Feline Reconstructive Surgery


Feline Reconstructive Surgery

Aug 01, 2007

There are many different causes of skin defects in both cats and dogs. Traumatic wounds such as degloving injuries, dog or cat bites, burns, deep fungal infections, and extensive wounds caused by surgical removal of neoplastic disease are examples of clinical situations where reconstructive surgical techniques may be necessary.

Before considering extensive reconstructive surgery a clear diagnosis of the disease process should be known. Fine needle aspiration and incisional biopsies should be liberally used for diagnostic purposes which will facilitate rational therapeutic planning. A knowledge and/or diagnosis of the local disease process is important however knowledge of the animals general health is also critical. For example, the presence of thoracic metastasis in an animal with neoplasia, Cushing's disease or diabetes, or FELV + status in a cat would potentially influence the therapeutic decision making process.

Local causes of Non-Healing Wounds
-Excessive movement (joints)
-Foreign Body
• Bacterial
• Fungal
-Hematoma & Seroma

Systemic causes of Non-Healing Wounds
-Endocrine Disease
• Cushing's Disease, Diabetes mellitus
-FeLV, Feline lentivirus

The surgical closure of cutaneous defects requires proper timing and planning. For example, infected wounds are treated as open wounds so multiple debridements can be performed and to allow formation of healthy granulation tissue. Interestingly, cats do not form granulation tissue in as vigorously as dogs. Closure of skin defects resulting from tumor excision (fibrosarcomas) is often performed at the same surgery as tumor excision. If tumor excision and reconstruction are performed concurrently, it is advisable to change instruments and gloves prior to the reconstructive procedure.

I. Axial Pattern flaps

These skin flaps are pedicle flaps based on direct cutaneous arteries. Since these flaps contain an arterial supply, they can be constructed in long lengths and mobilized to cover large distant or trunk defects.

Many types (about 10) of axial pattern flaps have been described in the dog and at least several have been evaluated and found to be useful in the cat as well.

Theory/How to construct- The flap is constructed based on its anatomic landmarks, lifted from its donor bed by dissecting deep to the panniculus muscle and subcutaneous tissues, and rotated to the recipient site. If the recipient site is close by a "bridge incision" is made between the base of the flap and the recipient site. If the recipient site is distal or some distance away, a "bridge incision" is made OR the intervening flap may be "tubed" to allow the flap to be used correctly. If "tubed", the tube is usually incised and removed for cosmetic reasons 3-4 weeks after the initial surgery. Since this involves an additional procedure most surgeons prefer the "bridge incision" when possible.