SPIDERPLASTY AND BOW-TIE TENSION RELIEVING SUTURE TECHNIQUES FOR LARGE SKIN DEFECTS IN DOGS
Loading...
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
The research study was undertaken in twelve canines that were presented to
the Small Animal Out-Patient Surgery Unit of Madras Veterinary College Hospital
with large cutaneous wounds. The dogs were divided into two study groups of six
animals each, viz. Group I (Spiderplasty technique) and Group II (Bow-tie
technique) after careful consideration of the inclusive and exclusive wound
criterion.
Both groups were subjected to pre-operative and post-operative parameter
study. Pre-operative parameters included subjective wound evaluation (Colour,
Odour and Exudate) and wound planimetry, which were assessed on days 0, 3 and
7. Post-operative parameters included subjective wound evaluation (Colour, Odour
and Exudate), Bacteriological examination, Histological evaluation and Colour
flow floppier ultrasonography. Post-operative pain scoring and assessment of
post-surgical complications were also additionally evaluated in all cases. Except
Bacteriological examination, which was performed on day post-operatively, all
other post-operative parameters were evaluated on days 3, 7 and 14 after surgical
intervention.
All cases selected for the study were determined to be chronic
contaminated or infected wounds through subjective wound evaluation. Hence, the
wounds were initially managed through conventional wound care methods that
included routine wound lavaging, debridement, wound dressings and bandages.
This ensued till the wounds presented a healthy wound bed granulation to enable
secondary closure.
Wound planimetry was one of the major parameters considered as the study
required reconstruction of large wounds that would be difficult to close in simple
apposition. Wounds >10cm2 were subjectively determined to be large wounds and
hence used for the study.
The two tension relieving techniques under the study were Spiderplasty and
Bow-tie. Both techniques demonstrated appreciable results in terms of tension free
surgical closure of large wounds, with no formation of dog-ears at the suture ends.
Bacteriological examination was performed on day post-operatively for
all the animals to determine an appropriate antibiotic therapy.
Histopathological evaluation was performed on the 3”*, 7* and 14* day
post- operatively. The tissues were collected with a 3 mm punch biopsy and
stained with Masson’s Trichrome Stain, after which Histological grading was done
for parameters such as acute inflammation, chronic inflammation, granulation
tissue density, granulation tissue maturation, re-epithelialisation and
neovascularisation.
Colour Flow Doppler Ultrasound was performed on post-operative days 3,
7 and 14, to determine adequate tissue perfusion which was vital for a healthy skin
flap uptake. The surgical wound along with the peri-wound area was assessed and
the time taken to visualize blood vessels was graded as high, moderate and low.
The post-operative pain assessment was noted on days 3, 7 and 14. All the
animals were clinically assessed for any signs of pain or discomfort inferred from
the Glasgow CMPS-SF pain scoring module which assessed 6 behavioural signs of
the animal, i.e., vocalisation, attention to wound, mobility, response to touch,
demeanour and posture/activity. All the wounds were carefully evaluated for any
post-operative complications.
Both Spiderplasty and Bow-tie techniques exhibited certain advantages and
disadvantages pertaining to wound reconstruction under clinical settings. The
Spiderplasty technique consumed more time, required more surgical expertise and
had slightly lower cost efficiency ratio. It could however be better utilised to close
wounds located in confined anatomical areas, as compared to the Bow-tie
procedure which was limited by its requirement to resect 36% of adjacent normal
tissue. The Bow-tie procedure was however, easier to perform and required less
surgical time as compared to the Spiderplasty procedure.