Application of transposition flap technique for reconstruction of large ventral wound in a calf.
Dog bite wounds are common in calves and results in tissue damage due to shearing, tensile and compressive forces (Dernell, 2006). If the defect is small, primary closure of bite wound is undertaken after debridement/ lavage and if there is extensive loss of skin/subcutaneous tissues reconstruction is done to close the defect without tension (David and Greg, 2000). The transposition flaps are rectangular, local flaps that bring additional skin when rotated on to large skin defects (Pavletic, 2010). The blood supply is by terminal branches of direct cutaneous arteries and veins (Baines, 1999). Advancement flaps may be created from all four limbs to cover even more extensive ventral abdominal and inguinal skin defects (Hunt, 1995). The case report describes reconstruction of large ventral skin defect in a calf due to dog bite.
History and Observation
A day old calf with history of large rectangular wound on ventral abdominal and inguinal region with an area of 46.72 [cm.sup.2] (Fig. 1) was presented. Physical examination revealed grade 2 wound with foreign debris, devitalized wound edges and exposure of ventral abdominal muscles.
Mechanical wound debridement was performed on day of presentation and wound was lavaged with warm sterile saline (500 ml) mixed with Gentamicin sulphate (80 mg) at 8 psi pressure, with the help of 22 gauge needle and 20ml syringe. Inj Ceftriaxone (Intacef (a)) @ 20 mg/kg and inj Meloxicam (Melonex (a)) @ 0.2 mg/kg was administered intravenously. As there was extensive loss of skin in ventral abdominal and inguinal region, reconstructive surgery by transposition flap technique was planned and performed.
General anaesthesia was induced with Ketamine @ 2.2 mg/kg and Xylazine @ 0.01 mg/kg intravenously. Local infiltration of 2% Lignocaine @ 4 mg/kg was performed. The calf was placed on right lateral recumbency. A skin flap planning was done by marking the area to be incised for flap, after calculating length and breadth of defect (Fig. 2). The flap edges were incised and undermined in a stepwise fashion until the flap could be transposed into defect with minimal tension. The flap was sutured into position with PGA 1-0 in a simple continuous pattern. Skin was sutured with polyamide size 1-0 as simple interrupted suture pattern. A small corrugated drain tube was placed at site of flap and sutured to provide adequate drainage of tissue fluids (Fig. 3). Chlorhexidine impregnated gauze was placed over the surgical site and soft absorbent bandaging was done following surgery. Postoperatively, Ceftriaxonea @ 20 mg/kg and Meloxicama @ 0.2 mg/kg was given for 7 days to aid wound healing. Post bite anti-rabies vaccination schedule was followed on 0, 3, 7, 14 and 21 days regularly. The drain tube was removed on 3rd day post surgery and sutures were removed on 10th post-operative day. Wound healed uneventfully without any complications.
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Primary closure of dog bite wound is decided based on degree of contamination, tissue traumatized and wound blood supply and requires strict adherence to basic surgical principles. In many cases of bite wounds, delayed primary closure is the best alternative, if wound is contaminated with compromised blood supply (David and Greg, 2000).
In the above case, the wound was closed on same day of presentation as degree of contamination and extent of devitalization of the tissue was less.
Skin fold advancement transposition flaps were used to close wounds created by excision of extensive squamous cell carcinoma, trauma, burns, abscess and bite wounds. These flaps were derived from elbow and flank folds, allowing primary closure of large ventral wounds without undue tension and without compromising limb mobility. The transposition flap described in the report was subdermal plexus flap, deriving its blood supply from terminal branches of direct cutaneous arteries (Hunt, 1995). The common transposition ongleis 90 degree as performed in this case. In animals with poorly developed flank folds, caudal superficial epigastric axial pattern flap may provide an alternate means of closing large wounds in these regions (Remedios et al., 1989).
The flap remained viable throughout the process of wound healing and no discolouration was seen.
Transposition flap reconstructive surgical technique for closure of large skin defect in ventral abdominal and inguinal region due to dog bite in a calf was discussed.
Baines, S.J. (1999). Surgical Draines. In: Fowler D, Williams J M (eds) BSAVA Manual of Canine and Feline Wound Management and Reconstruction. British Small Animal Veterinary Association, Cheltenham: pp 54-57.
David, E.H. and Greg Griffin. (2000). Bite wounds in dogs and cats. Vet. Clinic North Amer. Small Anim. Pract. 30: 669-79.
Dernell, W.S. (2006). Initial Wound Management. Vet. Clinic North Amer. Small Anim. Pract. 36: 713-38.
Hunt, G.B. (1995). Skin fold advancement flap for closing large sternal and inguinal wounds in cats and dogs. Vet Surg. 24:172-75.
Pavletic, M.M. (2010). Atlas of Small Animal Wound Management and Reconstructive Surgery, 3rd Edn., Wiley, Blackwell, Ames, p. 322-25.
Remedios, A.M., Bauer, M.S., Bowen, C.V. (1989). Thoracodorsal and caudal superficial epigastric axial pattern flaps in cats. Vet. Sur. 18: 380-85.
(a)--Brand of Intas Animal Health, Ahmedaba
R. Siva Shankar, M.S. Sabarish Babu (1) and Nitin J. D'Souza
Department of Veterinary Surgery and Radiology Madras Veterinary College Tamil Nadu Veterinary and Animal Sciences University (TANUVAS) Chennai--600007 (Tamil Nadu)
(1.) Corresponding author.
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|Title Annotation:||Short Communication|
|Author:||Shankar, R. Siva; Babu, M.S. Sabarish; D'Souza, Nitin J.|
|Date:||Jan 1, 2016|
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