 67: Superficial Temporal Axial Pattern Flap 458

    Plate 68: Lateral Caudal (Tail) Axial Pattern Flap 460

    14. Free Grafts 463

    Free Skin Grafts 464

    Classification of Free Grafts 465

    Graft Thickness 465

    Partial‐Coverage Grafts 466

    Dermatomes 467

    Preservation by Refrigeration 467

    Intraoperative Considerations 472

    Bandaging Technique for Skin Grafts 472

    Use of Plates 473

    Plate 69: Punch Grafts 476

    Plate 70: Pinch Grafts 478

    Plate 71: Strip Grafts 480

    Plate 72: Stamp Grafts 482

    Plate 73: Sheet Grafts 484

    Plate 74: Dermatome: Split‐Thickness Skin Graft Harvesting 486

    Plate 75: Mesh Grafts (With Expansion Units) 488

    Plate 76: Mesh Grafts (With Scalpel Blades) 490

    15. Facial Reconstruction 493

    Introduction: Facial Reconstructive Surgery 494

    Plate 77: Repair of Upper Lip Avulsion 515

    Plate 78: Repair of Lower Labial Avulsion 516

    Plate 79: Wedge Resection Technique 518

    Plate 80: Rectangular Resection Technique 520

    Plate 81: Full‐Thickness Labial Advancement Technique (Upper Lip) 522

    Plate 82: Full‐Thickness Labial Advancement Technique (Lower Lip) 524

    Plate 83: Buccal Rotation Technique 526

    Plate 84: Lower Labial Lift‐Up Technique 528

    Plate 85: Upper Labial Pull‐Down Technique 530

    Plate 86: Labial/Buccal Reconstruction with Inverse Tubed Skin Flap 532

    Plate 87: Skin Flap for Upper Labial and Buccal Replacement (Facial [Angularis Oris] Axial Pattern Flap) 536

    Plate 88: Feline Facial Axial Pattern Flap 538

    Plate 89: Cleft Lip Repair (Primary Cleft, Cheiloschisis, Harelip) 540

    Plate 90: Unilateral Rostral Labial Pivot Flaps 542

    Plate 91: Bilateral Rostral Labial Pivot Flaps 544

    Plate 92: Oral Commissure Advancement Technique 546

    Plate 93: Brachycephalic Facial Fold Correction 548

    Plate 94: Cheilopexy Technique for Drooling 550

    16. Myocutaneous Flaps and Muscle Flaps 553

    Introduction 554

    Myocutaneous Flaps 554

    Muscle Flaps 554

    Plate 95: Latissimus Dorsi Myocutaneous Flap 568

    Plate 96: Cutaneous Trunci Myocutaneous Flap 570

    Plate 97: Latissimus Dorsi Muscle Flap 572

    Plate 98: Latissimus Dorsi Bipedicle Muscle Flap 574

    Plate 99: Triceps Replacement with Latissimus Dorsi Muscle 576

    Plate 100: External Abdominal Oblique Muscle Flap 578

    Plate 101: Caudal Sartorius Muscle Flap 580

    Plate 102: Cranial Sartorius Muscle Flap 582

    Plate 103: Temporalis Muscle Flap 584

    Plate 104: Transversus Abdominis Muscle Flap 586

    Plate 105: Semitendinosus Muscle and Myocutaneous Flaps 588

    Plate 106: Flexor Carpi Ulnaris Muscle Flap 590

    Plate 107: Cranial Tibial Muscle Flap 592

    Plate 108: Internal Obturator Muscle Flap 594

    Plate 109: Superficial Gluteal Flap for Perineal Hernia Closure 596

    17. Oral Reconstructive Surgical Techniques 599

    Introduction 600

    Cleft Palate 601

    Palatal Defects/Oronasal Fistulas 602

    Plate 110: Mucosal Flaps 606

    Plate 111: Palatoplasty: Bipedicle Advancement Technique 608

    Plate 112: Cleft Palate Repair: Mucoperiosteal Flap Technique 612

    Plate 113: Palatine Mucosal Flap 614

    Plate 114: Soft Palate/Pharyngeal Mucosal Flaps 616

    Plate 115: Full‐Thickness Labial Flap Closure of Oronasal Fistulas 618

    Plate 116: Cartilage Grafts for Palatal Fistulas 620

    Plate 117: Angularis Oris Mucosal Flap 622

    18. Foot Pad Reconstruction 625

    Introduction 626

    Pad Laceration and Lesion Excision 626

    Digital Pad Transfer 631

    Metacarpal/Metatarsal Pad Transfer 632

    Accessory Carpal Pad 632

    Pad Grafting 634

    Digital Flaps for Wound Closure 634

    Fusion Podoplasty 634

    Plate 118: Digital Flap Technique: Major Digital/ Interdigital Defects 642

    Plate 119: Digital Flap Technique: Major Defects of Digits Two or Five 644

    Plate 120: Digital Pad Transfer 646

    Plate 121: Metatarsal/Metacarpal Pad Transfer 648

    Plate 122: Pad Grafting 650

    Plate 123: Segmental Pad Grafting Technique 652

    Plate 124: Fusion Podoplasty 654

    19. Major Eyelid Reconstruction 657

    Introduction 658

    The Eyelids 658

    Plate 125: Skin Flap Options for Cutaneous Defects of the Eyelid Regions 660

    Plate 126: Lip‐to‐Lid Procedure 662

    Plate 127: Oral Mucosal Graft onto Skin Flap 666

    Plate 128: Third Eyelid–Skin Flap Reconstruction of the Lower Eyelid 668

    20. Nasal Reconstruction Techniques 671

    Introduction: Nasal Anatomy 672

    Traumatic Wound Management 672

    Neoplasia 673

    Neoplasms and Surgical Margins 673

    Nasal Reconstruction Options 673

    Options for Managing Nasal Stenosis 682

    Plate 129: Septal Coverage Using Cutaneous Advancement Flaps 692

    Plate 130: Bilateral Sulcus Flap Technique 694

    Plate 131: Septal Resection Technique 696

    Plate 132: Dorsal Nasal Splitting Technique to Enhance Exposure of Septum 698

    Plate 133: Alar Fold Flaps 700

    Plate 134: Musculofascial Island Labial Flap 702

    Plate 135: Labial Mucosal Inversion Technique 706

    Plate 136: Nasal Reconstruction with the “Lip‐to‐ Lid Technique” Variation 708

    Plate 137: Oral Mucosal Graft with Nasal Stenting 710

    Plate 138: Intranasal Septal Window Technique 712

    Plate 139: Cantilever Suture Technique 714

    21. Cosmetic Closure Techniques 719

    Cosmetic Considerations 720

    Causes of Scars 720

    Minimization of Scarring 720

    Dog Ears 722

    Plate 140: Scar Concealment 724

    Plate 141: W‐Plasty 726

    Plate 142: Dog Ear: Surgical Correction 728

    22. Preputial Reconstructive Surgery 731

    Introduction 732

    Surgical Conditions 732

    Surgical Techniques 742

    Plate 143: Preputial Ostium Enlargement 756

    Plate 144: Preputial Ostium Reduction 758

    Plate 145: Preputial Advancement Technique 760

    Plate 146: Phallopexy 764

    Plate 147: Urethral Reconstruction for Subanal Hypospadias 766

    Plate 148: Preputial Urethrostomy Technique 768

    Plate 149: Urine Diversion Technique 770

    23. Pinnal Reconstructive Surgery 773

    Introduction 774

    Anatomy of the Pinna 774

    Surgical Conditions 779

    Wound Management and Reconstructive Surgical Techniques 780

    Aural Hematoma Management Options 786

    Plate 150: Skin Advancement Closure: Rostral Pinnal Base 796

    Plate 151: Skin Advancement Closure: Caudal Pinnal Base 798

    Plate 152: Transposition Flap Technique for Smaller Medial Pinnal Defects 800

    Plate 153: Transposition Flap Technique for Minor Lateral Pinnal Defects 802

    Plate 154: Large Transposition Flap Closure After Major Medial Pinnal Resection 804

    Plate 155: Transposition Flap for Major Lateral Pinnal Defects 806

    Plate 156: Direct Flap Reconstruction of the Pinna 808

    Plate 157: Resection of the Terminal Third of the Pinna 810

    Plate 158: Inverted “Triangle” Resection of the Central Third of the Pinna 812

    Plate 159: Incisional Drainage of Aural Hematomas 814

    Plate 160: Bandaging the Pinna 816

    Plate 161: Vacuum Drain Management of Aural Hematomas 818

    24. Miscellaneous Reconstructive Surgical Techniques 821

    Omentum 822

    Scrotum 822

    Tail Fold Intertrigo (Screw Tail) 823

    Disorders of the Vulva 827

    Managing Skin Fold Inversion of Urethrostomies 835

    Fecal Incontinence: Treatment Options 835

    Plate 162: Omental Flap Options 838

    Plate 163: Scrotal Flap Technique 840

    Plate 164: Caudectomy for Tail Fold Intertrigo 842

    Plate 165: Episioplasty 844

    Plate 166: Fascia Lata Sling and Silicone Banding for Managing Fecal Incontinence 846

    Plate 167: Spiral Rectal Diaphragm Technique (Rectal Rifling) 848

    Index 851

  • Michael M. Pavletic, DVM, Diplomate ACVS, is Director of Surgical Services at Angell Animal Medical Center in Boston, Massachusetts, USA.

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